Poster Abstracts / American Journal of Infection Control 41 (2013) S25-S145S42

cases of SSIs. An intervention was planned to decrease SSIs in CSpatients by adding pre-op bathing with CHG to the operativeprotocol.METHODS: Our hospital is a tertiary medical center performingover 500 CSs per year. On March 1, 2012, after education, preop-erative bathing with 2% chlorhexidine gluconate (CHG) impreg-nated wipes was started for scheduled CS patients. The wipes wereused on the patient’s abdominal operative area as well as the armsand hands in order to prevent recontamination. Documentationwas completed on the pre-op checklist in the electronic healthrecord. CS infections were captured by physicians completinga monthly questionnaire to report all CS infections that occurredwithin 30 days of the procedure.RESULTS: In the prior eight months we had 8 infections in 393procedures (rate 2.0). In the eight months after the interventionwehad 2 infections in 375 procedures (rate 0.53) p¼ 0.06. Compliancewith the preoperative bathing protocol was 85%.CONCLUSIONS: The use of 2% CHG pre-op bathing was effective inreducing the CS infection rate in this limited time period. Using theCHG wipes removed gross contamination and also provided pro-longed antibacterial effect which further reduced the level of thepatient’s own skin flora. Due to the success in decreasing infectionrates this protocol was extended to the unscheduled CS patientsas well.

Presentation Number 2-272Visualization of Clinically Relevant Bacteria DuringExposure to Disinfectants

Dean Swift BSc, BEd, FADM, Cert. Tox, Technical Director,Biolennia Laboratories; Deanna Del Re, Scientist - Microbiology,Biolennia Laboratories; Kruti Dhyani, Scientist, BiolenniaLaboratories; Richard Mair, Micrylium Laboratories;Milos Legner,University of Toronto; Dennis Cvitkovitch, University of Toronto

BACKGROUND/OBJECTIVES: Microbial biofilms play a major role inthe progression of infection and have been shown to be moredifficult to eradicate than planktonic cells. In a clinical setting,surface disinfection represents one of the primary means by whichthe spread of infection is minimized. With a wide variety of prod-ucts available, it can prove difficult for the clinician to determinewhich is most effective for their needs. The main objective of thisstudy was to directly visualize the effect of commercially availabledisinfectants on clinically relevant biofilms to determine theirefficacy.METHODS: Biofilms of Pseudomonas aeruginosa MPAO1, andclinical isolates of Escherichia coli and Staphylococcus aureus weregrown at 37�C for 48hr in 6-chamber flow cells. Following incu-bation, the biofilms were stained with BacLight Live/Dead stainfor 15min. Various disinfectants, including those commerciallyavailable, were injected through each flow cell, using PBS asa control. Starting before exposure to the disinfectants, images ofthe biofilm cells were captured using a fluorescence microscopewith the appropriate emission filters every 5 seconds for 2 minutes,followed by every 30 seconds for an additional 10 minutes. Imagesfrom each of the fluorescence channels were merged to generatea composite image showing proportions of live vs. dead cells overthe course of exposure. All experiments were performed induplicate.

APIC 40th Annual Conference j Ft L

RESULTS: Each of the disinfectants showed different efficaciesagainst the test strains. The ethanol-based products appeared to bethe most effective, with cells appearing to be dead in as little as 5seconds after exposure. Products containing quaternary ammo-nium compounds were the least effective, with little to no changein cell survival after 12 minutes. Peroxide products exhibited somecell death by the end of the exposure period, but the effects weremuch slower compared to the alcohol-based products.CONCLUSIONS: The results of this study demonstrate that differentdisinfectants exhibit varying degrees of effectiveness in killingbiofilm cells. This is the first study that has undertaken the task ofdirectly visualizing bacterial biofilms during the course of exposureto disinfectants. Results from this study will provide furtherknowledge into how disinfectants act on biofilms, thereby leadingto more effective infection control strategies.

Presentation Number 2-273Effectiveness of Eliminating Acinetobacterbaumannii through Environmental Cleaning

C. Marie Dalton RN, Infection Control Preventionist, UPMC Mercy;Julliet Ferrelli MS, MT(ASCP), CIC, Infection Control Coordinator,UPMC Mercy; Jamie Price RN, BSN CCRN, UPMC Mercy; ConnieHenry RN, BSN, UPMC Mercy; Frank Ricci RN, MSN, CCRN, UPMCMercy; Susan M. Fejka MLS(ASCP)CM, Lead MicrobiologyLaboratory Technologist, UPMC Mercy; Rahman S. Hariri PhD.,MBA, Director of Microbiology/Immunology, UPMC Mercy;Mohamed H. Yassin MD, PhD, Medical Director of InfectionControl, UPMC Mercy; Yohei Doi MD, PhD, University ofPittsburgh

BACKGROUND/OBJECTIVES: Acinetobacter baumannii (AB) isa Gram-negative coccobacillus that has emerged as an importantpathogen especially in Long-Term Care Facilities and Critical CareUnits. It is estimated that 60% of AB isolated are resistant tomultiple classes of antibiotics. Multi-drug resistant AB (MDR-AB)has been responsible for infection outbreaks in major hospitals. ABcan survive in both dry and moist areas for extended periods oftime. Contact isolation and adequate cleaning and disinfection areessential in preventing the spread of AB.METHODS: A study of environmental contamination in AB patientrooms included all Critical Care Units with patients who wereidentified with AB beginning June 1, 2012. The objective of thestudy was to evaluate the effectiveness of daily as well as terminalenvironmental disinfection using 0.55% sodium hypochloritewipes for prevention of AB transmission. Environmental surfaceswere swabbed upon discharge or transfer of an AB positive patientbefore and after terminal cleaning. Polywipe premoistenedsponge swabs were used to obtain the cultures. Sponges havea higher sensitivity and are able to culture larger surfacescompared to regular swabs. Kits, including a specimen bag withtwo sponges in pre labeled sterile containers and a lab slip weredistributed to the units for collection of samples. A single spongewas used to culture bed rails, infusion pump, and supply cart. Thesame contact points were sampled after terminal cleaning. Thesponge was placed back in the sterile container. The swabs werecultured using modified Leeds Acinetobacter selective medium(mLAM). Screening patients for AB is routinely done on admissionand weekly in the critical care units.

auderdale, FL j June 8-10, 2013

Poster Abstracts / American Journal of Infection Control 41 (2013) S25-S145 S43

RESULTS: A total of 38 samples were collected. Nineteen at the timeof discharge and nineteen after terminal cleaning were performed.Only one sample obtained at the time of discharge was positive. Nosamples were positive after terminal cleaning. No transmission ofAB was detected through admission and weekly cultures of thepatients concurrently on the units with the AB positive patients.CONCLUSIONS: The prevention of multidrug resistant Gramnegative rods (MDR GNR) especially AB is dependent on stricthand hygiene, appropriate isolation as well as effective environ-mental disinfection. Daily and terminal cleaning with 0.55%hypochlorite was effective in eliminating environmentalcontamination with AB.

Presentation Number 2-274Abstract Withdrawn

Presentation Number 2-275The Effect of Chlorhexidine as a Skin Antiseptics forBlood Culture Compared with Povidone-iodine

Min Hee Cho RN, Infection Control Nurse, Korea University GuroHospital; Hee Jin Cheong MD, Division of Infectious Diseases,Department of Internal Medicine, Korea University Medical College

BACKGROUND/OBJECTIVES: Blood culture contamination can leadto clinical misinterpretation and inappropriate treatment fol-lowed by unnecessary costs. Therefore, skin antiseptics to preventblood culture contamination are important. Povidone-iodine hasbeen used widely as a skin disinfectant performing blood culture.However it takes time to dry out and its color makes hard tovisualize superficial veins. We compared the blood contaminationrates of chlorhexidine as a skin antiseptics to that of povidone-iodine.METHODS: The study was conducted prospectively in an intensivecare unit of 850-bed tertiary care hospital located in southwesternSeoul, Korea. From Jul 2011 to Jan 2012, 2% alcoholic chlorhexidinewas introduced and applied for skin antiseptics and compliance of

Table 1TDC scores measured by hospital site and by location before and after terminal cleaning

Hospital Site Location Number of Surfaces TestedEnvironme

Monitoring Pr

1 Patient Rooms 96 N2 Patient Rooms 96 N3 Patient Rooms 140 Y4 Patient Rooms 180 Y5 (Phase 1) Patient Rooms 72 Y5 (Phase 2) Patient Rooms 160 Y6 (ATP) Patient Rooms 90 Y6 (CFUs) Patient Rooms 90 YAverages Patient Rooms (ATP only)1 Operating Rooms 100 N2 Operating Rooms 66 N3 Operating Rooms 208 N4 Operating Rooms 104 N5 (Phase 1) Operating Rooms 112 Y5 (Phase 2) Operating Rooms 80 Y6 (ATP) Operating Rooms 90 Y6 (CFUs) Operating Rooms 90 YAverages Operating Rooms (ATP only)

APIC 40th Annual Conference j Ft La

clinicians was investigated. Blood culture contamination rates werecompared with that of same period in 2010-2011, in which 10%povidone-iodine was used for skin disinfectant.RESULTS: The blood culture contamination rates were 1.2% (22/1,876) in 2% alcoholic chlorhexidine group and 2.1% (85/4,015) in 10%povidone-iodine era (p¼.01). Staphylococcus epidermidis (18, 81.8%)was the most common blood culture contaminants during studyperiod, followed by three Staphylococcus capitis and one Staphylo-coccus hominis. Six of nine clinicians (66.7%) replied that 2% alco-holic chlorhexidine was convenient to use for performing bloodculture due to short time to dry and its transparent color.CONCLUSIONS: Chlorhexidine would be superior skin disinfectantthan povidone-iodine for blood culture procedure with its lowercontamination rate and convenience for user.

Presentation Number 2-276A Multi-site Field Study Evaluating the Effectivenessof Terminal Cleaning in Patient and Operating Rooms

Marco Bommarito PhD, Lead Research Specialist, 3M InfectionPrevention Division; Dan J. Morse, Senior Biostatistical Specialist,3M Infection Prevention Division

BACKGROUND/OBJECTIVES: The objective of the study was tocompare the effectiveness of the terminal cleaning process inpatient and operating rooms, for six hospitals across the US. Todo so, we used ATP bioluminescence to measure theThoroughness of Disinfection Cleaning or TDC score as suggestedin the CDC Toolkit on Options for Evaluating EnvironmentalCleaning (http://www.cdc.gov/HAI/toolkits/Evaluating-Environmental-Cleaning.html).METHODS: Test plans for patient and operating rooms includedwell-known high touch surfaces. Surfaces were tested using a swabbased ATP test. ATP contamination levels in RLUs (Relative LightUnits) were determined using a hand-held luminometer. TDCscores were calculated as the number of clean surfaces / totalnumber of surfaces evaluated x 100. A surface was deemed cleanwhen the ATP level was

.

ntal Hygieneogram in Place

Thoroughness of Disinfection Cleaning Score (number of cleansurfaces / total number of surfaces evaluated � 100)

Before Terminal Clean After Terminal Clean Difference

o 27% 52% +25%o 35% 60% +25%es 43% 76% +33%es 33% 84% +51%es 64% 75% +11%es 36% 91% +55%es 56% 71% +15%es 87% 100% +13%

42% 73% +34%o 14% 22% +8%o 33% 27% -6%o 25% 30% +5%o 31% 52% +21%es 59% 77% +18%es 62% 70% +8%es 53% 82% +29%es 100% 100% 0%

40% 51% +11%

uderdale, FL j June 8-10, 2013