Ycml

Environment and HAI 04-‐11-‐14

ICAN 2014 1

I have absolutely no knowledge of.. environmental or healthcare..

waste management.!

Andreas Voss Radboud UMC & CWZ

Nijmegen The Netherlands

¤  Robert Weinstein esFmated that the source of pathogens causing a healthcare-‐associated infecFon in the intensive care unit was as follows: ²  paFents’ endogenous flora, 40%–60%;

²  incl. anFbioFc-‐driven changes in flora; ²  cross infecFon via the hands of personnel, 20%–40%;

²  other (incl. environment): 20%.

modified from Wenzel and Edmond


ICAN 2014 2

MRSA

ESBL

C.dif & Co

CRE

…..

PREVENT everything


ICAN 2014 3

Adapted from Oêr et al ICHE july 2011, vol. 32, no. 7

Innate surfaces Water

Air HCWs & pa?ents

Coming here

Hematology OperaFng room

Airborne isolaFon

or type


ICAN 2014 4

Brandt et al, Ann Surg 2008; 248:695-700.

¤  63 surgical departments parFcipaFng in KISS

¤  >99.000 operaFons

¤  Turbulent + HEPA versus laminar airflow + HEPA

¤ MulFvariate analyis to comtrol for other factors influencing outcome (SSI)


Significant ns ns ns ns ns


Follow-‐up study taking in account the size of the LAF plenum shows no difference in outcome

¤  Mycobacteria & endoscope reprocessing

¤  Legionella and aerosols

¤  Nonfermenters (especially Pseudo-‐ monas & Acinetobacter) in sinks & venFlators

¤  Molds in hematology units


ICAN 2014 5

Villegas et al ICHE 2003;24:284-‐95

Thus, what is all the fuzz about?

Weber et al. Am J Infect Control 2010;38:S25-‐33


ICAN 2014 6

Kramer et al. BMC Infect Dis 2006;6:130 Kramer et al. BMC Infect Dis 2006;6:130

Kramer et al. BMC Infect Dis 2006;6:130

C. difficile , VRE, MRSA 103 to 109 CFUs/g in stool Norovirus 1012 parFcles/g

Environment is generally <10 organisms per cm2

¤ The infecFous dose for most environmentally associated nosocomial pathogens appears to be low. ²  Less than 15 S. aureus cells were sufficient to cause infecFon in experimental lesions,

² Less than 1 CFU/cm2 was sufficient to cause C. difficile disease in mice

² A single norovirus parFcle is thought to have the capacity to cause infecFon

Oêr et al ICHE july 2011, vol. 32, no. 7

¤ The surface environment in rooms of colonized or infected paFents is frequently contaminated with the pathogen.

¤ Contact with hospital room surfaces or medical equipment by healthcare personnel frequently leads to contaminaFon of hands and/or gloves.

Weber & ICHE may 2013, vol. 34, no. 5


ICAN 2014 7

SFefel et al ICHE 2011:32:185-‐87 Bonten et al. Lancet 1996;348:1615-‐19

Bobulsky et al. CID 2008;46:447-‐50

Skin (orange), gloves (blue)

¤ Improved environmental cleaning has led to reduced risk of VRE and C. difficile transmission.

¤ Admission to a room previously occupied by a paFent with MRSA, VRE, Acinetobacter, or C. difficile increases the risk for the subsequent paFent admiêd to the room to acquire the pathogen

Weber & ICHE may 2013, vol. 34, no. 5

Oêr et al. AJIC 2013;41:56 Huslage et al. Infect Control Hosp Epidemiol 2010; 31(8):850-‐853


ICAN 2014 8

Huslage et al. Infect Control Hosp Epidemiol 2010; 31(8):850-‐853

Obviously all should be clean, but high-‐touch really needs to be!

Eckstein et al. BMC Infect Dis June 2007 Eckstein et al. BMC Infect Dis June 2007

C. difficile

Eckstein et al. BMC Infect Dis June 2007

VRE


ICAN 2014 9

Boyce et al. ICHE 2008;29:723

Copper a day - Keeps MRSA away

Noyce et al. J Hosp Infect 2006;63:289-‐297

Thom et al. Infect Control Hosp Epidemiol 2014;35:1060-‐62 Thom et al. Infect Control Hosp Epidemiol 2014;35:1060-‐62

¤  MSDS Poly spray (silicone quaternary amine)

¤  8 surfaces

²  sink, call buôn, bedside table, monitor, telephone, supply cart, door handle, floor

¤  Results:

² No significant effect on environmental contaminaFon


ICAN 2014 10

Thom et al. Infect Control Hosp Epidemiol 2014;35:1060-‐62

¤  Problem adherence?

¤  Love the concept of changing the surface

¤  Studies with copper, silver silica, Biosafe HM 4100 (polymer) embedded in polyurethane, light-‐acFvated anFmicrobials, … have worked before

Freeman et al. AnFmicrob Resistance Infect Control 2014;3:5

¤  We systemaFcally sampled 8 surfaces in the rooms and bathrooms of adult paFents colonized or infected with ESBL-‐EC or ESBL-‐KP throughout their hospital stay.

¤  Environmental contaminaFon was defined as recovery of an ESBL-‐producing organism matching the source paFent’s isolate

Freeman et al. AnFmicrobial Resistance and InfecFon Control 2014, 3:5 Freeman et al. AnFmicrobial Resistance and InfecFon Control 2014, 3:5

Rooms of paFents with ESBL-‐KP have substanFally higher contaminaFon rates than those with ESBL-‐EC. This finding may help explain the apparently higher transmissibility of ESBL-‐KP in the hospital serng


ICAN 2014 11

Kampf et al. BMC Infect Dis 2014;14:37 Kampf et al. BMC Infect Dis 2014;14:37

¤ Reusable Fssue dispensers with different surface disinfectants were randomly collected from healthcare faciliFes.

¤ 66 dispensers containing disinfectant soluFons with surface-‐acFve ingredients were collected in 15 healthcare faciliFes. 28 dispensers from nine healthcare faciliFes were contaminated

¤ In none of the hospitals dispenser processing had been adequately performed

… it is not about the details of this paper, but the point that even

“helpful parts of the environment” may be a source for infecFons

¤  Roomservice ¤  Roomservice-‐plus ¤  Registered nurse ¤  Nurse asistant ¤  Cleaning

Even if you think you know it, are they actually doing it?


ICAN 2014 12

Weber et al. J Hosp Infect 2012;80:252-‐4

¤ Highest rate of mannequin contamina?on was long sleeves + ?e (transmission occurred in 4/5 experiments) and lowest with short sleeves no ?e (0/5).

> >

Weber et al. J Hosp Infect 2012;80:252-‐4

Eli: “flaw in this study was that Fes were narrowly defined as neckFes and excluded bow Fes”

h^p://haicontroversies.blogspot.nl

¤ Enter a soluFon to all of our infecFon control problems: the Jumbo Squir?ng Bow Tie!

¤ This oven overlooked clothing accessory is a veritable infecFon prevenFon dream. ² A bow Fe can increase our professionalism and limit pathogen transmission.

² Add in the "Jumbo SquirFng" acFon and you can squirt alcohol hand rub into the eyes of non-‐compliant clinicians (operant condiFoning) and also into your own hands to improve compliance with the WHO 5 Moments.

h^p://haicontroversies.blogspot.nl


ICAN 2014 13

hZps://www.surveymonkey.com/r/2XG8LV6

Documents

Ycml