Download How to remove Bacteria from  common hospital surfaces Gram Negative Bacteria:  common characteristics

9/6/2013
How to remove Bacteria from common hospital surfaces
Evidence based cleaning and disinfecting
Greg S Whiteley
Gram Negative Bacteria: common characteristics
• Frequently feacal – oral association
• Ubiquitous (they’re everywhere)
• Can swap genes and so transfer antibiotic resistance • Live in biofilms – with other dissimilar bacteria
• Can colonise without causing disease
• MDRO varieties can kill
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Some GNB examples
• E. coli : common in gut and mouths
• Acinetobacter baumannii: common on skin and skin folds
• Enterobacteriaceae : all species in this genus • ESBL’s (e.g. Klebsiella pnuemoniae)
• Pseudomonas aeruginosa : skin and oral, liquids including some soaps/detergents
GNB ‐ vulnerability and strengths
Strengths
Vulnerability
• Strong association with healthy humans
• Rapid growth in biofilms • Biofilms can be heterogenous
• Resistance to some mild disinfectants
• Can grow in detergent solutions (especially Ps. aeruginosa) • Quickly killed by most stronger disinfectants
• Hospital Grade Disinfectants are all tested routinely against common GNB
• Killed quickly by heat & autoclaving
• Surface binding undone using strong detergent solutions (e.g. Matrix)
1: Vickery et al., AJIC:2009
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Surfaces associated with GNB
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Toilets/bathrooms – everywhere1
Patient surrounds – everywhere2
Patient related devices (e.g. remote control)1
Critical Care surfaces in biofilms3
Patient bathrooms4
Bedpan cleaners 4
Clinical workspaces5
1. Friedman et al, 2013; 2. Fitzgerald et al., 2013; 3. Vickery et al., 2012; 4. Carling et al., 2008; 5. Anderson & Dancer et al., 2012
NHMRC Recommendations for standard and additional precautions
• Standard Precautions
– Clean and wipe with neutral detergent
– NOTE: New Research suggests this may contribute to biofilm viability in some instances
• Additional Precautions
– 3 stage process:
1. clean and wipe with neutral detergent
2. Apply HGD disinfectant – TGA approved
3. Rinse away and leave to dry
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New Learning on Disinfection
• Wiping is THE critical process to remove and kill bacteria and other pathogens on surfaces1,2,3
• Non wiping will NOT WORK to remove bacteria (whether alive or dead)
• Latest study – out of Geelong – published in the American Journal of Infection Control in June 2013 (author: Dr Deborah Friedman)
1. Rutala et al., 2012; Sattar et al., 2013; Friedman et al., AJIC: 2013
The key and killer combination
• A moistened wipe – HGD wipe (TGA registered)
• A HGD Disinfectant – TGA registered
• Compatible formulations and allows interchange‐ability and interoperability
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3 Stage Chlorine Process
Clean with hot water & detergent
Disinfect with Chlorine at 1000ppm:
Leave for 10 minutes
Initial
VRE Count
25% of surfaces
Rinse with warm water and detergent
VRE Count (after)
11.1% of surfaces
(n = 251)
Single Stage Effective Clean/Disinfect
Clean with Viraclean or Finish
V‐Wipes
Initial Count: VRE
- 33% then down
to 4.5% surfaces
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VRE count (after)
<1.1% (n=282)
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Chlorine 3 stage vs. Viraclean
VRE Count Before VRE Count After Rx
Rx
3 Stage Chlorine Disinfect
Single Stage Viraclean
Initial Readings Only
Single Stage
Viraclean:
Full Data set
63/251 = 25.1%
28/251 = 11.1%
7/21 = 33%
2/25 = 8%
11/241 = 4.5%
3/282 = < 1.1%
3 Stage Chlorine (Clean, Disinfect, Rinse)
vs., Viraclean/ V‐Wipes (single pass)
30.00%
25.00%
20.00%
VRE Initial Counts
15.00%
VRE Count After Rx
10.00%
5.00%
0.00%
3 Stage Chlorine
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Viraclean/ V‐Wipes
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Observations from Friedman 2013 article
• Viraclean/ V‐Wipes not only killed and removed VRE but the contamination rates were reduced
• Viraclean/ V‐Wipes were preferred by environmental staff for ease of use and efficacy
• Viraclean/ V‐Wipes are “more user friendly” to staff
Patient Infection Rates (VRE) ‐ overall
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Haematology Ward VRE Infection Rates: 2010 (3 stage Chlorine); 2011 (Viraclean)
30
25
20
Haem 2010
15
Haem 2011
10
5
0
Q1
Q2
Q3
Q4
ICU Ward VRE Infection Rates: 2010 (3 stage Chlorine); 2011 (Viraclean)
10
9
8
7
6
5
ICU 2010
4
ICU 2011
3
2
1
0
Q1
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Q2
Q3
Q4
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References
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Friedman ND, Walton AL et al., “The effectiveness of a single‐stage versus traditional three‐
staged protocol of hospital disinfection at eradicating vancomycin‐resistant enterococci from frequently touched surfaces”: Am. J Infection Control:2013:41:227‐231
Vickery K, Deva A, … Gosbell I; “Presence of biofilm containing viable multiresistant
organisms despite terminal cleaning on clinical surfaces in an intensive care unit”: J Hospital Infection: 2012:80:52‐55
Rutala WA, Gergen MF, Weber DJ; “Efficacy of different cleaning and disinfection methods against Clostridium difficile spores: Importance of physical removal versus sporicidal inactivation”: Infection Control Hospital Epidemiology: 2012:33:1255‐1258
Sattar SA, Maillard J‐Y; “The crucial role of wiping in decontamination of high‐touch environmental surfaces: Review of the current status and directions for the future”: Am J Infection Control: 2013:41:S97‐S104
Moore G, Muzlay M, Wilson PR; “The type, level and distribution of microorganisms within the ward environment: A zonal analysis of an intensive care unit and a gastrointestinal surgical ward”: Infection Control Hospital Epidemiology: 2013:34:500‐506
References (continued)
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Fitzgerald G, Moore G, Wilson APR; “Hand hygiene after touching a patient’s surroundings: the opportunities most commonly missed”: J Hospital Infection: 2013:84:27‐31
Anderson RE, Young V,…Dancer SJ; “Cleanliness audit of clinical surfaces and equipment: who cleans what?”: J Hospital Infection: 2011:78:178‐181
Carling PC, Parry MM, Rupp ME, et al., “Improving cleaning of the environment surrounding patients in 36 acute care hospitals”: Infection Control Hospital Epidemiology: 2008:29:1035‐
1041
Vickery K, Ngo Q‐D, Zou J, Cossart YE; “The effect of multiple cycles of contamination, detergent washing, and disinfection on the development of biofilm in endoscope tubing”: Am J Infection Control: 2009:37:470‐475
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