Cleaning Regimen Research Articles

Removing asthma triggers and improving children's health: The Asthma Partnership Demonstration project

BackgroundStudies have revealed the efficacy of home-based environmental interventions on reduction of asthma symptoms as a strategy for managing asthma in children. A focus on education and behavior change alone is generally too limited to reduce exposure to asthma triggers that exist because of adverse housing conditions. ObjectiveTo demonstrate that housing conditions as a focus of a health intervention should be considered more widely as an effective means of addressing serious health problems such as asthma. MethodsResidences of 41 families of children identified with some of the highest rates of asthma-related hospital visits were assessed for the presence of asthma triggers. ResultsThe intervention had a positive effect on lessening the effect of the child's asthma on the family's lives and activities. Reductions in frequency of negative effects of children's asthma on sleeping, job or work around the house, and family activity plans, fewer worries or concerns about children getting enough sleep and performing normal daily activities, and fewer adverse effects of children's asthma medications were reported. Reduced use of asthma medication, medication applications, and health visits were noted. Households with return visits had 50% lower hospital bills for childhood asthma treatment. ConclusionHome environment conditions that lead to or exacerbate asthma may be reduced or eliminated by making minor repairs and introducing reasonable cleaning regimens that address sources of asthma triggers. This can produce greater awareness on the part of families about the presence of asthma triggers and motivate future action to address the conditions associated with these triggers.

How to perform a tracheostomy dressing and inner cannula change.

RATIONALE AND KEY POINTS: Proactive tracheostomy management increases patient safety and reduces adverse events. ▶ A cleaning regimen performed every four hours reduces the risk of a blocked tracheostomy cannula, complete tube occlusion and respiratory arrest. ▶ Sterile tracheostomy dressings allow secretions from the stoma to be absorbed and prevent pressure damage from the tracheostomy tube. ▶ Regular dressing changes and skin inspection permit timely identification of inflammatory processes and skin excoriation, enabling prompt treatment to be instigated. REFLECTIVE ACTIVITY: Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article will change your practice. 2. How you intend to develop your knowledge and skills regarding tracheostomy management.

DNA decontamination protocols

Aim: To determine the effectiveness of a cleaning protocol at removing DNA material from selected surfaces and items in a sexual assault examination room after deliberate contamination. A secondary aim is to determine the extent of background DNA by analysis of control samples. Background: The new Multi-Disciplinary Centre (MDC) in Dandenong, Victoria, includes two adjacent purpose-built examination suites dedicated for sexual assault examinations. The effectiveness of current cleaning protocols at removing DNA material from the sexual assault examination suites at the MDC remains untested. Method: Standardised and diluted single-donor blood samples, which when dried were not visible to the naked eye, were smeared onto pre-determined surfaces and items in a previously cleaned and sealed sexual assault examination room. Control samples were taken from the pre-determined sites before and after contamination using certified DNA free swabs dampened with DNA free water. A forensic clean was requested in the normal fashion and a trained cleaner, who was blinded to the deliberate contamination, cleaned the suite in accordance with established protocols after a sexual assault examination at the MDC. Within 12–24 hours of cleaning, samples were obtained from the previously contaminated sites. All samples, including positive and negative controls, were forwarded to the laboratory for nuclear DNA analysis. The current cleaning protocols and the results will be presented. Discussion: Potential contamination from the facility in which forensic samples are obtained can have significant impact on their forensic integrity and their admissibility in and reliance by the courts. A cleaning regimen that reliably removes sources of biological material from an examination room between examinations reduces, but does not eliminate, the chance of cross-contamination.

Diagnostic Role of Colon Capsule Endoscopy in Patients with Optimal Colon Cleaning.

Background. Colon capsule endoscopy (CCE) is a diagnostic test with relatively rare usage. In this study, we aimed to evaluate both the optimal cleaning regimen for CCE and the diagnostic value of test in the study group. Methods. A total of 62 patients were enrolled in this study. In the first step, 3 different colon preparing regimens were given to 30 patients [Group A: 3 days of liquid diet, sodium phosphate (NaP) (90 mL), and NaP enema; Group B: 3 days of liquid diet, 4 L of polyethylene glycol (PEG), and metoclopramide; Group C: 3 days of liquid diet, 4 L of PEG, NaP (45 mL), and bisacodyl after capsule ingestion] (10 patients in each group). The other consecutive 32 patients were cleaned with the best regimen which was NaP + PEG and CCE was performed. The results of CCE were controlled with colonoscopy in 28 patients. Results. Group C had the highest cleaning score, compared with the other groups (2.2 ± 0.4 versus 2.7 ± 0.4 versus 3.7 ± 0.4, p value = 0.000). The CCE findings were as follows in 28 patients who were also examined with colonoscopy: polyp (range: 5–10 mm) in 6 patients, internal hemorrhoids in 3 patients, angiodysplasia in 1 patient, diverticula in 1 patient, and ulcerative colitis in 1 patient. The sensitivity, specificity, PPV, and NPV of CCE were 100%, 92%, 93%, and 100%, respectively. Conclusions. Low dosage NaP combined with PEG provides optimal bowel preparation for CCE. CCE appears to be a highly sensitive diagnostic modality for detecting colonic pathologies.

Fouling in hollow fiber membrane microfilters used for household water treatment

The Sawyer PointOne hollow fiber membrane microfilter is promoted for household water treatment in developing countries. Critical limitations of membrane filtration are reversible and irreversible membrane fouling, managed by backwashing and chemical cleaning, respectively. The PointOne advertised lifespan is 10 years; users are instructed to backwash as maintenance. Owing to reduced turbidity and bacterial removal efficiencies, six PointOnes were removed from Honduran homes after 23 months of use. In the laboratory, we tested sterile water filtrate for turbidity and bacterial presence before and after backwashing and chemical cleaning. Sterile water filtrate from uncleaned filters had turbidity of 144–200 NTU and bacteria counts of 13–200 CFU. Cleaned filter effluent was positive for total coliforms. On one new and one used, cleaned filter, we imaged membranes with scanning electron microscopy and characterized surface elemental compositions with spectroscopy. Images and spectroscopy of the used, cleaned membrane revealed a dense, cake fouling layer consisting of inorganic metal oxides, organic material, and biofouling. Burst fibers were visually observed. This PointOne was thus irreversibly fouled and non-functional after <2 years of use. Further research is recommended to determine: impacts of source water quality on PointOne performance, a cleaning regimen to manage fouling, and an appropriate filter lifespan.

Mechanical vs manual cleaning of hospital beds: a prospective intervention study

Cleaning regimens for hospital beds were evaluated in the context of a rising prevalence of highly resistant micro-organisms and increasing financial pressure on healthcare systems. Dutch hospitals have to choose between standardized, mechanical bed-washers advised in national guidance and manual cleaning. To evaluate the quality of mechanical and manual bed-cleaning regimens. The multi-faceted analysis of bed-cleaning regimens consisted of three steps. In Step 1, the training of the domestic service team was evaluated. In Step 2, the cleaning quality of manual and mechanical regimens was assessed. Soiled beds, obtained at random, from different departments were evaluated using microbiological analysis (N=40) and ATP (N=20). ATP and microbiological contamination were measured in five predetermined locations on all beds. In Step 3, manual cleaning was introduced over a two-month pilot study at the surgical short-stay unit, and beds from other departments were processed according to the 'gold standard' mechanical cleaning. ATP levels were evaluated in three locations on 300 beds after cleaning. Training was found to improve the quality of cleaning significantly. Mechanical cleaning resulted in significantly lower ATP levels than manual cleaning. Mechanical cleaning shows less variation and results in consistently lower ATP levels than manual cleaning.

BACTERIOLOGICAL ASSESSMENT OF SOME AUTOMATED TELLER MACHINE (ATM) KEYPADS IN ILORIN METROPOLIS

An investigation was conducted on the level of bacterial contaminants on the metallic keypads of automated teller machines (ATMs) in Ilorin metropolis.  Total of 32 samples were collected in eight banks and sampling was done at two times of the day using standard microbiological methods.  Results showed that total aerobic bacterial count on the ATM keypads ranged from 2.6 x101 cfu/m2 to 2.13 x 102 cfu/m2 in the morning, while it ranged from 2.9 x 101 cfu/m2 to 8.3 x 101 cfu/m2 in the afternoon. The results indicated the possibility of cross-contamination during usage of the machines with pathogens such as: Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus aerogenes, Escherichia coli, Lactobacillus fermentii, Lactobacillis casei and Klebsiella pneumoniae. Proper cleaning regimen to sanitize these facilities regularly and public education on their hygienic usage are therefore recommended to reduce the associated risks.

MRSA care in the community: why patient education matters.

In primary care, patients are prescribed decolonisation treatment to eradicate meticillin-resistant Staphylococcus aureus (MRSA). This complex treatment process requires the patient to apply a topical antimicrobial treatment as well as adhering to rigorous cleaning regimens to ensure the environment is effectively managed. A pilot study was carried out that involved developing an enhanced, nurse-delivered education tool, training a community nurse to use it, then testing its use with a patient. Three interviews were carried out: one with a patient who received usual care, one with a patient who received the enhanced education and one with the community nurse who delivered the enhanced education tool. The patient who received the enhanced education reported better knowledge and understanding of the application of treatment than the patient who did not. These results are interesting and point the way forward for larger research studies to build on the learning from this limited exploration and develop more effective management of MRSA in primary care.

Effect of Different Cleaning Regimens on the Adhesion of Resin to Saliva‐Contaminated Ceramics

The aim of this study was to evaluate the influence of different cleaning regimens on the microshear bond strength (μSBS) of three different all-ceramic surfaces after saliva contamination. Cubic ceramic specimens (3 × 3 × 3 mm(3) ) were prepared from three types of ceramics: zirconium dioxide (Z), leucite-reinforced glass ceramic (E), lithium disilicate glass ceramic (EX; n = 12/subgroup). A total of 144 composite resin cylinders (diameter: 1 mm, height: 3 mm) were prepared. Three human-saliva-contaminated surfaces of ceramic specimens were cleaned with either water spray (WS), with 0.5% sodium hypochlorite solution (HC), or with a cleaning paste (CP). Control surface (C) was not contaminated or cleaned. Composite cylinders were bonded to each surface with a resin luting cement. All specimens were stored at 37°C in deionized water until fracture testing. μSBS tests were performed in a universal testing machine (0.5 mm/min), and the results (MPa ± SD) were statistically analyzed (two-way ANOVA, Bonferroni a = 0.05). Fractured surfaces were analyzed to identify the failure types using an optical microscope at 50× magnification. Two representative specimens from all groups were examined with scanning electron microscopy. μSBS test results were significantly affected by the saliva cleaning regimens (p = 0.01) and the ceramic types (p = 0.03). The interaction terms between the ceramic type and saliva cleaning regimen were also significant (p < 0.05). There were no significant differences among the μSBS values (MPa ± SD) for the Z group (C = 17.5 ± 8.8; WS = 16.0 ± 4.9; HC = 17.6 ± 5.8; CP = 16.6 ± 7.5; p > 0.05). In the EX group, C resulted in significantly higher μSBS values (32.6 ± 7.4) than CP (17.4 ± 8.9), WS (15.6 ± 7.3), and HC (14.3 ± 4.5) (p < 0.05); however, C (20.4 ± 7.1) and HC (19.2 ± 7.5) showed higher μSBS values than CP (13.8 ± 4.8) and WS (10.9 ± 5.7) in the E group. Some cohesive failures within the luting resin were observed in the E and EX groups, whereas only adhesive failures were seen in zirconia groups for all surface treatments. Different ceramic surface cleaning regimens after saliva contamination of the zirconium dioxide revealed μSBS similar to the control group, whereas all surface cleaning regimens tested significantly decreased the bond strength values in the lithium disilicate glass ceramic. The leucite-reinforced glass-ceramic group benefited from 0.5% sodium hypochlorite solution cleaning with increased bond strengths. Adhesive cementation of zirconia presents a clinically challenging protocol, and the cementation surface contamination of the zirconia restorations and the inadequate removal of the contaminants increase the risk of failure, as for all ceramic types. This study demonstrated that surface cleaning regimens should be applied according to different ceramic properties.

Bacterial Contamination and Public Health Risk Associated with the Use of Banks’ Automated Teller Machines (Atms) in Ebonyi State, Nigeria

Contamination of environmental objects and surfaces is a common phenomenon. Human beings have a marked tendency to pick up microorganisms from environmental objects, and specially the hand has been shown to play a role in the transmission of organisms. The ATM machine is likely to be contaminated with various microorganisms due to their vast contact by multiple users. This study was aimed to investigate ATM as a potential source of bacterial contamination. The study was conducted from August to October, 2013 and it involved collection of samples by using cotton swabs, culturing on different media such as nutrient agar, MacConkey as well as identifying the isolated organisms using its colonial, morphological and biochemical characteristics. The results of the study indicated that some of the Automated Teller Machines were positive for the presence of microorganisms as indicated: Staphylococcus auerus 4 (28.57%), Coagulase-negative staphylococcus 3 (21.43%), Streptococcus species 2 (14.29%), Pseudomonas species 1 (7.14%), Enterobacter species 1 (7.14%) and Escherichia coli 3 (21.43%). The antibiogram study was done using Kirby Bauer disc- diffusion method and the results showed that majority of the bacteria were highly resistant to standard antibiotics. Susceptibility of isolates ranged from 6.25% to of 25.0%, indicating that most of the antibiotics used were ineffective. Staphylococcus. aureus, Streptoccus spp and P. aeruginosa showed 68.75% resistance to the antibiotics, whilst E. coli (56.25%), Enterobacter spp (50%) and CNS showed 18.75% susceptibility each. Overall, Gentamicin was the most effective antibiotic, while Ofloxacin, Clindamycin, Cefixine, Levofloxacin and Ciprofloxacin were least effective. Hand washing after ATM usage and proper cleaning regimen should be practiced to reduce contamination on the ATMs.

Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings

Evidence that contaminated surfaces contribute to the transmission of hospital pathogens comes from studies modeling transmission routes, microbiologic studies, observational epidemiologic studies, intervention studies, and outbreak reports. This review presents evidence that contaminated surfaces contribute to transmission and discusses the various strategies currently available to address environmental contamination in hospitals.

Lack of enhanced effect of a chlorine dioxide-based cleaning regimen on environmental contamination with Clostridium difficile spores

Spores of Clostridium difficile may play a significant role in transmission of disease within the healthcare environment and are resistant to a variety of detergents and cleaning fluids. A range of environmental cleaning agents has recently become available, many of which claim to be sporicidal. We investigated the effect of changing to a chlorine dioxide-based cleaning regimen on C.difficile environmental contamination and patient infection rates. The prevalence of environmental contamination was unaffected with a rate of 8% (9/120) before and 8% (17/212) following the change. Rates of patient infection were also unchanged during these periods.

ANTIBIOGRAM OF BACTERIA ISOLATED FROM AUTOMATED TELLER MACHINES WITHIN ABAKALIKI METROPOLIS

The Automated Teller Machine (ATMs) is likely to be contaminated with various microorganisms due to their vast dermal contact by multiple users. The metallic keypads of ATMs were examined to investigate their potentials as source of bacterial contamination and also the antibiogram of the isolated organisms. The study lasted from August, 2012 to October, 2012 involving several procedures like culturing, identifying the organisms using biochemical tests and Kirby Bauer disc diffusion method for antibiotic sensitivity tests. Swabs from the keypads of 20 ATMs were examined and the results indicated the contamination of the keypads with Staphylococcus aureus 9 (50%), Klebsiella species 6 (33.3%) and Escherichia coli 3 (16.7%). The antibiogram were ascertained using Kirby Bauer disc diffusion method and the result showed that Staphylococcus aureus was 89% resistant to ampicillin, followed by penicillin (78%), nalidixic acid (78%) and augmentine (70%), while 33% and 30% were susceptible to peflacine and gentamycin respectively. Klebsiella species were 100% resistant to erythromycin, followed by tetracycline (83%), penicillin (83%), ampicillin (83%) and nalidixic acid (70%) but showed high level susceptibility to cotrimoxazole (65%), ciproflocacin (64%) and augmentine (64%). Escherichia coli were 100% resistant to tetracycline and penicillin, followed by augmentine (90%) and ampicilin (85%), but 70% susceptible to ceporex, followed by peflacine (65%) and ciprofloxacin (65%). Hand washing and proper cleaning regimen should be practiced to reduce contamination on the ATMs.

Long-term survival of salivary streptococci on dental devices made of ethylene vinyl acetate

Bacterial infection associated with the use of medical or dental devices is a serious concern. Although devices made of ethylene vinyl acetate (EVA) are often used in the oral cavity, there are no established standards for their storage. We investigated bacterial survival on EVA sheets under various storage conditions to establish a standard for hygienic storage of such dental devices. Bacterial counts were evaluated, which showed a significant decrease after washing with sterilized water, mechanical brushing and rinsing, and using Mouthguard Cleaner as compared to untreated samples. In addition, no bacteria were detected on samples stored 2 days or longer in a ventilated environment, whereas they were detected for up to 14 days on samples without any cleaning stored in a closed environment. Bacterial counts for the untreated samples gradually declined, while surviving bacteria on samples treated with sterilized water and mechanical brushing showed a rapid decrease. Additionally, bacterial identification using polymerase chain reaction (PCR) revealed that Streptococcus oralis was dominantly detected on salivary samples after 14 days of storage among both two subjects. For effective hygienic storage of dental devices made of EVA, washing with sterilized water is important to remove absorbed salivary compounds along with storage in a ventilated environment.

The Effectiveness of Various Cleaning Regimens and Current Guidelines in Contact Lens Case Biofilm Removal

Lens case hygiene is important for safe contact lens wear. However, there are no evidence-based data to suggest optimum hygiene regimens. This in vitro study aimed to evaluate and compare the effectiveness of manufacturers' guidelines and several other regimens in removing biofilm using various types of contact lens cases and disinfecting agents. Biofilms of Staphylococcus aureus ATCC 6538 and Pseudomonas aeruginosa 122 were formed on two types of unused contact lens cases. Subsequently, each contact lens case was subjected to one of four cleaning regimens using two different multipurpose disinfecting solutions or distilled water: "rinse and air-dry (guidelines)," "rub, rinse and air-dry," "tissue-wipe and air-dry," and "rub, rinse, tissue-wipe, and air-dry." The levels of residual biofilm were then quantified using viable counts and compared. The manufacturers' guidelines resulted in 1 to 2 log CFU reduction of either biofilm. "Rub, rinse, tissue-wipe, and air-dry" was the most effective cleaning regimen (P < 0.001), capable of removing 4 to 6 log CFUs of bacteria; higher levels of biofilm were removed by mechanical friction from nonridged cases than that of ridged cases (P < 0.001). Biofilm removal varied with multipurpose solution tested. Current manufacturers' guidelines are not adequate in eliminating microbial contamination. Simply incorporating a rubbing/wiping step in daily case hygiene reduces viable organism recovery. Factors such as the cleaning regimen, antimicrobial potency of multipurpose solution, and the interior topography of a lens case may impact the surface detachment of biofilm during the cleaning process.

The impact of active surveillance cultures in reducing methicillin-resistant Staphylococcus aureus infections in a surgical intensive care unit in Singapore

Infection and colonization with methicillin-resistant Staphylococcus aureus (MRSA) is associated with significant morbidity and mortality. To study the impact of active surveillance cultures (ASC), environmental cleaning and decolonization regimen in reducing MRSA infections in Surgical Intensive Care Unit (SICU).

O23 Poor hand hygiene can negate the efficacy of an enhanced cleaning regimen

O23 Poor hand hygiene can negate the efficacy of an enhanced cleaning regimen

Evaluation of the Efficacy of a Conventional Cleaning Regimen in Removing Methicillin-ResistantStaphylococcus aureusFrom Contaminated Surfaces in an Intensive Care Unit

Evaluation of the Efficacy of a Conventional Cleaning Regimen in Removing Methicillin-Resistant<i>Staphylococcus aureus</i>From Contaminated Surfaces in an Intensive Care Unit

Preventing cross-contamination

An appropriate cleaning and disinfection regimen can help prevent cross-contamination.

Post Space Cleaning Using a New Nickel Titanium Endodontic Drill Combined with Different Cleaning Regimens

This study compared the effect of two drills and five cleaning regimens on post space debridement. One hundred extracted premolars were instrumented and obturated with warm vertical compaction of gutta percha. The teeth were divided into two groups according to the drill used to remove gutta percha/sealer and for post space preparation: a Largo drill (Largo; Dentsply, St Quentin en Yvelines, France) or a MTwo-PF drill (Sweden&Martina, Due Carrare, Padova, Italy). The following cleaning regimens were used: EDTA, ultrasonics, ultrasonics + EDTA, phosphoric acid, and distilled water. Scanning electron microscopic images of the post spaces were taken, and the presence of debris and of open dentin tubules were evaluated. The ultrasonics + EDTA, phosphoric acid, and EDTA groups were comparable in open tubules scores for both drills and in debris scores after the use of MTwo-PF (p > 0.05). The ultrasonics and control groups performed significantly worse (p < 0.05). The MTwo-PF drill resulted as effective as the Largo drill in obtaining a good post space cleaning, especially when followed by ultrasonics + EDTA irrigant regimen.