Disinfection Policies Research Articles

Surface contamination by SARS-CoV2 RNA in dedicated COVID care area of a tertiary care hospital in North India.

Environmental surfaces are potential source of SARS-CoV2 transmission. The study assessed the efficacy of hospital disinfection policy and contamination of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) RNA in COVID management Hospital. Inanimate surfaces from both patient areas (n = 70) and non-patient areas (n = 39) were sampled through surface swabbing and subjected to Reverse transcriptase PCR. Out of the 70 samples collected from the COVID hospital, SARS-CoV2 RNA positivity of 17.5% (7/40) and 6.7% (2/30) was seen in high risk and moderate risk area respectively. Samples from Non COVID related patient area such as CD ward and administrative block were assessed and the SARS CoV-2 RNA positivity was 0% and 10% respectively. Among the total 8 environmental surface samples positive for SARS-CoV2 RNA detected from the area surrounding the SARS-CoV2 infected patients, maximum positivity of 31.8% (7/22) was found among the environmental samples collected around the patients with < 20 Ct value in nasopharyngeal swab samples followed by 3.3% positivity (1/30) around patients with Ct value ranging from 20 to 25 whereas no SARS-CoV2 RNA (0/5) was detected around the patient with > 25 Ct value. Nearly 50% (2/4) of the surface samples came positive from the resident PPE and mobile of the treating doctors which largely elaborates the need for stringent doffing measurement and hand hygiene policy post doffing. The study emphasizes the necessity of frequent and aggressive disinfection policy to prevent nosocomial infection in such high risk areas within close vicinity of the patients.

Desinfection Policy and Infections Associated with Healthcare in Neurologic Patients

Introduction: The problems surrounding healthcare associated infections is a necessity of governments and in particular for each health center, which better guides prevention actions, control and continuous adjustment of disinfection policy according to hospital infection rates. Objectives: To demonstrate the trend of HAIs and key factors that influence their control, emphasizing the continuous adjustment of disinfection policies over a period of five years, establishing a forecast for the 2020-2022 triennium. Methods: a descriptive, longitudinal and retrospective study of the HAIs was carried out at the Institute of Neurology and Neurosurgery of Cuba during the 2015-2019 five-year period, according to the disinfection policy and the actions carried out to raise the quality of the HAIs control program, calculating values forecasts through the least squares method. Results: during 2015-2019 rates of HAIs between 3.76 and 6.42 were maintained, with a prognostic estimate for the triennium 2020-2022 of a rate between 1.60 and 2.93, with a strong downward trend, maintaining the current mechanical and environmental disinfection policy established. Bacterium colonizations related to assisted mechanical ventilation prevailed in 34% of the patients and urinary tract infections in 25%, varying these data per year with a clear decrease of up to 18 percentage points according to the HAIs type. Conclusions: it is possible to implement a prospective in-hospital sepsis surveillance system in neurological patients, to increase the quality of the care process, establish prognoses and evaluate the impact of the disinfection policies used.

1-D Titanium Dioxide Nanotubes Aided by UVC Radiation for Inactivation of Human Coronavirus

SAR-CoV-2 virus, a pathogenic human coronavirus led to a global outbreak called COVID-19. Nearly, 150 million COVID-19 cases have been confirmed worldwide by the end of April 2021. Safety precautions and effective disease control strategies appear to be vital for preventing the virus spread in the public places. Due to the longevity of the virus on smooth surfaces, photocatalytic properties of “self-disinfecting/cleaning” surfaces appear to be a promising tool to help guide disinfection policies to control infectious SAR-CoV-2 spread in high-traffic areas such as hospitals, grocery stores, airports, schools, and stadiums. In this study, we have demonstrated the effectiveness of TiO2 nanotubes (TNTs) towards photocatalytic inactivation of a close genetic relative of SAR-CoV-2, OC43. TNTs with different diameter and length were synthesized by anodization process and their impact on the photocatalytic inactivation performance of TNTs was examined by quantitative RT-qPCR and virus culture assays. The virucidal efficacy was tested under different UV exposure time. Reusability experiments showed the remarkable cyclic stability of TNTs. The findings also form the basis for the application of an electrical bias on the TiO2 electrodes towards inactivation of the virus. Efforts to extrapolate the underlying concepts described in this study to SARS-CoV-2 are currently underway.

A case-control study of airborne dissemination of bacteria during CT colonography.

The COVID-19 pandemic has highlighted the importance of aerosol spread of infection. We have conducted a study to detect bacterial contamination of room surfaces and room air during CT colonography and confirm the efficacy of room disinfection procedures carried out between examinations. Systematic sampling of the CT examination couch and horizontal surfaces 1 m and 3 m from the couch was performed before and after patient examinations. A 1 m3 sample of room air was obtained during patient examinations. Samples were processed using routine laboratory methods. A case-control study design was used (30 CT colonography and 30 routine body CT scans). Evidence of airborne dissemination of bacteria was detected in >30% of CT colonography examinations and <10% of control examinations (p = 0.01). No pathogenic bacteria were detected in surface samples taken before patient examinations. The room disinfection policy in use in our CT department is effective in eliminating pathogenic bacteria from surfaces in the patient environment. CT colonography causes contamination of room air with enteric bacteria in a significant proportion of cases. CT colonography may possibly be an aerosol-generating procedure. Larger-scale investigation is needed to fully evaluate this potential infection risk.

Prevention and control strategies for the post-pandemic era: finding a balance between COVID-19 and reviving medical service.

Public life in China is gradually returning to normal with strong measures in coronavirus 2019 (COVID-19) control. Because of the long-term effects of COVID-19, medical institutions had to make timely adjustments to control policies and priorities to balance between COVID-19 prevention and daily medical services. The framework for infection prevention and control in the inpatient department was effectively organized at both hospital and department levels. A series of prevention and control strategies was implemented under this leadership: application of rigorous risk assessment and triage before admission through a query list; classifying patients into three risk levels and providing corresponding medical treatment and emergency handling; establishing new ward visiting criteria for visitors; designing procedures for PPE and stockpile management; executing specialized disinfection and medical waste policies. Till June 2020, the bed occupancy had recovered from 20.0% to 88.1%. In total, 13045 patients were received in our hospital, of which 54 and 127 patients were identified as high-risk and medium-risk, respectively, and 2 patients in the high-risk group were eventually laboratory-confirmed with COVID-19. No hospital-acquired infection of COVID-19 has been observed since the emergency appeared. The strategies ensured early detection and targeted prevention of COVID-19 following the COVID-19 pandemic, which improved the recovery of medical services after the pandemic.

Bacteriological Surveillance of Ambulance Vehicles from a Tertiary Care Hospital of North India.

Objective An ambulance is a medically equipped vehicle which is used in case of any medical emergency for the transport of patients to treatment facilities. The ambulances help in the transportation of thousands of patients per year, and such patients may carry infectious microorganisms which pose a major threat to the treatment of such patients. In this study, we analyzed the extent of bacterial contamination in our ambulance vehicles and measured the degree of antimicrobial resistance among isolated pathogens. Material and Method This study included five ambulances of our tertiary care hospital and different random sites were swabbed in each vehicle. These were selected based on their well-known high frequency of contact by emergency personnel and patients. Swabs were inserted into sterile test tubes containing normal saline and immediately transferred to our microbiology laboratory to identify bacterial contaminants utilizing standard microbiological procedures. Result A total of 198 swab samples were collected from all the five ambulances, out of which 170 (85.8%) swabs were sterile and 28 (14.2%) swabs yielded potentially pathogenic bacterial isolates. The highest contamination rate with pathogenic bacteria was detected in the oxygen flow meter knob (60%), suction machine tubing (60%), and stethoscope (40%). Staphylococcus aureus (32%) was the most frequently detected microorganism. Conclusion Our study showed low prevalence of bacterial contamination in ambulances because of good infection control policy of our hospital, however, some areas still need improvement and require proper standard operating procedures of disinfection policies of these emergency vehicles.

Inactivation of Human Coronavirus (SARS-CoV-2) By Titania Nanoparticle Coatings and UVC Radiation

The novel pathogenic human coronavirus, SARS-CoV-2, led to an atypical pneumonia-like severe acute respiratory syndrome (SARS) outbreak called coronavirus disease 2019 (abbreviated as COVID-19). Nearly, 77 million cases have been confirmed worldwide with the highest COVID-19 cases been confirmed in the United States. Substantial efforts to create a potential vaccine to combat COVID-19 are underway. In the meantime, safety precautions and effective disease control strategies appear to be vital for preventing the virus spread in the public places. Due to the longevity of the virus on smooth surfaces, photocatalytic properties of “self-disinfecting/cleaning” surfaces appear to be a promising tool to help guide disinfection policies to control infectious SAR-CoV-2 spread in high-traffic areas such as hospitals, grocery stores, airports, schools, and stadiums. The photocatalytic properties of nanosized TiO2 (TNPs) as induced by the UV radiation, towards virus deactivation have been explored in this study. The preliminary results using close genetic relative of SAR-CoV-2, HCoV-NL63, showed the virucidal efficacy of photoactive TNPs deposited on glass coverslips, as examined by quantitative RT-qPCR and virus culture assays. The photocatalytic inactivation performance of TNPs was evaluated under different light intensities, humidic conditions, and UV-exposure time. The findings form the basis for the application of an electrical bias on the TiO2 electrodes towards removal and inactivation of the virus. Efforts to extrapolate the underlying concepts described in this study to SARS-CoV-2 are currently underway.

818. Healthcare Worker Feedback Regarding the Implementation of a New Disinfection Tracking System

BackgroundTracking of disinfection of portable medical equipment (PME) and demonstration of compliance with PME disinfection policies can be difficult to demonstrate. A Disinfection Tracking System (DTS) was implemented in our hospital to assess the impact of such a system on the disinfection events of PME and its ability to capture disinfection events. The DTS system improved the total disinfection events as well as disinfection events on commonly used items such as Computer-on-wheels (COWs) and vitals machine (VM) (Figures 1 & 2). Here we present a summary of healthcare workers’ (HCWs) opinions about the implementation of the DTS system in their routine work flow.Image of DTS Mounted on a Computer-on-Wheel Image of a DTS Mounted on a Vitals Machine MethodsThe study was conducted on two medical-surgical acute care units in Temple, TX Veterans Affairs hospital. The DTS devices were equipped with sensors to detect moisture events corresponding to disinfection. A display on the device indicated the last time the PME was disinfected. Opinions were obtained after the 10-week study period through a survey and facilitated group discussions between frontline HCWs and managers who had encountered the DTS during their daily work routine. The survey measured level of agreement with 13 items on a Likert-type scale system ranging from one (least agreement) to ten (most agreement).Disinfection Tracking System with Screen Displaying Time Since Last Disinfection ResultsA total of 17 surveys were completed. The lowest mean agreement score was 5.1 for the statement - the DTS system display corresponds to a real disinfection of the equipment and the highest mean agreement scores included - the DTS system was easy to understand and follow and the DTS system can easily be adopted in my routine workflow. Lastly, - the DTS system helped improve the disinfection of my COW and the DTS system will improve patient outcomes corresponded to agreement score means of 8.1 and 7.9, respectively. In the group discussions, all the involved groups of healthcare workers expressed agreement in the ease of use of the system and minimal disruption in workflow.ConclusionOur survey and interview results indicate that most of the HCWs who interacted with the device had a positive interaction with the device. They stated the DTS system helped serve as an indicator about the last disinfection event. They also noted the system integrated well into their workflow without any disruption or additional workload.DisclosuresSarah Simmons, DrPH, Xenex Disinfection Services (Employee, Shareholder) Mark Stibich, PhD MHS, Xenex Disinfection Services, Inc (Board Member, Employee) Chetan Jinadatha, MD, MPH, AHRQ (Research Grant or Support)Department of Veterans Affairs (Other Financial or Material Support, Owner: Department of Veterans Affairs. Licensed to: Xenex Disinfection System, San Antonio, TX)Inventor (Other Financial or Material Support, Methods for organizing the disinfection of one or more items contaminated with biological agents)NiH/NINR (Research Grant or Support)NSF (Research Grant or Support)Xenex Healthcare Services (Research Grant or Support)

Inactivation of Human Coronavirus by Titania Nanoparticle Coatings and UVC Radiation: Throwing Light on SARS-CoV-2.

The newly identified pathogenic human coronavirus, SARS-CoV-2, led to an atypical pneumonia-like severe acute respiratory syndrome (SARS) outbreak called coronavirus disease 2019 (abbreviated as COVID-19). Currently, nearly 77 million cases have been confirmed worldwide with the highest numbers of COVID-19 cases in the United States. Individuals are getting vaccinated with recently approved vaccines, which are highly protective in suppressing COVID-19 symptoms but there will be a long way before the majority of individuals get vaccinated. In the meantime, safety precautions and effective disease control strategies appear to be vital for preventing the virus spread in public places. Due to the longevity of the virus on smooth surfaces, photocatalytic properties of “self-disinfecting/cleaning” surfaces appear to be a promising tool to help guide disinfection policies for controlling SARS-CoV-2 spread in high-traffic areas such as hospitals, grocery stores, airports, schools, and stadiums. Here, we explored the photocatalytic properties of nanosized TiO2 (TNPs) as induced by the UV radiation, towards virus deactivation. Our preliminary results using a close genetic relative of SAR-CoV-2, HCoV-NL63, showed the virucidal efficacy of photoactive TNPs deposited on glass coverslips, as examined by quantitative RT-qPCR and virus infectivity assays. Efforts to extrapolate the underlying concepts described in this study to SARS-CoV-2 are currently underway.

Preventing medical-device-borne outbreaks: High-level disinfection policy for duodenoscopes.

Preventing medical-device-borne outbreaks: High-level disinfection policy for duodenoscopes.

The Importance of Environmental Screening in a Methicillin-Resistant Staphylococcus aureus (MRSA) Outbreak Investigation in a Transplant Unit

Background: Methicillin-resistant Staphylococcus aureus (MRSA) colonization conveys a higher risk of invasive infection. The transplant cohort is a group of immunocompromised patients who are at higher risk of infection. We conducted an outbreak investigation of hospital-acquired MRSA colonization within the transplant unit, which led to the discovery of positive isolates within our environment and to changes in our hospital disinfection policies. Methods: Our transplant unit consists of 8 single, positive-pressure rooms housed separately at the side of a larger ward. Staffing from this unit differs from the rest of the shared ward that houses up to 60 patients. As part of hospital screening, we found that a patient admitted for a stem-cell transplant had acquired nosocomial MRSA colonization. Given the unusual occurrence of such an event, a root-cause analysis was conducted. Results: A meeting was convened together with nursing, medical staff, and ancillary staff. Identified areas of potential transmission were deemed equipment, staff, and patients, and screening was performed. Shared equipment included the portable electrocardiogram (ECG) machines and portable x-ray machines and boards. In particular, ECG machines were shared with the adjoining nontransplant oncology ward. The usual practice was to clean the machine after use but not prior to the next use. This was deemed a possible exposure risk in view of a recent MRSA outbreak in a separate section of the ward. Positive isolates were found on both the x-ray and ECG machines. All healthcare workers were screened and were negative for MRSA. Furthermore, 7 patients admitted during the same time period were also screened for MRSA and were negative. Given the concurrent outbreak within the ward, pulsed-field gel electrophoresis was performed for all MRSA isolates obtained and the outbreak strain. These were found to be nonclonal (Table 1). Work processes for both the cleaning of ECG and x-ray machines were enhanced and modified. Hand hygiene measures to ward and radiology staff were reinforced. Thus far, no further cases have been detected. Conclusions: The environment is an important part of outbreak investigation. Shared equipment is often overlooked during day to day processes but should not be neglected. This can result in changes to hospital disinfection policy.Funding: NoneDisclosures: Indumathi Venkatachalam reports receiving honoraria for speaking engagements for bioMérieux and Pfizer and serving on an expert panel for MSD Pharma.

Prevention of Late Onset Sepsis and Central-line Associated Blood Stream Infection in Preterm Infants.

Late onset sepsis (LOS) and central-line associated blood stream infection (CLA-BSI) contribute toward the mortality and morbidity in prematurely born infants. The aim of this study is to investigate the effects of hospital-wide and unit-based interventions on LOS and CLA-BSI in infants born at <32 weeks gestation. Intensive care, high dependency days and catheter days were obtained from the unit database and blood culture results from a microbiology laboratory database. Poisson regression was used to evaluate the effects of interventions on LOS and CLA-BSI. Quarterly rates of LOS reduced from 26.1 to 2.9 per 1000 intensive care, high dependency days and CLA-BSI from 31.6 to 4.3 per 1000 catheter days between 2007 and 2012. Appointment of a hospital specialist vascular device nurse, a change in the mode of administration of vancomycin, standardization of the hospital skin and hub disinfection policy and the introduction of a venous infusion phlebitis scoring system were associated with a reduction of LOS to 55% (95% confidence interval: 40-74%) and CLA-BSI 45% (95% confidence interval: 33-61%) of pre-intervention levels. The standardization of the neonatal unit policy for skin disinfection and a move to a new building were associated with reductions of LOS to 64% (47-87%) and 54% (34-88%), respectively, and aseptic no touch technique for infusion access with CLA-BSI to 53% (37-75%) of pre-intervention levels. A multifaceted approach involving changes in antimicrobial and skin disinfection policy, training for aseptic no touch technique and surveillance resulted in sustained reduction in LOS and CLA-BSI rates.

Disinfection in the laboratory: theory and practice in disinfection policy in late C19th and early C20th England

This article examines the relationship between theory and practice in nineteenth century English public health disinfection practice. Disinfection undertaken by local authorities and practised on objects, spaces and people became an increasingly common public health practice in the last quarter of the nineteenth century, and was part of a newly developed public health system of 'stamping out' disease as described by Hardy. Despite disinfection's key role in public health policy, it has thus far not received significant investigation or historiographical attending. This article explores the development of disinfection policy at local level, highlighting that despite commentators assumptions that increasingly exacting standards of disinfection required professional oversight rather than that of the 'amateur' public, there was a significant gap between laboratory based knowledge and evidence derived from practical experience. Laboratory conditions could not replicate those found in day-to-day disinfection, and there were myriad debates about how to create a mutually understandable scientific standard for testing. Despite increasing efforts to bring local disinfection in line with new ideas promulgated by central government and disinfection researchers, the mismatches between the two meant that there was greater divergence. This tension lay at the heart of the changes in disinfection theory and practice in the second half of the nineteenth century, and illustrate the complexities of the impact of germ theory on public health policy.

Risk Factors of Carbapenem-Resistant Klebsiella pneumoniae Infection: A Serious Threat in ICUs

BackgroundNosocomial infections caused by Carbapenem-resistant Klebsiella pneumoniae (CRKP) are increasing. Our aim in this study was to investigate the risk factors of CRKP infections.Material/MethodsA retrospective cohort study was performed between 1 January and 31 December 2012 in ICU patients. Data was taken from the hospital infection control database for CRKP. The clinical samples collected from the patients were tested by an automatized system and disk diffusion. SPSS software v11.5 was used for statistical analysis.ResultsTotally, 105 Klebsiella pneumoniae isolates were found in 2012 and the carbapenem resistance rate was 48%. The first episode of infection was taken into risk factor analysis. Of the 98 patients, 61 (62.2%) were male and the mean and median ages were 30.4±29.8 and 25 (0–93). The length of stay was longer in the resistant group (p=0.026). Mortality was 48% in the whole group and similar between groups (p=0.533). There was a relationship between meropenem and third-generation cephalosporin use and resistance (OR 3.244 (1.193–8.819) and OR: 3.590 (1.056–12.209). The other risk factors in univariate analysis were: Immunosuppression OR: 2.186 (1.754–2.724), nasogastric catheter OR: 3.562 (1.317–9.634), peripheral arterial catheter OR: 2.545 (1.027–6.307), and being admitted to the neurosurgical unit OR: 4.324 (1.110–16.842).The multivariate analysis showed use of third-generation cephalosporin OR: 4.699 (1.292–17.089), nasogastric catheter use OR: 3.983 (1.356–11.698), and being admitted to neurosurgical ICU OR: 4.603 (1.084–19.555) as independent risk factors.ConclusionsRestriction of third-generation cephalosporin and carbapenem use and invasive procedures, along with infection control precautions and disinfection policies, may be effective in reducing the carbapenem resistance in ICUs.

Knowledge and Use of Disinfection Policy in Some Government Hospitals in South-East, Nigeria

Knowledge and Use of Disinfection Policy in Some Government Hospitals in South-East, Nigeria

Comparative analysis of newly introduced disinfectants in hospitals in India: An important aspect of infection control policy

the effective use of disinfectants constitute an important factor in preventing hospital acquired infections. this study was undertaken to compare the effects of three newly introduced disinfectants in a number of tertiary care hospitals in India, namely superoxidized water (SOW) and two quaternary ammonium compounds (QACs), against the effects of 70% ethyl alcohol as one of the most commonly used disinfectants. All the disinfectants were tested for their effectiveness against multidrug resistant (MDr) Pseudomonas aeruginosa, meticillin resistant Staphylococcus aureus (MrSA) and vancomycin resistant enterococci (Vre). Suspension of ≥10 6 bacteria was subjected to the action of different disinfectants for different length of time and in presence and absence of organic matter. reduction in colony count was noted by semiquantitative surface viable colony count method. results were expressed as percentage reductions and analyzed statistically. SOW showed good activity against most of the isolates, except against MrSA in presence of organic matter, where QACs were better. the disinfectants varied in their effects towards different organisms in different environmental conditions and with varying exposure time. therefore, disinfection policies should take into consideration the type of ward and surfaces to be disinfected along with reasons for disinfection for an effective step towards infection control.

Knowledge and Use of Disinfection Policy in Some Government Hospitals in South-East, Nigeria

Aims: This study was carried out to evaluate the knowledge and use of disinfection policy in government hospitals in south-east geopolitical zone of Nigeria and to compare the three categories of government hospitals. Study Design: This was a descriptive, cross sectional study. Place and Duration of Study: Intensive Care Units and Special Care baby Units (SCBU), Departments of Pharmacy (Compounding/Storage Unit), Medical Laboratory Services, Surgery, Obstetrics and Gynecology, between February and May 2012. Methodology: A structured self administered and pre-tested questionnaires were administered to 200 randomly selected healthcare workers which included 40 Pharmacists, 59 Nurses, 55 Resident/General Practice Medical doctors and 46 Medical laboratory scientists, employed full-time in selected government hospitals in southeast geopolitical zone of Nigeria. Results: The sample size and the response rate were 200 and 100% respectively.

Pseudomonas aeruginosain a neonatal intensive care unit: molecular epidemiology and infection control measures

BackgroundPseudomonas aeruginosa, a non-fermentative, gram-negative rod, is responsible for a wide variety of clinical syndromes in NICU patients, including sepsis, pneumonia, meningitis, diarrhea, conjunctivitis and skin infections. An increased number of infections and colonisations by P. aeruginosa has been observed in the neonatal intensive care unit (NICU) of our university hospital between 2005 and 2007.MethodsHand disinfection compliance before and after an educational programme on hand hygiene was evaluated. Identification of microrganisms was performed using conventional methods. Antibiotic susceptibility was evaluated by MIC microdilution. Genotyping was performed by PFGE analysis.ResultsThe molecular epidemiology of Pseudomonas aeruginosa in the NICU of the Federico II University hospital (Naples, Italy) and the infection control measures adopted to stop the spreading of P. aeruginosa in the ward were described. From July 2005 to June 2007, P. aeruginosa was isolated from 135 neonates and caused severe infections in 11 of them. Macrorestriction analysis of clinical isolates from 90 neonates identified 20 distinct genotypes, one major PFGE type (A) being isolated from 48 patients and responsible for 4 infections in 4 of them, four other distinct recurrent genotypes being isolated in 6 to 4 patients. Seven environmental strains were isolated from the hand of a nurse and from three sinks on two occasions, two of these showing PFGE profiles A and G identical to two clinical isolates responsible for infection. The successful control of the outbreak was achieved through implementation of active surveillance of healthcare-associated infections in the ward together with environmental microbiological sampling and an intense educational programme on hand disinfection among the staff members.ConclusionP. aeruginosa infections in the NICU were caused by the cross-transmission of an epidemic clone in 4 neonates, and by the selection of sporadic clones in 7 others. An infection control programme that included active surveillance and strict adherence to hand disinfection policies was effective in controlling NICU-acquired infections and colonisations caused by P. aeruginosa.

Nosocomial outbreak of vancomycin-resistant Enterococcus faecium at a German University Pediatric Hospital

Nosocomial Infections caused by vancomycin–resistant enterococci (VRE) are an emerging threat to critically ill patients. At the University Hospital Eppendorf, VRE were isolated from 38 patients between August 1993 and April 1997, of whom 32 were hospitalized at the Department of Pediatrics. Pulsed-field gel electrophoresis revealed that 26 Enterococcus faecium isolates from patients of the Department of Pediatrics were identical or closely related, and that isolates from three additional patients of the same department were possibly related. All of these isolates were of vanA genotype. They were resistant to glycopeptides, ampicillin, ciprofloxacin, clindamycin, and erythromycin. Most isolates displayed high–level resistance to gentamicin, but all remained susceptible to quinupristin/dalfopristin. Implementation of stringent hand disinfection and environmental disinfection policies, as well as measures for patient isolation contained this first outbreak of VRE at a German Children's hospital, which emphasizes the importance of hygienic measures for the control of nosocomial spread of these organisms.

How to produce a hospital disinfection policy

The steps required to produce and implement a hospital disinfection policy are discussed including: the formation of the team responsible for the policy; the investigation and compilation of current methods of decontamination; assessment of these methods and selection of the best options by reference to model disinfection policies; planning and producing the policy; choosing the best format; implementation of the policy and staff training; and auditing and updating the policy. Guidance is given on the selection of suitable procedures for decontamination of the environment, the skin and mucous membranes, and endoscopes and other items.