William A. Rutala Research Award: Redesign of portable suction equipment cases: An economical engineering approach to a disinfection problem

Abstract

BACKGROUND/OBJECTIVES: Ambulatory patients with tracheotomies carry a case that contains necessary suctioning supplies. The commercially obtained cases have nylon fabric inside and outside with various materials between the nylon, from plastics (sides) to chipboard (bottom), to give shape to the case. A case that was returned to our hospital respiratory department cultured positive for methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) even after it had been cleaned (wiped off) with an FDA-approved phenolic disinfectant. The purpose of this study was to determine 1) the source of the MRSA and 2) how to provide a microbiologically safe case for the next patient. METHODS: An epidemiologic review of patient cultures plus pulsed-field gel electrophoresis (PFGE) of a number of MRSA isolates were used to determine the source of the MRSA. Repeated wiping with various detergents/disinfectants still did not remove the MRSA from the case, which could not be immersed for cleaning because of the chipboard component of the case bottom. The garment fabrication department of our burn unit designed a case made of denim fabric with sides and bottom filled with a completely washable synthetic fiber to provide shape. The new cases were purposefully contaminated, washed (detergent with bleach) and dried in a regular clothes washer and dryer, then cultured using routine microbiologic technique. RESULTS: The epidemiologic and PFGE testing indicated that the MRSA was from the patient who had most recently used the case and that this patient had been colonized prior to use of the case. Contamination of the new denim case with the original MRSA, followed by washing and drying, resulted in a case that was free of the MRSA. The contamination, washing, and culturing were repeated for four other common pathogens in our hospital <i>(Pseudomonas aeruginosa, Enterrococcus faecium, Acinetobacter sp, Klebsiella pneumoniae)</i>, and in each case the pathogen was removed by the routine laundering. Commercial cases cost $150 each, while our fabricated cases cost about $110. CONCLUSIONS: Commercially available cases for suctioning equipment can become contaminated with pathogens from the user and can subsequently be difficult to disinfect. Re-engineering the case, specifically making it out of totally washable materials, resulted in less expensive cases that can be readily disinfected.