Healthcare Acquired Infection Risk and Toothbrush Contamination in the ICU.

Abstract

HEALTHCARE ACQUIRED INFECTION RISK AND TOOTHBRUSH CONTAMINATION IN THE ICU. By Michelle R. Frazelle, RN, MSN, CCRN A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2011 VCU Chair: Mary Jo Grap, PhD, RN, FAAN Professor, Adult Health and Nursing Systems School of Nursing NIH/NINR NRSA Chair: Cindy L. Munro, PhD, RN, FAAN Associate Dean, University of South Florida, School of Nursing Hospital acquired infections (HAIs) are a complex and multi-factorial problem associated with high morbidity, mortality, and cost. Toothbrushes (TBs) may be at risk for contamination with potential pathogenic microorganisms (PPMs) from the patient care environment or autoinoculation from the patient. We focused on three PPMs: methicillin resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococcus spp. (VRE), and Acinetobacter spp. Specific aims were to (1) describe environmental factors associated with TB contamination in the ICU and (2) describe the relationship between TB contamination and oral colonization in critically ill adults. A cross-sectional design was used to examine the physical environment in which TBs were found as well as microbial flora in 100 paired samples (subjects and their TBs) over a 72 hour period (at 24, 48 and 72 hours). Concordance among microbial cultures was determined by genetic typing. Data were analyzed by linear and logistic regression, chi-square analysis, Fisher’s exact test and ANOVA. Fourteen TBs were found to be contaminated; 1 TB had more than one PPM species. Contamination occurred at all three time points. All but one of the contaminated TBs was located on the nursing cart; TBs in cart drawers had the highest recovery rates for all PPMs. Toothbrush contamination increased as the distance to the bathroom increased. Toothbrush contamination increased as the distance to the sink decreased. Ten of the contaminated TBs were in contact with some type of patient care article. There was a significant association between the presence of TB contamination and the use of a storage container. The toothbrush weight (moisture and debris) was associated with TB contamination. Baseline oral colonization for PPMs was 19% while repeat was 20%. We found that TBs in the ICU became contaminated with all 3 PPMs; TBs might act as fomites and increase the risk of infection in the critically ill. Additional research linking contamination to patient outcomes is critical in understanding the level of risk. Nurses should carefully consider handling and storage of TBs. A closed drawer or storage with other care items is not ideal.