High-touch Areas Research Articles

Candida tropicalis is the most prevalent yeast species causing candidemia in Algeria: the urgent need for antifungal stewardship and infection control measures

BackgroundDespite being associated with a high mortality and economic burden, data regarding candidemia are scant in Algeria. The aim of this study was to unveil the epidemiology of candidemia in Algeria, evaluate the antifungal susceptibility pattern of causative agents and understand the molecular mechanisms of antifungal resistance where applicable. Furthermore, by performing environmental screening and microsatellite typing we sought to identify the source of infection.MethodsWe performed a retrospective epidemiological-based surveillance study and collected available blood yeast isolates recovered from the seven hospitals in Algiers. To identify the source of infection, we performed environmental screening from the hands of healthcare workers (HCWs) and high touch areas. Species identification was performed by API Auxa-Color and MALDI-TOF MS and ITS sequencing was performed for species not reliably identified by MALDI-TOF MS. Antifungal susceptibility testing followed CLSI M27-A3/S4 and included all blood and environmental yeast isolates. ERG11 sequencing was performed for azole-resistant Candida isolates. Microsatellite typing was performed for blood and environmental Candida species, where applicable.ResultsCandida tropicalis (19/66) was the main cause of candidemia in these seven hospitals, followed by Candida parapsilosis (18/66), Candida albicans (18/66), and Candida glabrata (7/66). The overall mortality rate was 68.6% (35/51) and was 81.2% for C. tropicalis-infected patients (13/16). Fluconazole was the main antifungal drug used (12/51); 41% of the patients (21/51) did not receive any systemic treatment. Candida parapsilosis was isolated mainly from the hands of HCWs (7/28), and various yeasts were collected from high-touch areas (11/47), including Naganishia albida, C. parapsilosis and C. glabrata. Typing data revealed interhospital transmission on two occasions for C. parapsilosis and C. glabrata, and the same clone of C. parapsilosis infected two patients within the same hospital. Resistance was only noted for C. tropicalis against azoles (6/19) and fluconazole-resistant C. tropicalis isolates (≥8 μg/ml) (6/19) contained a novel P56S (5/6) amino acid substitution and a previously reported one (V234F; 1/6) in Erg11p.ConclusionsCollectively, our data suggest an urgent need for antifungal stewardship and infection control strategies to improve the clinical outcome of Algerian patients with candidemia. The high prevalence of C. tropicalis joined by fluconazole-resistance may hamper the therapeutic efficacy of fluconazole, the frontline antifungal drug used in Algeria.

Ongoing Challenges with Healthcare-Associated Candida auris Outbreaks in Oman.

Candida auris has emerged in the past decade as a multi-drug resistant public health threat causing health care outbreaks. Here we report epidemiological, clinical, and microbiological investigations of a C. auris outbreak in a regional Omani hospital between April 2018 and April 2019. The outbreak started in the intensive care areas (intensive care unit (ICU), coronary care unit (CCU), and high dependency unit) but cases were subsequently diagnosed in other medical and surgical units. In addition to the patients’ clinical and screening samples, environmental swabs from high touch areas and from the hands of 35 staff were collected. All the positive samples from patients and environmental screening were confirmed using MALDI-TOF, and additional ITS-rDNA sequencing was done for ten clinical and two environmental isolates. There were 32 patients positive for C. auris of which 14 (43.8%) had urinary tract infection, 11 (34.4%) had candidemia, and 7 (21.8%) had asymptomatic skin colonization. The median age was 64 years (14–88) with 17 (53.1%) male and 15 (46.9%) female patients. Prior to diagnosis, 21 (65.6%) had been admitted to the intensive care unit, and 11 (34.4%) had been nursed in medical or surgical wards. The crude mortality rate in our patient’s cohort was 53.1. Two swabs collected from a ventilator in two different beds in the ICU were positive for C. auris. None of the health care worker samples were positive. Molecular typing showed that clinical and environmental isolates were genetically similar and all belonged to the South Asian C. auris clade I. Most isolates had non-susceptible fluconazole (100%) and amphotericin B (33%) minimal inhibitory concentrations (MICs), but had low echinocandin and voriconazole MICs. Despite multimodal infection prevention and control measures, new cases continued to appear, challenging all the containment efforts.

Does hotel cleanliness correlate with surfaces guests contact?

PurposeThis study aims to strengthen implications about hotel cleaning outcomes by comparing guests’ perception of the amount of contact they have with cleanliness of hotel surfaces.Design/methodology/approachThis study used two data-collection methods, a survey and an adenosine triphosphate (ATP) test. Data were collected from recent hotel guests using Amazon Mechanical Turk. Guests were asked to identify hotel surfaces that they touch most frequently. Actual hotel cleanliness was measured using empirical data collected with ATP meters. The two data sets were used to compare guests’ perceptions about the amount of contact they have with actual cleanliness measurements of those hotel surfaces.FindingsThis study found that amount of guest contact was related to cleanliness of surfaces in guestrooms. Significant differences were found in guest perception between high- and low-touch areas and between guestrooms and hotel public areas. More high-touch areas and higher ATP readings were found in guestrooms than in hotel public areas.Originality/valueTo the best of the authors’ knowledge this study is the first to compare guest contact with hotel surfaces to a scientific measure of hotel cleanliness. In addition, this study is unique because it assesses guest contact and cleanliness of public areas to provide a holistic view of hotel-cleaning needs. The study offers industry empirically based results from guest perception and scientifically based data that can be used to improve hotel housekeeping programs.

Not Just a Cleaner but Your Frontline Defense

BACKGROUND The last several decades have seen an increase in outpatient and ambulatory healthcare delivery. According to a monthly hospital publication, the total community hospital outpatient visits grew from 383?million in 1994 to 693?million in 2014. As the demographics change over the coming years, it is critical to ensure that effective infection prevention measures are in place to help reduce Healthcare Associated Infections (HAIs). All healthcare personnel, including Environmental Service employees, must be knowledgeable in infection prevention measures and understand how every employee's role affects overall infection control in their facility. METHODS By means of standardized specific work practices and specialized training, environmental service employees were educated on infection control measures in the healthcare setting. Management certified in Infection Prevention, conducted a series of audits with Fluorescent marking sprays to systematically track performance of the disinfection processes. Data was gathered by identifying whether the Fluorescent marking spray was fully removed, partially removed or not removed from high-touch points using a three-star grading system. RESULTS A total of 77 audits were performed with a quality objective of 2,542 points. Environmental Service employees scored 2,310 points and a total 91% with a deficiency count of 42. Light switch plates and cabinet door handles were two high-touch point areas with the highest deficiency count. Porous surface areas which absorbed the Fluorescent marking spray were excluded from the data totals. CONCLUSIONS It is critical for Environmental Service employees to understand that they are an integral part of infection control. Employee feedback demonstrated that a comprehensive training program is necessary for infection control measures to be carried out effectively. This change in mindset and focus on education will be the future of infection prevention.

1151. A Safer, More Effective Method for Cleaning and Disinfecting GI Endoscopic Procedure Rooms

BackgroundHealthcare acquired infections are increasing. Current cleaning and disinfecting (C&D) methods subject staff to toxic chemicals and can be damaging to the facility. Hypochlorous acid (HOCl) is a disinfecting solution that is 80–200 times more effective than bleach in surface disinfection of bacteria yet is nontoxic to humans. The aim of this study was to determine whether HOCl is as effective as standard cleaning methods for C&D GI ambulatory surgery center (ASC) rooms as determined by ATP (adenosine triphosphate) measurements over a 2-week period.MethodsTwo similar GI ASCs, each with two procedure rooms, were studied. One ASC received postprocedure STANDARD C&D with quaternary ammonium compounds in nonwoven fabric for surface wiping of high touch areas followed by terminal benzalkonium chloride foam/spray on these areas. The second ASC received HOCl C&D using on-site freshly prepared HOCl, 1,000 ppm. Microfiber cloths semi-wet with HOCl were used for wiping surfaces for both C&D. In the HOCl rooms, after terminal manual wiping, misting with HOCl of the entire room was performed. Selected high touch area ATP testing was performed in all rooms before procedures in the AM and 10 minutes after terminal manual cleaning. In the HOCL rooms, testing was also performed 10 minutes after misting. High touch areas tested in each room included: endoscopic cart (three locations/cart), both gurney bed rails, computer mouse (two), working counters (two areas), light switch, door knob. ATP scores were compared within each site using analysis of means (ANOM).ResultsAfter terminal cleaning, the average ATP score in the HOCl CLEANING and DISINFECTING study arm was significantly lower than that for the STANDARD CLEANING and DISINFECTING rooms (P < 0.0017) (Figure 1). In evaluating the effect of the HOCl misting, the ATP scores in the HOCl rooms had a post cleaning, pre-misting average score of 2.7. The post misting average score was 1.7, showing that misting produced a further significant reduction (improvement) in ATP scores (P = 0.01).ConclusionHOCl cleaning and disinfection in GI ASCs is more effective than standard procedures in lowering ATP scores following endoscopic procedures in procedure rooms. HOCl terminal misting of the rooms further improves the cleaning and disinfecting results.Figure 1.Disclosures B. Overholt, HOCl Solutions: Shareholder, none to date.

2181. Efficacy of UV-C Disinfection with or Without Sodium Hypochlorite Compared with Usual Disinfection of Hospital Environmental Surfaces: Pilot Study

BackgroundThe hospital environment is known to harbor pathogens that cause healthcare-associated infections. Sodium hypochlorite (NaClO) has been a common method for disinfection due to its low cost and wide availability. Nevertheless, UV-C is less time-consuming and less prone to human errors. We are aware of only one study that has directly compared UV-C against NaClO in a high-income country.1MethodsA pilot study was designed to test three different methods for terminal room disinfection: (1) NaClO (1,000 ppm); (2) UV-C (two 5-minute cycles at a maximum radius of 2.4 m with the UVDI UV360™ device); and (3) NaClO followed by UV-C. After patient discharge, housekeeping staff cleaned every room with detergent. Next, the rooms were subjected to one of the three disinfection procedures in a nonrandomized way. Environmental cultures were taken before and after cleaning and after every disinfection procedure, from three high touch areas: bedrails, patient tables and mattresses. Bedrails were sampled with swabs and the rest of the surfaces with RODAC™ plates. Cultures were processed by the same external accredited laboratory. Our main objective was to calculate reductions in total bacterial counts (measured in CFUs) to estimate the sample size for a larger multicenter study. We hypothesized that similar bacterial count reductions would be observed for the three methods.ResultsEight rooms were tested in 4 hospitals in Mexico City (total of 85 cultures). Median bacterial count reductions with their respective IQRs, adjusted to CFUs after cleaning, were: 1 (0–10) after NaClO only; 5 (0–30) after UV-C only, and 1 (0–10) after NaClO + UV-C (Kruskal–Wallis test, P = 0.419); the respective median proportion reductions were 95.8% (0–100%), 90.1% (75–100%) and 100% (10–100%).ConclusionAll three disinfection methods seem to be equally effective for the reduction of total bacterial counts on hospital surfaces, regardless the type of hospital or ward. With a sufficiently powered study, we will attempt to demonstrate that UV-C alone could be used instead of NaClO (reference disinfectant in Mexico), possibly with time and economic savings.Disclosures All authors: No reported disclosures.

1153. UV-C Technology Is an Effective Adjunct to Terminal Cleaning in Environmental Pathogen Reduction in a Tertiary Pediatric Hospital

BackgroundEffective environmental surface cleaning plays a vital role in reducing transmission of hospital-acquired infections. There remains a paucity of data in the pediatric literature regarding environmental pathogen reduction utilizing UV-C light. The objective of this study was to evaluate the reduction of environmental pathogens using UV-C light (Clorox Optimum-UV) as an adjunct to terminal cleaning in a free-standing tertiary pediatric hospital.MethodsUpon patient discharge, a subset of patient rooms were tested for pathogens. Surface swabs were collected from high touch surfaces (call button, telemetry monitor, door handle, flush handle of toilet, faucet, bed rail, phone, keyboard pad, mouse, side table, dresser, and light switch). After terminal cleaning of the room, per hospital protocol the Clorox Optimum-UV completed one or two cycles of 5 minutes each depending on the dimensions of the room. Post-UV-C surface swabs were obtained from the same high touch areas in the room. Total colony count was reported from each of the surfaces swabbed. Swabs were streaked onto non-selective agar and incubated at 30-35oC for 72–96 hours. Mean plate colony count was determined manually and reported as CFU/swab. Data analysis was performed in Minitab 18.1. Fisher least significant difference (LSD) test was used to describe the difference between total bacterial counts at each time point (Pre-clean: dirty room, Post-clean: pre-UV-C/post-terminal clean, Post-UV: post UV-C light cycle).ResultsMean total colony counts prior to cleaning the room was 92.3 CFU (33 surfaces), Pre-UV-C light 45.6 CFU and post-UV-C light 5.8 CFU (64 surfaces). Total bacterial counts are represented in Graphs 1 and 2. Upon multivariate analysis, the time the sample was taken (preclean, postclean, or post-UV) was the single explanatory variable for the differences seen in the means of total bacterial counts (P = 0).ConclusionOur study demonstrates that UV-C disinfection is a highly effective adjunctive cleaning method with standard terminal cleaning to reduce bacterial burden from environmental surfaces.Graph 1: Total Bacterial Counts (CFU) at each timepoint of surface sampling.Graph 2: Total Bacterial Counts (CFU) with 95% Confidence Intervals at each timepoint of surface sampling.Disclosures A. Lucas, Clorox: Research Contractor, Grant recipient. M. Nayakwadi Singer, Clorox: Grant Investigator, Grant recipient.

Bayesian evidence and epidemiological implications of environmental contamination from acute respiratory infection in long-term care facilities.

Skilled nursing home facilities (SNFs) house a vulnerable population frequently exposed to respiratory pathogens. Our study aims to gain a better understanding of the transmission of nursing home-acquired viral respiratory infections in non-epidemic settings. Symptomatic surveillance was performed in three SNFs for residents exhibiting acute respiratory symptoms. Environmental surveillance of five high-touch areas was performed to assess possible transmission. All resident and environmental samples were screened using a commercial multiplex polymerase chain reaction platform. Bayesian methods were used to evaluate environmental contamination. Among nursing home residents with respiratory symptoms, 19% had a detectable viral pathogen (parainfluenza-3, rhinovirus/enterovirus, RSV, or influenza B). Environmental contamination was found in 20% of total room surface swabs of symptomatic residents. Environmental and resident results were all concordant. Target period prevalence among symptomatic residents ranged from 5.5 to 13.3% depending on target. Bayesian analysis quantifies the probability of environmental shedding due to parainfluenza-3 as 92.4% (95% CI: 86.8-95.8%) and due to rhinovirus/enterovirus as 65.6% (95% CI: 57.9-72.5%). Our findings confirm that non-epidemic viral infections are common among SNF residents exhibiting acute respiratory symptoms and that environmental contamination may facilitate further spread with considerable epidemiological implications. Findings further emphasise the importance of environmental infection control for viral respiratory pathogens in long-term care facilities.

Quantification of pathogen cross-contamination during fresh and fresh-cut produce handling in a simulated foodservice environment

Fresh and fresh-cut produce are associated with a significant proportion of foodborne disease outbreaks, driving the need for proper food handling that mitigates the risk of pathogen spread in foodservice environments. The objective of this study was to investigate cross-contamination patterns resulting from preparing these foods. For the first part of the study, forty-five participants simulated preparing fresh and fresh-cut produce in a mock deli kitchen in three scenarios. Produce or participant hands were coated with an innocuous fluorescent compound (Glo Germ™), then, following the simulations, high touch areas were swabbed to quantify cross-contamination. For scenarios 1–3, the cutting board, leafy greens, and participant gloves had the highest log10 percent of fluorescent compound (1.81, 1.31, 1.48, respectively). These results reinforce the need to properly sanitize kitchen equipment and to properly wash hands to reduce the likelihood of spreading harmful microorganisms. For the second part of the study, microbial experiments were conducted in a BSL-2 laboratory with two scenarios to determine how and to what extent Listeria monocytogenes, E.coli O157:H7, and Salmonella spp. spread from handling dip inoculated fresh and fresh-cut produce. Findings showed the propensity for pathogen harborage in utensils and wash water in scenario one. E.coli O157:H7 counts increased 33% from the inoculated lettuce sample to a second sample soaked in the same ice bath. By identifying and quantifying cross-contamination outcomes from food preparation, researchers can design task-specific educational materials that improve work flows which may reduce the risk of foodborne disease outbreaks.

Middle East respiratory syndrome coronavirus on inanimate surfaces: A risk for health care transmission

The Middle East Respiratory syndrome coronavirus (MERS-CoV) has been responsible for multiple health care–associated outbreaks. We investigated whether high-touch surfaces in 3 rooms of laboratory-confirmed MERS-CoV patients were contaminated with MERS-CoV RNA. We found 2 out of 51 surfaces were contaminated with MERS-CoV viral genetic material. Hence, environmental contamination may be a potential source of health care transmission and outbreaks. Meticulous environmental cleaning may be important in preventing transmission within the health care setting.

Usability of an Alcohol Disinfectant Containing Organic Acids and Metal Salt for Environmental Surfaces.

Environmental cleaning and disinfection plays an important role as a part of the standard precautions to prevent healthcare-associated infections, whereas hand hygiene is one of the most important strategies for breaking the chain of transmission. Cleaning and disinfection of high-touch areas in a health-care facility is emphasized. And wiping with an alcohol-saturated cloth which has features such as low corrosion and a wide range of antimicrobial activity is performed commonly for this purpose. Although alcohol provides immediate activity against enveloped viruses, its virucidal activity against certain non-enveloped viruses, including norovirus, is insufficient. We created a novel alcohol-based hand rub, MR06B7, which is safe for the skin, and is active against an extended spectrum of microorganisms including non-enveloped viruses. For environmental surface disinfection, a novel disinfectant MR13B15, which is based on MR06B7, has been developed. In vitro antimicrobial activity against a variety of pathogens, material compatibility, and simulated surface disinfection and decontamination efficacy of MR13B15 were investigated. According to the results, MR13B15 demonstrated potent bactericidal, fungicidal, mycobactericidal, and virucidal activity within a short contact time in addition to superior efficacy against non-enveloped viruses compared to ethanol for disinfection. Moreover, MR13B15 showed better material compatibility. Two simulation tests conducted for evaluating the disinfection and decontamination potency on environmental surfaces against feline calicivirus, a surrogate for norovirus, indicated that MR13B15 had superior efficacy for surface treatment compared to ethanol. These findings suggest that MR13B15, which satisfies most requirements of an environmental surface disinfectant, may contribute to accomplishing advanced standard precautions in preventing infections.

A pilot study to assess the effectiveness and cost of routine universal use of peracetic acid sporicidal wipes in a real clinical environment

Peracetic acid sporicidal wipes have been shown to be an effective disinfectant, but in controlled test environments. Their high cost may restrict use. This pilot study investigated the efficacy and compared the costs of routine universal use of peracetic acid sporicidal wipes versus sporicidal quaternary ammonium compound and alcohol wipes in the disinfection of a hospital environment. The routine universal use of peracetic acid wipes (Clinell Sporicidal; GAMA Healthcare Ltd, London, UK) was allocated to a study ward, whereas the control ward continued with the use of quaternary ammonium compound wipes (Tuffie 5; Vernacare, Bolton, UK) and alcohol wipes (PDI Sani-Cloth 70; PDI, Flint, UK). Twenty high-touch areas in the 2 wards were sampled for the presence of indicator organisms. The weekly detection rates of indicator organisms and weekly healthcare associated infection (HCAI) rates in the 2 wards were compared and examined for decreasing trends over the trial period. The detection rates of indicator organisms and HCAI rates were not significantly different in the 2 wards, and did not decrease significantly over the trial period. However, the peracetic acid wipes seem to be more effective against gram-negative organisms but at a significantly higher cost. Further prospective studies are needed to assess the cost-effectiveness of peracetic acid wipes.

Determining high touch areas in the operating room with levels of contamination.

The Centers for Disease Control and Prevention put forth the recommendation to clean areas considered high touch more frequently than minimal touch surfaces. The operating room was not included in these recommendations. The purpose of this study was to determine the most frequently touched surfaces in the operating room and their level of contamination. Phase 1 was a descriptive study to identify high touch areas in the operating room. In phase 2, high touch areas determined in phase 1 were cultured to determine if high touch areas observed were also highly contaminated and if they were more contaminated than a low touch surface. The 5 primary high touch surfaces in order were the anesthesia computer mouse, OR bed, nurse computer mouse, OR door, and anesthesia medical cart. Using the OR light as a control, this study demonstrated that a low touch area was less contaminated than the high touch areas with the exception of the OR bed. Based on information and data collected in this study, it is recommended that an enhanced cleaning protocol be established based on the most frequently touched surfaces in the operating room.

Respiratory syncytial virus is present in the neonatal intensive care unit.

Nosocomial transmission of respiratory syncytial virus (RSV) occurs in children within the neonatal intensive care unit (NICU). During peak community RSV transmission, three swabs were collected from the nose, hand and personal clothing of visitors and health care workers (HCW) in NICU once every week for eight weeks. Nasal swabs were collected from every third neonate and from any neonate clinically suspected of having a respiratory infection. Environmental sampling of high touch areas was done once during the study period. All swabs were tested for RSV using real time RT-PCR. There were 173 (519 total) and 109 (327 total) swabs, each of nose, hand and dress from 84 HCWs and 80 visitors respectively and 81 nasal swabs from 55 neonates collected. Thirty five environmental swabs from surfaces of the beds, side tables, counter tops, chairs, tables and computers were collected. Overall 1% of nasal swabs from each of HCWs, visitors and neonates, 4% of dress specimens from visitors and 9% of environmental swabs were positive for RSV-RNA. The results suggest that though the risk for RSV in the NICU remains low, personnel clothing are contaminated with RSV-RNA and may have a role in transmission.

Family experience survey in the surgical intensive care unit

The experience of critical care is stressful for both patients and their families. This is especially true when patients are not able to make their own care decisions. This article details the creation of a Family Experience Survey in a surgical intensive care unit (SICU) to capture and improve overall experience. Kolcaba's "Enhanced Comfort Theory" provided the theoretical basis for question formation, specifically in regards to the four aspects of comfort: "physical," "psycho-spiritual," "sociocultural" and "environmental." Survey results were analyzed in real-time to identify and implement interventions needed for issues raised. Overall, there was a high level of satisfaction reported especially with quality of care provided to patients, communication and availability of nurses and doctors, explanations from staff, inclusion in decision making, the needs of patients being met, quality of care provided to patients and cleanliness of the unit. It was noted that 'N/A' was indicated for cultural needs and spiritual needs, a chaplain now rounds on all patients daily to ensure these services are more consistently offered. In addition, protocols for doctor communication with families, palliative care consults, daily bleach cleaning of high touch areas in patient rooms and nurse-led progressive mobility have been implemented. Enhanced comfort theory enabled the opportunity to identify and provide a more 'broad' approach to care for patients and families.

An Evaluation of Environmental Terminal Cleaning in the Operating Room

The Operating Room (OR) is considered a sterile environment and assumed to be the cleanest area in the hospital. Is the Operating Room as clean as perceived? Operating room cleanliness was evaluated in 15 operating rooms by marking consistent immobile high touch areas with fluorescent gel.

Observation and relative quantification of cross-contamination within a mock retail delicatessen environment

Ingestion of ready-to-eat deli meats contaminated with foodborne pathogens has been linked to several outbreaks. For this study, a fluorescent compound (FC) was used to observe deli workers in cross-contamination events to visualize and quantify how potential microbial contamination can move within a mock retail deli environment. Twenty-one participants were recruited and were asked to complete a series of steps involving the slicing of deli meats in which one of the meat products was inoculated with the FC. Upon completion, 16 separate areas (5 × 5 cm) per participant were swabbed to quantify the amount of FC present. A standard curve for the FC (based on absorbance at 370 nm) was developed in order to quantify the amount of FC. For each participant, both video and image data were also collected. These data were normalized and reported as percentages of the total amount of FC collected per participant to allow the amount of FC in each area to be compared across participants. Concentrations of FC by area swabbed and participant were highly variable; even so, consistently elevated levels of FC were found on participants' gloves (18%), on the slicer's meat grip (16%), the outside wall of the carriage tray (16%) and within the collection area (13%). Video analysis revealed that high-touch areas include the deli meat, deli meat wrapper, deli paper, and plastic bags which comprised 74% (87 of 118 touches) of the total average hand contact frequency per participant. The relationship between frequency of hand contact and % FC on a particular area swabbed was analyzed, and a Pearson's r value of 0.37 was determined indicating a medium-strength, positive correlation. The findings in this study demonstrate that there is variability among participants within a mock retail deli environment, and thus, likely to be similar variability among workers in an actual retail deli environment. In addition, even in the presence of this variability, this study identifies both areas of elevated contamination levels as well as areas of high hand contact within a deli environment. To our knowledge, this is the first study to quantify cross-contamination events using a FC and to identify potential areas of concern with respect to cleaning and sanitizing as well as employee training.

Assessment of microbiological contamination of radiographic devices in School of Dentistry

Although dental radiology is not directly involved in either invasive procedures or in the use of piercing-cutting material, the high-touch areas of dental x-ray device, including radiographic films, are a potential source of infection. The purpose of this study was to assess the amount of cross infection present in the dental x-ray devices of the School of Dentistry of the Federal University of Maranhão by investigating the presence of pathogenic microorganisms in high-touch areas of dental x-ray devices (tube head, timer button, portable processing box and lead apron). Twenty surfaces of 4 dental radiology clinics were cultured in different media. The results showed that 70 percent of the surfaces had contamination. All the dental x-ray devices assessed were contaminated (tube head, timers or both) as well as all the lead aprons. The portable processing boxes showed 75 percent of contamination. The groups found no statistical significance between the different surfaces assessed and the microorganisms. The highest frequent microorganisms found were from Staphylococcus genus. The authors concluded that because of the high incidence of contamination found, the x-ray devices used in the dental clinics could be at potential risk of cross infection, demonstrating the necessity for applying biosecurity practices when taking radiographic and during radiographic processing.

Comparison of the Surface Disinfection Capabilities of Two Different Methods Using Automated Devices: Ultraviolet Light Versus Hydrogen Peroxide Fogging Machine

The prevalence of healthcare associated infections has given rise to the need for additional surface disinfection of high-touch areas. Manual cleaning and disinfection from the housekeeping staff has proved insufficient and would greatly benefit from the supplementation of an automated disinfection machines that facilitate disinfection of hard to reach surfaces and provide thorough disinfection of environmental services. Two methods of automated surface disinfection evaluated here are chemical (hydrogen peroxide fog) and non-chemical (ultraviolet light) means of disinfection.

Evaluation of the biological efficacy of hydrogen peroxide vapour decontamination in wards of an Australian hospital

This study assessed the efficacy of a 'dry' hydrogen peroxide vapour decontamination in an Australian hospital via a two-armed study. The invivo arm examined the baseline bacterial counts in high-touch zones within wards and evaluated the efficacy of cleaning with a neutral detergent followed by either hydrogen peroxide vapour decontamination, or a manual terminal clean with bleach or Det-Sol 500. The invitro arm examined the efficacy of hydrogen peroxide vapour decontamination on a variety of different surfaces commonly found in the wards of an Australian hospital, deliberately seeded with a known concentration of vancomycin-resistant enterococci (VRE). All bacterial counts were evaluated by a protocol of contact plate method. In the invivo arm, 33.3% of the high-touch areas assessed had aerobic bacterial count below the detection limit (i.e. no bacteria recoverable) post hydrogen peroxide decontamination, and in all circumstances the highest microbial density was ≤3cfu/cm(2), while in the invitro arm there was at least a reduction in bacterial load by a factor of 10 at all surfaces investigated. These results showed that dry hydrogen peroxide vapour room decontamination is highly effective on a range of surfaces, although the cleanliness data obtained by these methods cannot be easily compared among the different surfaces as recovery of organisms is affected by the nature of the surface.