scholarly journals A Continuously Active Antimicrobial Surface Coating Reduces Bioburden in a Healthcare Setting

2020 ◽  
Vol 41 (S1) ◽  
pp. s439-s439
Author(s):  
Valerie Beck
Keyword(s):  
Surface Coating ◽  
Geometric Mean ◽  
Healthcare Setting ◽  
Aerobic Bacteria ◽  
Healthcare Settings ◽  
Additional Layer ◽  
Clostridioides Difficile ◽  
Sustained Reduction ◽  
Before And After ◽  
Healthcare Associated

Background: It is well known that contaminated surfaces contribute to the transmission of pathogens in healthcare settings, necessitating the need for antimicrobial strategies beyond routine cleaning with momentary disinfectants. A recent publication demonstrated that application of a novel, continuously active antimicrobial surface coating in ICUs resulted in the reduction of healthcare-associated infections. Objective: We determined the general microbial bioburden and incidence of relevant pathogens present in patient rooms at 2 metropolitan hospitals before and after application of a continuously active antimicrobial surface coating. Methods: A continuously active antimicrobial surface coating was applied to patient rooms in intensive care units (ICUs) twice over an 18-month period and in non-ICUs twice over a 6-month study period. The environmental bioburden was assessed 8–16 weeks after each treatment. A 100-cm2 area was swabbed from frequently touched areas in patient rooms: patient chair arm rest, bed rail, TV remote, and backsplash behind the sink. The total aerobic bacteria count was determined for each location by enumeration on tryptic soy agar (TSA); the geometric mean was used to compare bioburden before and after treatment. Each sample was also plated on selective agar for carbapenem-resistant Enterobacteriaceae (CRE), vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and Clostridioides difficile to determine whether pathogens were present. Pathogen incidence was calculated as the percentage of total sites positive for at least 1 of the 4 target organisms. Results: Before application of the antimicrobial coating, total aerobic bacteria counts in ICUs were >1,500 CFU/100 cm2, and at least 30% of the sites were positive for a target pathogen (ie, CRE, VRE, MRSA or C. difficile). In non-ICUs, the bioburden before treatment was at least 500 CFU/100 cm2, with >50% of sites being contaminated with a pathogen. After successive applications of the surface coating, total aerobic bacteria were reduced by >80% in the ICUs and >40% in the non-ICUs. Similarly, the incidence of pathogen-positive sites was reduced by at least 50% in both ICUs and non-ICUs. Conclusions: The use of a continuously active antimicrobial surface coating provides a significant (P < .01) and sustained reduction in aerobic bacteria while also reducing the occurrence of epidemiologically important pathogens on frequently touched surfaces in patient rooms. These findings support the use of novel antimicrobial technologies as an additional layer of protection against the transmission of potentially harmful bacteria from contaminated surfaces to patients.Funding: Allied BioScience provided Funding: for this study.Disclosures: Valerie Beck reports salary from Allied BioScience.

Healthcare Settings

2019 ◽  
pp. 341-362 ◽  
Author(s):  
Bryan E. Christensen ◽  
Ryan P. Fagan
Keyword(s):  
Urinary Tract ◽  
Respiratory Tract ◽  
Medical Devices ◽  
Disease Transmission ◽  
Healthcare Setting ◽  
Healthcare Settings ◽  
Outbreak Investigations ◽  
Mode Of Transmission ◽  
Healthcare Associated ◽  
General Community

Healthcare-associated infections (e.g., bloodstream, respiratory tract, urinary tract, or surgical site) can be common in patients. Patients receiving acute and chronic healthcare across various settings, such as hospitals, dialysis clinics, and nursing homes, tend to have comorbidities that make them more susceptible to infection than their counterparts in the general community. Also, some pathogens may be more likely to cause infection in healthcare settings because of the unique exposures that patients can experience, such as invasive procedures or indwelling medical devices. Similar to community outbreak investigations, the primary purpose of an investigation in a healthcare setting is to determine the source of the outbreak, define mode of transmission, disrupt disease transmission, and prevent further transmission.

Clostridioides difficile and Norovirus

2019 ◽  
pp. 123-140
Author(s):  
Thomas J. Sandora
Keyword(s):  
Diagnostic Methods ◽  
Direct Patient Care ◽  
Infectious Dose ◽  
Environmental Cleaning ◽  
Healthcare Settings ◽  
Clostridioides Difficile ◽  
Contaminated Food ◽  
Clinically Significant ◽  
Healthcare Associated ◽  
Pediatric Healthcare

Clostridioides difficile and norovirus are common causes of healthcare-associated gastroenteritis and both organisms cause outbreaks in pediatric healthcare settings. The spores are resistant to routine environmental cleaning with detergents and can survive in the environment for months. C. difficile can easily be transmitted on the hands of healthcare workers, either from direct patient care activities or through contact with a contaminated environment. Norovirus is highly contagious, with an estimated infectious dose as low as 18 viral particles. Transmission occurs either person-to-person or through ingestion of contaminated food and water. This chapter outlines strategies to prevent transmission of healthcare-associated C. difficile and norovirus infections. It includes recommendations for surveillance, isolation, hand hygiene, environmental cleaning and removal of isolation precautions. Diagnostic methods are reviewed, highlighting the challenge of distinguishing between colonization and clinically significant C. difficile infection in young children.

scholarly journals Risk of Hospital-Onset C. difficile Infection Increases With Prior Inpatient and Outpatient Visits

2020 ◽  
Vol 41 (S1) ◽  
pp. s78-s79
Author(s):  
Aaron Miller ◽  
Alberto Segre ◽  
Daniel Sewell ◽  
Sriram Pemmaraju ◽  
Philip Polgreen
Keyword(s):  
Substance Abuse ◽  
Nursing Home ◽  
Long Term Care ◽  
Prior Exposure ◽  
Term Care ◽  
Healthcare Settings ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Healthcare Associated

Background:Clostridioides difficile is a leading cause of healthcare-associated infections, and greater healthcare exposure is a primary risk factor for Clostridioides difficile infection (CDI). Longer hospital stays and greater CDI pressure, both at the hospital level and the level, have been linked to greater risk. In addition, symptoms associated with healthcare-associated CDI often do not present until a patient has been discharged. Our study objective was to estimate the extent to which exposure to different types of healthcare settings (eg, prior hospitalization, emergency department [ED], outpatient or long-term care) increase risk for hospital-onset CDI. Methods: We conducted a case-control study using the Truven Marketscan Commerical Claims and Medicare Supplemental databases from 2001 to 2017. Case patients were selected as all inpatient visits with a secondary diagnosis of CDI and no previous CDI diagnosis in the prior 90 days. Controls were selected from all inpatient admissions without any CDI diagnosis during the current admission or prior 90 days. A logistic regression model was used to estimate risk associated with prior healthcare exposure. Indicators were created for prior exposure to different healthcare settings: separate indicators were used to indicate transfer, exposure to that setting in the prior 1–30 days, 31–60 days and 61–90 days. Separate indicators were created for prior hospitalization, ED, outpatient clinic, nursing home or long-term care facilities (LTCFs), psychiatric or substance-abuse facility or other outpatient facility. We also included an indicator for prior exposure to a family member with CDI and prior outpatient antibiotics. Results: Estimates for selected variables (odds ratios) are presented in Table 1. Prior hospitalization, ED visits, outpatient clinics, nursing home and LTCFs were all associated with increased risk of secondary diagnosed CDI. Prior hospitalization and nursing home/LTCF conveyed the greatest risk. In addition, a ‘dose-–response’ relationship occurred for each of these exposure settings, with exposure nearest the admission date having the largest risk. Prior exposure to psychiatric , substance abuse, or other outpatient facilities were not risk factors for CDI. Having a family member with prior CDI and both low-risk and high-risk outpatient antibiotics were associated with increased risk. These factors also exhibited a ‘dose–response’ pattern. Conclusions: Exposure to various healthcare settings significantly increased risk for secondary CDI. Prior healthcare exposures occurring nearest to the point of admission conveyed the greatest risk. These results suggest that many hospital-associated CDI cases attributed to a current hospital stay may actually be acquired from prior healthcare settings.Funding: CDC Modeling Infectious Diseases (MInD) in Healthcare NetworkDisclosures: None

scholarly journals Evaluation of Novel “No-Touch” Technologies for Decontamination of Toys in Pediatric Healthcare Settings

2020 ◽  
Vol 41 (S1) ◽  
pp. s229-s229
Author(s):  
Hanan Haydar ◽  
Jessica Kumar ◽  
Jennifer Cadnum ◽  
Claudia Hoyen ◽  
Curtis Donskey
Keyword(s):  
Healthcare Facility ◽  
Ease Of Use ◽  
Candida Auris ◽  
Healthcare Settings ◽  
Clostridioides Difficile ◽  
Ultraviolet C ◽  
Submicron Droplets ◽  
High Level ◽  
Healthcare Associated ◽  
Pediatric Healthcare

Background: Toys in playrooms are often shared among patients in pediatric healthcare settings; they can present a risk for transmission of bacterial and viral pathogens. Effective cleaning and disinfection of toys using disinfectant wipes is labor intensive and difficult due to irregular surfaces. Methods: We conducted a point-prevalence culture survey to determine the frequency of contamination of in-use toys and high-touch surfaces in playrooms in a pediatric healthcare facility with methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Clostridioides difficile. Using a variety of toys inoculated with pathogens, we evaluated efficacy and ease-of-use of 3 novel “no-touch” technologies: (1) an electrostatic sprayer, (2) a small ultraviolet-C (UV-C) box (18.9 × 9.9 × 1.8 inches) for smaller toys, and (3) a high-level disinfection cabinet using ultrasonic submicron droplets of peracetic acid and hydrogen peroxide. Test pathogens included C. difficile, MRSA, and Candida auris. Results: Of 135 items cultured in playrooms, 6 (4.4%) were contaminated with MRSA, 1 (0.7%) was contaminated with VRE, and none were contaminated with C. difficile. Each of the technologies reduced all pathogens by >4 log10 CFU on all types of toys tested (plastic, soft rubber, and tablet). The electrostatic sprayer was considered the easiest to use by all users because large numbers of toys could be processed much more quickly (ie, spray for 20 seconds and allow to air dry) than with disinfectant wipes. The disinfection cabinet required 21 minutes for cycle completion, whereas the decontamination cycle for the UV box was only 30–90 seconds but with limited capacity to hold toys. Conclusions: Three “no-touch” technologies were effective for disinfection of toys contaminated with healthcare-associated pathogens. The electrostatic spray application of disinfectant was considered the easiest to use for rapid decontamination of toys.Funding: NoneDisclosures: None

Evaluating the sustained effectiveness of a multimodal intervention aimed at influencing PIVC insertion practices in the emergency department

2020 ◽  
Vol 37 (7) ◽  
pp. 444-449
Author(s):  
Zheng Jie Lim ◽  
Daniel Nagle ◽  
Fern McAllan ◽  
Radha Ramanan ◽  
Claire Dendle ◽  
...  
Keyword(s):  
Improve Patient Safety ◽  
Healthcare Personnel ◽  
Post Intervention ◽  
Healthcare Settings ◽  
Sustained Effect ◽  
Sustained Reduction ◽  
Before And After ◽  
Long Term Follow Up

IntroductionMultimodal interventions (MMI) are frequently used in various healthcare settings to encourage change in healthcare personnel practices and improve patient safety. In 2013, an MMI conducted in an Australian metropolitan ED used clinician champions, guidelines, education sessions and promotional materials to encourage a reduction in unused and inappropriate peripheral intravenous cannulas (PIVC). A 60-day postintervention demonstrated a successful reduction in the number of unused PIVCs without changes in appropriate insertions. We aimed to investigate if this MMI produced a sustained effect in reducing the frequency of unused PIVCs inserted in this ED.MethodsA single-centre retrospective cohort study of adult patients presenting to the above ED in Victoria, Australia, was conducted in April 2018. A random sample of 380 patients with a PIVC inserted in ED was assessed to determine if the PIVC was used (termed ‘Long-term follow-up’). The appropriateness of unused PIVCs was assessed. Our findings were compared with previously collected data in 2013 (‘Pre-Intervention’ and ‘Immediately Post-Intervention’) to determine a sustained reduction in the frequency of unused PIVC insertions was achieved. Long-term analysis of the MMI, including the overall frequency of PIVC insertions in ED before and after the MMI, was also collected.ResultsIn our Long-term follow-up cohort, 101 of 373 (27.1%, 95% CI 22.6% to 31.9%) PIVCs were unused (seven cases excluded). This was significantly lower than the Pre-Intervention cohort (139/376, 37.0%, 95% CI 32.1% to 42.1%). While not significant, the frequency of unused PIVCs in the Post-Intervention cohort was lower in comparison (73/378, 19.3%, 95% CI 15.4% to 23.7%). No significant change in the appropriateness of unused PIVCs was observed between the Post-Intervention and Long-term follow-up. The overall proportion of patients receiving a PIVC has remained low since the MMI.ConclusionAn MMI aimed at reducing unused PIVC insertions in ED has been effective in eliciting sustained change. Unused but appropriately inserted PIVCs seem unaffected by the intervention.

scholarly journals Effects of Antibiotic Cycling Policy on Incidence of Healthcare-Associated MRSA and Clostridioides difficile Infection in Secondary Healthcare Settings

2019 ◽  
Vol 25 (1) ◽  
pp. 52-62 ◽  
Author(s):  
Geraldine Mary Conlon-Bingham ◽  
Mamoon Aldeyab ◽  
Michael Scott ◽  
Mary Patricia Kearney ◽  
David Farren ◽  
...  
Keyword(s):  
Healthcare Settings ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Antibiotic Cycling ◽  
Healthcare Associated

Pathogens Spread via Respiratory Route

2019 ◽  
pp. 1-30
Author(s):  
Claudette Poole ◽  
Ann-Christine Nyquist
Keyword(s):  
Disease Transmission ◽  
Respiratory Infections ◽  
Healthcare Setting ◽  
Healthcare Personnel ◽  
Post Exposure Prophylaxis ◽  
Respiratory Pathogens ◽  
Healthcare Settings ◽  
Hands On ◽  
Exposure Prophylaxis ◽  
Healthcare Associated

This chapter covers common and epidemiologically significant pediatric respiratory pathogens, and provides recommendations for preventing transmission in the healthcare setting. Respiratory infections in children are one of the most common reasons for evaluation by a healthcare provider in all healthcare settings. These infections pose significant challenges for infection prevention and contribute to the burden of healthcare-associated infections (HAIs). In addition, family members, who may be less aware about disease transmission, provide direct hands-on care for their children while hospitalized, and then move freely throughout the hospital. Strategies for post-exposure prophylaxis are described for pertussis, varicella, measles, and influenza. Special considerations for pregnant and breastfeeding women are described, with an emphasis on healthcare personnel.

scholarly journals Application of a Continuously Active Antimicrobial Surface Coating in Two Professional Sports Training Facilities

2020 ◽  
Vol 41 (S1) ◽  
pp. s440-s440
Author(s):  
Gavriel Grossman ◽  
Valerie Beck ◽  
Dan Watson ◽  
Ece Toklu ◽  
Maha El-Sayed
Keyword(s):  
Treatment Period ◽  
Surface Coating ◽  
Professional Sports ◽  
Surface Contamination ◽  
Sports Training ◽  
Before And After ◽  
Plate Counts ◽  
Healthcare Associated ◽  
Occupancy Rates ◽  
The Impact

Background: The role of surface contamination in infections is of interest in healthcare as well as other industries, especially where infections incur high cost. One such industry is professional sports, where infections pose significant risks to players and the organizations that employ them. Sports training facilities experience highly variable occupancy rates due to differing seasonal activities, presenting a measurement challenge because the relationship between occupancy and surface contamination is not well described. In a recent publication, a continuously active antimicrobial (CAA) surface coating demonstrated a reduction in bacterial bioburden in ICUs alongside a reduction in healthcare-associated infections (HAIs). Objective: We investigated the impact of a CAA surface coating on bioburden in 2 professional sports training facilities, despite changes in occupancy. Methods: A CAA surface coating was applied using an electrostatic sprayer to all surfaces in both facilities during a period of high-occupancy at facility A and during low occupancy at facility B. Surface cultures were taken using 3M Sponge-Sticks from lockers, gym equipment, and physiotherapy surfaces before treatment, 4–13 weeks after treatment at facility A and 4–23 weeks after treatment at facility B. Total aerobic bacteria counts were obtained by plating on tryptic soy agar, and geometric means of aerobic plate counts (APCs) were used to compare bioburden before and after treatment at both facilities and for an out-of-efficacy period at facility B (17–23 weeks). Occupancy rates were monitored as person days per week (pd/w) over the course of the study. Results: APC counts at facility A decreased 61% (585 CFU/100 cm2 to 226 CFU/100 cm2) from baseline to posttreatment, and occupancy remained constant (165 pd/w to 171 pd/w). At facility B, there was no significant change in APC (76 CFU/100 cm2 to 80 CFU/100 cm2), although occupancy increased >13,000% during the treatment period (3 pd/w to 386 pd/w). During the out-of-efficacy period at facility B, total bacteria increased 170% (217 CFU/100 cm2) compared to the treatment period, and the occupancy remained relatively constant (344 pd/w). Conclusions: Levels of bioburden were significantly influenced by the application of the CAA surface coating, especially considering the variation in occupancy in both facilities before, during, and after the efficacy period. Facility A saw a significant reduction in bioburden during the treatment period (P < .0001), and a significant increase was observed at facility B during the out-of-efficacy period (P < .0001) despite constant occupancy rates, demonstrating the ability of the surface coating to reduce bioburden levels despite large changes in occupancy.Funding: Allied BioScience, Inc, provided Funding: for this study.Disclosures: Gavri Grossman, Valerie Beck, and Daniel S Watson report salary from Allied BioScience.

Epidemiology of Healthcare-Associated Bloodstream Infection Caused by USA300 Strains of Methicillin-ResistantStaphylococcus aureusin 3 Affiliated Hospitals

2009 ◽  
Vol 30 (3) ◽  
pp. 233-241 ◽  
Author(s):  
Timothy C. Jenkins ◽  
Bruce D. McCollister ◽  
Rohini Sharma ◽  
Kim K. McFann ◽  
Nancy E. Madinger ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Methicillin Resistance ◽  
Healthcare Setting ◽  
Safety Net ◽  
Dominant Factor ◽  
Healthcare Settings ◽  
Safety Net Hospital ◽  
Strain Type ◽  
Independent Risk Factors ◽  
Healthcare Associated

Objective.To describe the epidemiology of bloodstream infection caused by USA300 strains of methicillin-resistantStaphylococcus aureus(MRSA), which are traditionally associated with cases of community-acquired infection, in the healthcare setting.Design.Retrospective cohort study.Setting.Three academically affiliated hospitals in Denver, Colorado.Methods.Review of cases of S.aureusbloodstream infection during the period from 2003 through 2007. Polymerase chain reaction was used to identify MRSA USA300 isolates.Results.A total of 330 cases of MRSA bloodstream infection occurred during the study period, of which 286 (87%) were healthcare-associated. The rates of methicillin resistance among theS. aureusisolates recovered did not vary during the study period and were similar among the 3 hospitals. However, the percentages of cases of healthcare-associated MRSA bloodstream infection due to USA300 strains varied substantially among the 3 hospitals: 62%, 19%, and 36% (P< .001) for community-onset cases and 33%, 3%, and 33% (P= .005) for hospital-onset cases, in hospitals A, B, and C, respectively. In addition, the number of cases of healthcare-associated MRSA bloodstream infection caused by USA300 strains increased during the study period at 2 of the 3 hospitals. At each hospital, USA300 strains were most common among cases of community-associated infection and were least common among cases of hospital-onset infection. Admission to hospital A (a safety-net hospital), injection drug use, and human immunodeficiency virus infection were independent risk factors for healthcare-associated MRSA bloodstream infection due to USA300 strains.Conclusions.The prevalence of USA300 strains among cases of healthcare-associated MRSA bloodstream infection varied dramatically among geographically clustered hospitals. USA300 strains are replacing traditional healthcare-related strains of MRSA in some healthcare settings. Our data suggest that the prevalence of USA300 strains in the community is the dominant factor affecting the prevalence of this strain type in the healthcare setting.

scholarly journals Basic life support training with high schools’ teachers in Bahia, Brazil: an experimental study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
T Vivas ◽  
M Duarte ◽  
V Puschel ◽  
H Oliveira ◽  
P Sales ◽  
...  
Keyword(s):  
High School Teachers ◽  
Primary Healthcare ◽  
Basic Life Support ◽  
Life Support ◽  
Health Workers ◽  
Healthcare Setting ◽  
Practical Skill ◽  
Healthcare Settings ◽  
Before And After ◽  
The Mean

Abstract Background Early performing of cardiopulmonary resuscitation is the cornerstone of survival in out-of-hospital cardiac arrest, doubling the odds of survival when correctly performed. The American Heart Association and the European Resuscitation Council advocate for training the entire population in order to enable a quick and effective response to out-of-hospital cardiac arrests, improving its outcomes. In primary healthcare settings the health workers can act as trainers, using the family and territorial approach to deliver basic life support (BLS) basis to general population, assuring that key social actors are skilled enough to aid community when needed. This study aims to compare the knowledge and practice skill of high school teachers before and after a BLS training delivered by health workers and students in a primary healthcare setting. Methods Teachers of three public high schools in Bahia, Brazil were assessed by a test for theoretical and practical skill in BLS and then trained by a group of primary care workers and students. Training included a 20min lecture and 40min practice session in a simulated scenario. After the training the teachers were assessed with the same test for theoretical and practical skill. A paired-samples T test was used to detect the difference in the mean total score before and after the training, with a significance level of 0.05 (two-sided test) and 95% confidence interval. Results The mean total score after the BLS training (8.2 ± 1.5) was significantly higher (p &lt; 0.000) from before training (4.5 ± 1.7). Conclusions The high school teachers were unable to deliver proper cardiopulmonary resuscitation before the intervention. Following a BLS training a significant immediate improvement in the knowledge and practical skill was detected. Health workers were able to achieve these results in a primary healthcare setting. Further studies should assess this outcome with larger samples, evaluating the retention of knowledge and skills provided. Key messages Basic life support training can be delivered to general population by health workers in primary healthcare settings in order to improve the outcomes to out-of-hospital cardiac arrests. Teachers and health workers can act as key actors in intersetorial health-education initiatives, promoting the health of their communities.

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