Abstract
BackgroundContaminated environmental surfaces may play an important role in transmission of some healthcare-associated pathogens. In this study, we assessed the adequacy of cleaning practices in rooms of patients with Clostridium difficile-associated diarrhea (CDAD) and vancomycin-resistant Enterococcus (VRE) colonization or infection and examined whether an intervention would result in improved decontamination of surfaces.MethodsDuring a 6-week period, we cultured commonly touched surfaces (i.e. bedrails, telephones, call buttons, door knobs, toilet seats, and bedside tables) in rooms of patients with CDAD and VRE colonization or infection before and after housekeeping cleaning, and again after disinfection with 10% bleach performed by the research staff. After the housekeeping staff received education and feedback, additional cultures were collected before and after housekeeping cleaning during a 10-week follow-up period.ResultsOf the 17 rooms of patients with VRE colonization or infection, 16 (94%) had one or more positive environmental cultures before cleaning versus 12 (71%) after housekeeping cleaning (p = 0.125), whereas none had positive cultures after bleach disinfection by the research staff (p < 0.001). Of the 9 rooms of patients with CDAD, 100% had positive cultures prior to cleaning versus 7 (78%) after housekeeping cleaning (p = 0.50), whereas only 1 (11%) had positive cultures after bleach disinfection by research staff (p = 0.031). After an educational intervention, rates of environmental contamination after housekeeping cleaning were significantly reduced.ConclusionOur findings provide additional evidence that simple educational interventions directed at housekeeping staff can result in improved decontamination of environmental surfaces. Such interventions should include efforts to monitor cleaning and disinfection practices and provide feedback to the housekeeping staff.
Highlights
Contaminated environmental surfaces may play an important role in transmission of some healthcare-associated pathogens
We found that vancomycin-resistant enterococci (VRE) and Staphylococcus aureus were frequently acquired on hands of investigators after contact with contaminated objects such as bed rails and bedside tables in colonized patients' rooms [2,3]; daily disinfection of environmental surfaces in vancomycin-resistant Enterococcus (VRE)-colonized patients' rooms was associated with reduced acquisition of VRE on investigators' hands [2]
Pre-intervention assessment of cleaning practices Prior to the intervention, we studied 17 patients with VRE colonization and 9 patients with Clostridium difficile-associated diarrhea (CDAD)
Summary
Contaminated environmental surfaces may play an important role in transmission of some healthcare-associated pathogens. We assessed the adequacy of cleaning practices in rooms of patients with Clostridium difficile-associated diarrhea (CDAD) and vancomycin-resistant Enterococcus (VRE) colonization or infection and examined whether an intervention would result in improved decontamination of surfaces. Direct contact with patients is generally considered the major source for acquisition of pathogens on healthcare workers' hands and subsequent transmission to other patients, several recent studies suggest that contaminated environmental surfaces may play an important role in pathogen transmission [2,3,4,5,6,7,8,9,10]. Environmental decontamination with 10% bleach has been associated with reductions in Clostridium difficile infections [9,10]
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