the microbial jungle present in the facility and the patient risks
associated with the environment. The goal of identifying the
targeted microbe or pathogen is one of the first steps to breaking
the chain of infection.
Microbiologists working in laboratories can be allies to
infection preventionists (IPs). By identifying a pathogen, its
species and the genome, the team is equipped with the needed
information to make informed decisions. The facility antibiogram
(bugs & drugs report) helps to identify the pathogens within a
facility and the antibiotics prescribed to treat infections. That
is why an IP focuses on antibiotic stewardship.
The EVS team does not prescribe antibiotics for patients, yet
they are teamed with IPs in specifying appropriate EPA-registered,
hospital-grade disinfectants for the environmental pathogens.
This use of disinfectants is a form of antimicrobial stewardship;
just as the human body has many organs and life-sustaining
systems that are factors in a patient’s health, a hospital building
has many critical systems that require close monitoring and care.
A hospital is comparable to a human body. The HVAC
system provides clean air, like the lungs. Fresh, clean, safe water
circulates through potable water-pipe systems are similar to the
blood. The circulatory system of arteries, veins, coronary, and
portal vessels, is required throughout the facility. The waste line
plumbing is similar to the gastrointestinal tract, and the largest
organ in the body, the skin, is analogous to the external hospital
surfaces. Water consumed by the human body is essential, just
as water added to EPA registered, hospital-grade disinfectants
is required for the disinfectant to work correctly.
Know the EVS Arsenal for the War on Pathogens
EVS teams must be equipped with knowledge, proper
cleaning tools, EPA-registered and hospital-grade disinfectants,
plus sufficient time to incorporate:
➊ Microbiological sampling of the environment
➋ Assessing the efficacy of wiping cloths and mops at:
a) Removing Surface microorganisms (bioburden) and other
materials like dust, soil, blood, and bodily fluid.
b) Moist biofilm and dry surface biofilm (DSB) destruction
and removal
c) Endotoxin removal
➌ Assessing the efficacy of reusable and reprocessed
wiping cloths and mops. (e.g., launderable to CDC guidelines
(HICPAC 2003).
Microbiologists can assist EVS and IP teams in providing
knowledge of the pathogens and how to remove and destroy the
threats to human health. Additionally, they can give validation
of useful products, processes and programs. Depending on
the type of product and its purpose, there are three main
categories of microbial quality control tests requiring the use
of growth media:
TYPE OF PRODUCT TEST PURPOSE
Non-sterile
Non-sterile
Microbial
enumeration tests
Tests for specific
organisms
Counts the total number
of bacteria and/or fungus
in a product sample
Identifies objectionable
organisms, such as
Salmonella, in a product
sample
Sterile Sterility tests Checks sterility of a
product sample
Guidelines for Microbial Examination of Non-Sterile
Products
The microbial limits test procedures are performed to
determine whether a non-sterile product complies with given
specifications for microbial quality. Such non-sterile products
include cosmetic, healthcare and pharmaceutical products. The
microbial enumeration tests are a range of tests manufacturers
can use to help ensure the bioburden of finished goods remains
within safe limits. This is typically used in pharmaceutical product
manufacturing for non-sterile products, we are mentioning
only as a point of reference of an established best practice to
compare/contrast for healthcare textiles although not required or
warranted by CDC as actual transmission of infection has been
determined insignificant through healthcare textiles in outsourced
laundries. Most contamination is during improper handling or
laundry within the hospital.
The microbial limits test procedures are performed to determine
whether a non-sterile product complies with given specifications
for microbial quality. Such non-sterile products include cosmetic,
healthcare and pharmaceutical products. The microbial enumeration
tests are a range of tests manufacturers can use to help
ensure the bioburden of finished goods remains within safe limits.
This is typically used in pharmaceutical product manufacturing
for non-sterile products, we are mentioning ONLY as a point of
reference of an established best practice to compare/contrast
for healthcare textiles although not required or warranted by
CDC as actual transmission of infection has been determined
insignificant through healthcare textiles in outsourced laundries.
The majority of contamination is during improper handling or
laundry within the hospital.
As described in US Pharmacopoeia, USP <61> is a microbial
enumeration test that provides a quantitative evaluation of the
microbial content of a sample, also known as microbial bioburden
testing or microbial limits testing. Simply put, USP <61> is what
gives the number of colony-forming units (cfu) in a given sample.
USP <62> is the method used to determine what organisms are
present within a sample.
Returning to the jungle analogy, knowing that there are 20
animals in an area is knowledge, but knowing what those 20
animals are is empower. As established by Sattar et al., there is
statistical variations in log reduction based upon type of substrate
or cloth used to wipe surfaces. That is why the work outlined
in the paper, Decontamination of high-touch environmental
surfaces (HITES) by wiping: Assessment of a carrier platform
for quantitative and field-relevant assessment of pathogen
inactivation, removal and transfer, is helpful as we continue to
evaluate the device, and the procedure, based on to address a
major gap in assessing wiping of HITES.
34 august 2020 • www.healthcarehygienemagazine.com