patients ( high respiratory infection issues ) in prescription of broad-spectrum antibiotics for possible other complications from bacterial pathogens when on ventilators , etc ., this leads to more AMR in the long run .”
Rohde says that any decrease in surface cleaning and disinfection is a concern .
“ The balance is very important , complex and difficult to achieve but we must try ,” he says . “ We need to be aware of the pathogens in our environments ( perhaps more environmental epidemiology / sampling ), as well as the pathogen in our patients ( if healthcare ). Knowing this , we can work to maintain proper antibiotic treatment with the right ( narrow ) antibiotics while balancing the correct EPA-registered disinfectant against the environmental pathogens , including dealing with biofilms and persister cells . A tough job for all but we must try .”
Resistance issues in general have been subjugated to the global fight against COVID-19 . Huttner , et al . ( 2020 ) are among other researchers raising concerns about COVID-19 dominating the medical agenda while other significant issues , such as antibiotic / antimicrobial resistance , are ignored .
They observe , “ The SARS-CoV-2 pandemic is currently dominating every aspect of health care across the globe , putting other longer-term public health issues — including the steady rise of antimicrobial resistance — in the shade . Yet , there will be a time after COVID-19 , and we should not lose sight of problems that will persist and may potentially be exacerbated by this pandemic … Despite the viral origin of COVID-19 , a standard reflex by physicians is to start treatment with antibiotics , since cough , fever and radiological infiltrates are hallmarks of bacterial community-acquired pneumonia which requires antibiotic treatment . The anxiety and uncertainty surrounding the pandemic and the absence of antiviral treatments with proven efficacy are probably other contributors to the widespread and excessive prescription of antibiotics .”
The rationale for antibiotic treatment in patients with COVID-19 seems to be based on the experience with bacterial superinfection in influenza , where most studies report initial co-infection or secondary bacterial pneumonia in hospitalized patients caused mostly by Streptococcus pneumoniae and Staphylococcus aureus .
Huttner , et al . ( 2020 ) acknowledge that , “… given the difficulty of differentiating COVID-19 from bacterial pneumonia , the uncertainty regarding bacterial superinfections , the lack of specific antiviral agents with proven efficacy , and the high mortality — antibiotics should be considered as part of the empirical treatment strategy for
Continued on Page 26 on the COVID-19 negative and positive ‘ control ’ wards included bed rails , call button / remote control , in-room telephone , over-bed tray table , sink and soap dispenser , chair , windowsill , and the floor . Walking computer workstations , hand-held glucometers , and vital sign machines represented shared surface samples and microwaves and refrigerator samples were taken from the staff common areas . Sampling occurred randomly throughout the daytime hours , without regard to the timing of daily or terminal cleaning ; however , since most of these surfaces are cleaned daily , the time from last cleaning to sampling was most often less than 36 hours .
At the ACH , immediately after a SARS-CoV-2 infected patient was discharged or transferred out of their room , nursing notified the authors who coordinated with EVS . The same eight stationary surface types were sampled immediately before and after terminal cleaning with a non-bleach sporicidal disinfectant containing hydrogen peroxide and peracetic acid . Additionally , at the ACH , three types of terminal cleaning enhancements were also evaluated : UV-C treatment at 60,000 mJ / cm2 , adding electrostatic spraying following terminal cleaning , and adding both UV-C and electrostatic spraying . These enhancements were applied in addition to terminal cleaning when terminal was completed . To ensure each enhancement had an equal amount of RNA contamination present before cleaning , 100 cm2 surfaces in vacated patient rooms were spotted with 1250 copies of SARS-CoV-2 genomic RNA before terminal cleaning . During the post-cleaning sample collection , those spotted areas were included in the streaking of the target surface type ( floor , bed rail , etc .). At the LTCF , rooms were sampled before and after routine daily cleaning and also after a professional remediation service using three different proprietary room fogging agents . Adenosine triphosphate ( ATP ) testing of surfaces was also performed using an ATP monitoring system .
The researchers report that 417 surface samples were collected ; 214 from the ACH and 203 from the LTCF . Of surfaces swabbed , 59 ( 24 percent ) at the ACH , and 47 ( 23 percent ) at the LTCF had detectable RNA . Based on the proportion of positive surfaces , the difference between the overall contamination rates at the ACH and LTCF was not significant . Similarly , surface contamination based on mean PCR mean cycle threshold values of the ORF1ab gene was also similar between the ACH and the LTCF . Mean cycle threshold value at the ACH was 35.4 compared to 35.9 at the LTCF .
At both the ACH and LTCF , viral RNA was detected more often on dedicated COVID-19 units , and on wards or units that were experiencing an outbreak or nosocomial transmission . The researchers found that the overall facility level contamination was no different between an ACH and a corresponding LTCF . The room cleaning protocols used at the ACH significantly reduced environmental RNA , with UV -C light appearing to degrade RNA more than electrostatic spraying .
Commercial cleaning services that spent more time per room cleaning resulted in a larger reduction in contamination , unlike previously published reports that showed time spent cleaning did not translate into more bioburden reduction .
The researchers point out that their study was conducted under real-world conditions of staffing shortages during the height of the pandemic , and that prior SARS-CoV-2 studies did not have a controlled assessment of cleaning and did not include shared equipment and ATP measurements . These findings can assist in allocation of scarce cleaning and disinfection resources for maximum impact . They add , “ Studies of the survivability of the virus on fomites have been criticized as lacking real-life generalizability . Data in this report were obtained from a ‘ typical ’ general hospital and nursing home , representative of the type of settings ( general / community / non-university-based hospitals ) where much of healthcare is delivered . Studies for these settings
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