Reducing Biofilm Infections in Burn Patients’ Wounds and Biofilms on Surfaces in Hospitals, Medical Facilities and Medical Equipment to Improve Burn Care: A Systematic Review

Biofilms in burns are major problems: bacterial communities rapidly develop antibiotic resistance, and 60% of burn mortality is attributed to biofilms. Key pathogens are Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and multidrug-resistant Acinetobacter baumanii. Purpose: identify current and novel interventions to reduce biofilms on patients’ burns and hospital surfaces and equipment. Medline and Embase were searched without date or language limits, and 31 possible interventions were prioritised: phages, nano-silver, AgSD-NLs@Cur, Acticoat and Mepilex silver, acetic acid, graphene-metal combinations, CuCo2SO4 nanoparticles, Chlorhexidene acetate nanoemulsion, a hydrogel with moxifloxacin, carbomer, Chitosan and Boswellia, LED light therapy with nano-emodin or antimicrobial blue light + Carvacrol to release reactive oxygen species, mannosidase + trypsin, NCK-10 (a napthalene compound with a decyl chain), antimicrobial peptide PV3 (includes two snake venoms), and polypeptides P03 and PL2. Most interventions aimed to penetrate cell membranes and reported significant reductions in biofilms in cfu/mL or biofilm mass or antibiotic minimal inhibitory concentrations or bacterial expression of virulence or quorum sensing genes. Scanning electron microscopy identified important changes in bacterial surfaces. Patients with biofilms need isolating and treating before full admission to hospital. Cleaning and disinfecting needs to include identifying biofilms on keyboards, tablets, cell phones, medical equipment (especially endoscopes), sinks, drains, and kitchens.

Ultraviolet C lamps for disinfection of surfaces potentially contaminated with SARS-CoV-2 in critical hospital settings: examples of their use and some practical advice

Background UltraViolet-C (UV-C) lamps may be used to supplement current hospital cleaning and disinfection of surfaces contaminated by SARS-CoV-2. Our aim is to provide some practical indications for the correct use of UV-C lamps. Methods We studied three UV-C lamps, measuring their spatial irradiance and emission over time. We quantify the error that is committed by calculating the irradiation time based exclusively on the technical data of the lamps or by making direct irradiance measurements. Finally, we tested specific dosimeters for UV-C. Results Our results show that the spatial emission of UV-C lamps is strongly dependent on the power of the lamps and on the design of their reflectors. Only by optimizing the positioning and calculating the exposure time correctly, is it possible to dispense the dose necessary to obtain SARS-CoV-2 inactivation. In the absence of suitable equipment for measuring irradiance, the calculated irradiation time can be underestimated. We therefore consider it precautionary to increase the calculated times by at least 20%. Conclusion To use UV-C lamps effectively, it is necessary to follow a few simple precepts when choosing, positioning and verifying the lamps. In the absence of instruments dedicated to direct verification of irradiance, photochromic UV-C dosimeters may represent a useful tool for easily verifying that a proper UV-C dose has been delivered.

Knowledge, attitudes and practices of hospital cleaning services staff towards Coronavirus Disease-2019 (COVID-19) in a Middle Eastern country: A web-based cross-sectional study

Background Hospital cleaners are the unsung heroes in the fight against the COVID-19 pandemic. This study aims to assess the knowledge, attitudes, and practices (KAP) of hospital cleaners towards COVID-19 and to determine factors associated with good practices. Methods A cross-sectional study was conducted in Lebanon between 1st and 14th November 2020. Data was collected through an online survey that was sent to governmental-run and private hospitals. The questionnaire consisted of socio-demographic characteristics, clinical information, and KAP of hospital cleaners towards Covid-19. The collected data was exported to SPSS for analysis. The relation between nominal variables was tested using the chi-squared test. The variables in bivariate analysis with p-value<0.2 were entered into multivariable logistic regression. Adjusted odds ratio and their 95% confidence intervals were reported. The level of statistical significance was set at a p-value < 0.05. Results A total of 453 cleaners completed the survey of which 54.3% were females. Most of the participants had a good level of COVID-19 knowledge (98%) and good preventive practices (89.7%). Regarding attitude, 90.7% had a positive attitude toward health facilities, 78.8% towards cleaning and disinfection, and 73.5% towards health authorities. Sociodemographic characteristics including younger age, higher levels of education, working in private hospitals, and having more than 3 years of experience were positively associated with good preventive practices. Our results also showed that participants with good knowledge about COVID-19, COVID-19 prevention and treatment, cleaning and disinfection process, and COVID-19 risk factors had a higher likelihood of positive preventive practices. Finally, a positive attitude towards health facilities, health authorities, and cleaning and disinfection were positively associated with good practices. Conclusion Our results indicate that cleaners have a high level of knowledge, expressed positive attitudes towards health facilities and health authorities, and good preventive practices. Understanding the determinants of cleaning performance is critical in tailoring interventions to improve hospital cleaning.

An UV disinfection robot combined cleaning and housekeeping strategy for the hospital during COVID-19 pandemic: How we protect the hospital cleaning staff?

Background The Coronavirus Disease 2019 (COVID-19) pandemic presents important infection control challenges for the health care facilities. Proper cleaning of the patient's room after the discharge of the patients is important to protect the housekeeping staff as well as other patients Methods In this study, we reviewed our experience with a novel multipurpose hybrid UV disinfecting and air disinfecting robot and the impact of it for preventing hospital cleaners getting occupational COVID-19 infection. Results Between 11, March 2020 and 11 December 2020, a total of 301 children with COVID-19 were hospitalized at the COVID-19 ward. The mean hospital stay was 3.77 ± 2.71 days (range from1 to 20 days) and total COVID-19 related-care. The mean working time was 9.4 ± 1.6 months (range 5 to 10 months). The total working hours for a month for one hospital cleaner was 196 to 204 hours per month. The total duration of the UVC-robot was 491 hours 33 minutes for fans and 473 hours 20 minutes for UV lamps. During the follow-up period, two of the hospital cleaners had definitively community-acquired COVID-19 infection, but none of them had symptomatic COVID-19 infection during the study period. Conclusions During the COVID-19 pandemic, none of the hospital cleaners got hospital-associated COVID-19 infection. The combination of personal protective equipment in addition to UVC-robot integrated environmental disinfection is an important strategy to protect health-care workers.

An investigation on the contamination of microorganisms on privacy curtains in hospital

Background: The occurrence of nosocomial infection(NI) is closely related to the environment. As an important part of hospital environment, the contamination of privacy curtain by microorganism is an important factor of NI.Methods: 360 samples of privacy curtains were sampled and distributed in common ward (CW) and Intensive Care Unit (ICU). Each curtain had three sampling heights, which were 100cm, 150cm and 200cm away from the ground. The samples were collected by cotton swab method and cultured in incubator for 48h.Results: The contamination rate of curtain in CW was 48.89%, higher than that in ICU ( P < 0.05). The contamination rate of samples at 3 months frequency was higher than that at 1 month frequency ( P <0.05).The contamination rate of the curtains in CW and ICU at the frequency of 1 month was lower than that at the frequency of 3 months ( P <0.05). In this two cleaning frequency，the contamination rate of curtains with a height of 200cm was lower than that of samples with a height of 150cm and 100cm. The main microorganisms on privacy curtains were coagulase negative Staphylococcus.Conclusion : The contamination rate of sampling in ICU is lower than that in CW. The contamination in the higher position of the curtain is less than that in the lower part. It can reduce the contamination of microorganisms on the curtain and save the cost of hospital cleaning by removing the curtain in sections and cleaning regularly.

Ultraviolet disinfection robots to improve hospital cleaning: Real promise or just a gimmick?

The global COVID-19 pandemic due to the novel coronavirus SARS-CoV-2 has challenged the availability of traditional surface disinfectants. It has also stimulated the production of ultraviolet-disinfection robots by companies and institutions. These robots are increasingly advocated as a simple solution for the immediate disinfection of rooms and spaces of all surfaces in one process and as such they seem attractive to hospital management, also because of automation and apparent cost savings by reducing cleaning staff. Yet, there true potential in the hospital setting needs to be carefully evaluated. Presently, disinfection robots do not replace routine (manual) cleaning but may complement it. Further design adjustments of hospitals and devices are needed to overcome the issue of shadowing and free the movement of robots in the hospital environment. They might in the future provide validated, reproducible and documented disinfection processes. Further technical developments and clinical trials in a variety of hospitals are warranted to overcome the current limitations and to find ways to integrate this novel technology in to the hospitals of to-day and the future.

The Inactivation of SARS-CoV-2 in Critical Hospital Settings by Means of Ultraviolet C Lamps: Examples of Their Use and Some Practical Advice

Background UltraViolet-C (UV-C) lamps may be used to supplement current hospital cleaning and disinfection of surfaces contaminated by SARS-CoV-2. Our aim is to provide some practical indications for the correct use of UV-C lamps. Methods We studied three UV-C lamps, measuring their spatial irradiance and emission over time. We quantify the error that is committed by calculating the irradiation time based exclusively on the technical data of the lamps or by making direct irradiance measurements. Finally, we tested specific dosimeters for UV-C. Results Our results show that the spatial emission of UV-C lamps is strongly dependent on the power of the lamps and on the design of their reflectors. Only by optimizing the positioning and calculating the exposure time correctly, is it possible to dispense the dose necessary to obtain SARS-CoV-2 inactivation. In the absence of suitable equipment for measuring irradiance, the calculated irradiation time can be underestimated. We therefore consider it precautionary to increase the calculated times by at least 20%. Conclusion To use UV-C lamps effectively, it is necessary to follow a few simple precepts when choosing, positioning and verifying the lamps. In the absence of instruments dedicated to direct verification of irradiance, photochromic UV-C dosimeters may represent a useful tool for easily verifying that a proper UV-C dose has been delivered.

Resiliência no trabalho e fatores associados em trabalhadores do serviço hospitalar de limpeza

Objetivo: Analisar a resiliência no trabalho e os fatores associados em trabalhadores do Serviço Hospitalar de Limpeza de um Hospital Universitário do Sul do Brasil. Método: Estudo transversal, desenvolvido com 149 trabalhadores terceirizados de um Hospital Universitário do Rio Grande do Sul, Brasil. Os dados foram coletados por meio de um questionário de caracterização sociodemográfica, laboral, de saúde e a Resilience at Work Scale – Brasil 25. Realizou-se análise descritiva e inferencial. Considerou-se associação significativa quando p<0,05. Resultados: Os trabalhadores do Serviço Hospitalar de Limpeza possuem média resiliência no trabalho (78,9 ± 11,5). Dos fatores avaliados, a realização de treinamento sobre riscos ergonômicos, mostrou-se associada com o maior nível de resiliência no trabalho (p=0,028). Conclusões: Os trabalhadores capacitados executam as suas funções com conhecimento e segurança, repercutindo em melhorias no processo de adaptação à situações adversas no trabalho. O desenvolvimento de estratégias, individuais, coletivas e de gestão, para a promoção da resiliência e saúde no intuito de favorecer ambientes saudáveis no trabalho, são importantes.Descritores: Enfermagem; Saúde do Trabalhador; Resiliência; Serviço Hospitalar de Limpeza. Resilience at work and associated factors in hospital cleaning service workersObjective: To analyze resilience at work and associated factors among workers in the Hospital Cleaning Service of a University Hospital in southern Brazil. Methodo: Cross-sectional study, developed with 149 outsourced workers from a University Hospital in Rio Grande do Sul, Brazil. The data were collected through a questionnaire of sociodemographic, occupational, health and Resilience at Work Scale - Brasil 25. Descriptive and inferential analysis was carried out. A significant association was considered when p<0,05. Results: Hospital Cleaning Service workers have a medium resilience at work (78.9 ± 11.5). Of the factors evaluated, training on ergonomic risks was shown to be associated with a higher level of resilience at work (p = 0.028). Conclusion: Trained workers perform their duties with knowledge and safety, resulting in improvements in the process of adapting to adverse situations at work. The development of strategies, individual, collective and management, to promote resilience and health in order to favor healthy environments at work, are important.Descriptors: Nursing; Worker's Health; Resilience; Hospital Cleaning Service. Resiliencia en el trabajo y factores asociados en trabajadores del servicio de limpieza hospitalariaObjetivo: Analizar la resiliencia en el trabajo y los factores asociados entre los trabajadores del Servicio de Limpieza de Hospitales de un Hospital Universitario en el sur de Brasil. Método: Estudio transversal, desarrollado con 149 trabajadores subcontratados de un Hospital Universitario en Rio Grande do Sul, Brasil. Los datos se recolectaron a través de un cuestionario de escala sociodemográfica, ocupacional, de salud y de Resilience at Work Scale - Brasil 25. Se realizó un análisis descriptivo e inferencial. Se consideró una asociación significativa cuando p<0,05. Resultados: Los trabajadores del Servicio de Limpieza de Hospitales tienen una resistencia media en el trabajo (78.9 ± 11.5). De los factores evaluados, la capacitación sobre riesgos ergonómicos se asoció con un mayor nivel de resiliencia en el trabajo (p = 0,028). Conclusión: Los trabajadores capacitados realizan sus tareas con conocimiento y seguridad, lo que resulta en mejoras en el proceso de adaptación a situaciones adversas en el trabajo. Es importante el desarrollo de estrategias, individuales, colectivas y de gestión, para promover la resiliencia y la salud a fin de favorecer entornos saludables en el trabajo.Descriptores: Enfermería; Salud del Trabajador; Resistencia; Servicio de Limpieza Hospitalaria.