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Clostridium Difficile Infection
Published in Meera Chand, John Holton, Case Studies in Infection Control, 2018
Signs were placed on the isolation room doors to remind staff of the use of contact precautions, that is, appropriate personal protective equipment (PPE) and hand hygiene (Figure 5.1). PPE should include gloves and gowns or aprons; masks are not needed. Enhanced environmental cleaning was undertaken, which involved daily cleaning and disinfection of surfaces and equipment with special attention to high-touch surfaces and cleaning of toilets 3–4 times a day. Disinfectants, such as chlorine-releasing agents, which are effective against C. difficile spores, and the terminal cleaning of curtains and mattresses upon discharge of patients were also part of the regimen to prevent further cases. Ward audits of hand hygiene and environmental cleaning were reviewed and problems identified from these audits addressed. This is the recommended standard of care to prevent spread in the hospital environment.
Enterococcus
Published in Dongyou Liu, Laboratory Models for Foodborne Infections, 2017
The intervention measures for controlling the spread of VRE in health-care settings range from (1) active periodic surveillance (cultures or molecular tests) of highest risk carriage patients, (2) decontamination of the hands of health-care workers before and after all patients contact, (3) adherence to barrier precautions (gloves and gowns) and hand antisepsis after glove removal, to (4) thorough terminal cleaning of rooms occupied by patient with VRE and daily cleaning of high-touch items such as bedside rails, tables, toilets, and handles [3].
Clostridium difficile Infection: Overview and Update with a Focus on Antimicrobial Resistance as a Risk Factor
Published in Robert C. Owens, Lautenbach Ebbing, Antimicrobial Resistance, 2007
Robert C. Owens, August J. Valenti, Mark H. Wilcox
From an environmental control perspective, it is not only important to consider the choice of cleaning agents (e.g., proven sporicidal activity), but also to address the cleaning process itself. This means cleaning horizontal (high-touch) surfaces that commonly harbor C. difficile spores (e.g., bedrails, call buttons, telephones, floors) more often than upon terminal cleaning of the room. In Canada, a best practices document actually recommends twice daily cleanings in healthcare facilities. Due to staffing inadequacies faced by hospitals today, environmental services departments may have altered important cleaning practices unbeknownst to the infectious diseases experts within the facility. Failure to clean high-touch surfaces with the appropriate agent may lead to increased transmission within an institution. When faced with an outbreak (or even as a preventative measure), multidisciplinary discussions that include environmental services leadership should take place to determine what cleaning products are being used, what surfaces are being cleaned, and how often. “Bundled” approaches where resources are dedicated toward environmental cleaning, infection control, and programmatic antimicrobial stewardship interventions have been shown to be most effective in quelling outbreaks (49,80,83,84).
Cost-Benefit Analysis of Allowing Additional Time in Cleaning Hospital Contact Precautions Rooms
Published in Hospital Topics, 2021
Aaron M. Wendelboe, Sue E. Kim, Sharyl Kinney, Alison E. Cuellar, Linda Salinas, Ann F. Chou
The enhanced cleaning protocol will likely help prevent transmission of other hospital-acquired infections, such as MRSA and VRE. As shown in Table 3, the per room cost savings are relatively similar to those for preventing C. difficile ($758), with MRSA at $919 and VRE at $821. On the other hand, there is a breakeven point at which hospitals would begin to incur a financial loss to implement an enhanced terminal cleaning protocol. Keeping the risk reduction in the base-case, the effectiveness of the enhanced terminal clean must be 0.2% less than the current standard protocol to achieve cost neutrality. The impact of assuming higher overhead from paying housekeepers a higher wage ($30/hour vs. $12.89) was minimal, resulting in a per-room cost savings of $754, or $4.32 less than those of the base case.
COVID-19 challenge: proactive management of a Tertiary University Hospital in Veneto Region, Italy
Published in Pathogens and Global Health, 2020
Giovanni Carretta, Cristina Contessa, Deris Gianni Boemo, Greta Bordignon, Silvia Eugenia Bennici, Stefano Merigliano, Margherita Boschetto, Alfio Capizzi, Annamaria Cattelan, Francesco Causin, Vito Cianci, Luciano Flor, Alberto Friziero, Paolo Navalesi, Maria Vittoria Nesoti, Anna Maria Saieva, Maria Scapellato, Ivo Tiberio, Roberto Vettor, Andrea Vianello, Renato Salvador, Daniele Donato
Frequency of cleaning and disinfection of environmental surfaces was increased, and hypochlorite-based products were used at higher concentrations of 0.5% (5000 ppm), according to international guidelines [8]. Rooms where patients with COVID-19 cared for underwent extraordinary sanitization interventions using no-touch technologies (vaporized hydrogen peroxide and silver salts) to supplement terminal cleaning after a patient had been discharged or transferred. Additional training of outsourcing cleaning staff was implemented to reinforce good practices, standard precautions, safe disinfectant preparation, use of equipment and use of dedicated or single-use supplies for COVID-19 ward. We also organized training sessions for healthcare workers to refresh environmental cleaning procedures and adequate use of PPE. Inside the Hospital, high-touch surfaces such as door and window handles, elevator panels, handrails, bathroom surfaces and work surfaces were identified as priority zones and items for disinfection.
Multidrug-resistant Candida auris: an epidemiological review
Published in Expert Review of Anti-infective Therapy, 2020
Arunaloke Chakrabarti, Shreya Singh
Chlorine based disinfectants were found effective for C. auris disinfection during an outbreak in United Kingdom in 2015. Decontamination of patient care areas was performed as terminal cleaning by hydrogen peroxide vapor [18]. In a study comparing different chorine-based disinfectants, it was found that >4,000 parts per million chlorine containing disinfectant is effective to clear C. auris within one minute [108]. CDC, Atlanta has recommended the use of United States Environmental protection Agency (EPA)–registered hospital grade disinfectants, which is also used against Clostridium difficile spores. Terminal cleaning with hypochlorite (1000 parts per million) is recommended for environmental disinfection by the WHO, Public health England (PHE), Public health agency of Canada (PHAC), while the ECDC recommend disinfectants with certified antifungal activity [82,109–111]. The Indian council of medical research (ICMR) recommends using a two- three-bowl method for the disinfection of surfaces and fogging by hydrogen peroxide vapors for terminal cleaning of patient rooms and the same is also recommended by the South African Center for Opportunists, Tropical and Hospital Infections (COTHI) [109,110]. Although patient decolonization by any antiseptic is not clearly recommended due to insufficient evidence, 2% chlorhexidine gluconate (CHG) body wash and 0.5% CHG mouth wash were used successfully for decolonization of patients in Indian ICUs [28]. A uniform policy of disinfection use is required for decolonization and environmental cleaning against C. auris.