Healthcare Hygiene magazine January 2020 | Page 22

Several studies have
recommended that
public surfaces
such as doorknobs
and surfaces in
and around toilets
in patients’ rooms
be cleaned and
disinfected on a
more frequent
schedule.”
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the highest values. The average distances from the
public surfaces to any other surface were short,
indicating that public surfaces are highly efficient
at spreading MRSA to other surfaces.”
In the baseline scenario, the average exposure
to the susceptible patients was 17.5 CFU. The
researchers found that, even with a low cleaning
efficacy of 0.25, the average reduction was
about 0.60, which indicated surface cleaning
could effectively lower the exposure. As the
surface cleaning efficacy (0.25, 0.5, 0.75 and 1)
increased, the corresponding average reduction
(0.60, 0.69, 0.73 and 0.75) also rose, but the
growth rate decreased. The researchers say that
for hospitals on a limited budget, the efficacy of
0.5 is an acceptable choice, with a relatively high
average reduction.
The observe, “Ideally, if we cleaned all the
environmental surfaces infinite times with a
cleaning efficacy of 1, these surfaces would
be always clean and would not play any role in
spreading the MRSA. However, since MRSA can
be transmitted via HCWs’ hands, the exposure to
the susceptible patients remains. Given infinite
cleaning, exposure will be reduced by 0.91, which
is just a little bit better than the exposure reduction
achieved with a cleaning frequency of 16/day,
0.86. Thus, excess enhanced surface cleaning does
not offer substantial benefits, particularly given the
high financial burden of hospitals and the heavy
workload of cleaners, which might inversely lead
to an increased infection risk.”
To increase the efficiency of frequent cleaning,
Xiao, et al. (2019) also investigated which cleaning
strategies produced a high reduction of exposure to
the susceptible patients. They found that frequent
cleaning on the normal patients’, the adjacent
patient’s and the index patient’s surfaces had
weak, modest, and strong effect on the reducing
the MRSA exposure among susceptible patients,
respectively: “The exposure reduction is driven by
the diversity of MRSA concentrations on surfaces, as
cleaning environmental surfaces with higher MRSA
concentrations, such as the index patient’s surfaces,
removes more MRSA, and this cascades through
the network to reduce MRSA on the surfaces
of susceptible patients. Many recommendations
have been proposed to clean near-patient sites
in hospitals, which could be made more specific.
Among all the near-patient sites, more attention
should be paid to effectively cleaning surfaces
around the adjacent and the index patients than
to cleaning surfaces around normal patients. Early
detection and isolation of index patients could help
prevent transmission of MRSA.”
Of note, the researchers say that for public
surfaces, the association between high exposure
reduction and cleaning frequency indicates that
it is effective to clean these surfaces frequently:
“Several studies have recommended that public
surfaces such as doorknobs and surfaces in and
around toilets in patients’ rooms be cleaned and
disinfected on a more frequent schedule. Public
surfaces are a kind of high-touch surfaces since
they are touched by many people, despite the
low average touching frequency by each person.
They are different from another kind of high-
touch surfaces around patients, such as bedding,
that are touched frequently by few people. The
reason that enhanced cleaning on public surfaces
reduced exposure was more related to their
influential role in the entire MRSA transmission
process than to the frequency people touched
the surfaces. Therefore, the recommendations to
clean high-touch surfaces could be more specific
as enhancing cleaning on public surfaces touched
by many people.”
In their study, Xiao, et al. (2019) asserted that
“Implementation of improved cleaning and anti-
microbial surfaces on all environmental surfaces
equally will be a heavy burden on healthcare
resources. More efficient implementation should
distinguish ‘important’ environmental surfaces
that contribute significantly to infection risk in a
hospital ward from others and concentrate the
available cleaning resources and antimicrobial
surfaces and coatings on them.”
Patient-care items are among the most
frequently touched items in the healthcare
environment and warrant attention. As such,
Kanamori, et al. (2017) examined the role that
patient-care items play in healthcare-associated
outbreaks, updating their 1987 review. They
note, “Fomites recognized in the previous review
(humidifier, nebulizer, urine-measuring device,
stethoscope, thermometer, suction apparatus,
pressure transducer) have continued to be
implicated in healthcare-associated outbreaks.
There were also various contaminated fomites
implicated without having clear evidence of
healthcare-associated outbreaks and infections.
During the three decades since our last review,
additional healthcare fomites (hand soap/sanitizer
dispenser, ultrasound probe/gel, computer key-
boards) have been identified. The type of patient
care items as a fomite has changed over time, and
some of them were likely to be reduced nebulizer,
pressure transducer, thermometer), but others
were not. The number of healthcare-associated
outbreaks via a patient-care item may be affected
by publication bias, depending on authors’ interest
(rare organism or fomite) and findings.”
Let’s briefly review some of these culprits.
As for respiratory-care equipment, the
literature contains reports of contaminated
humidifiers, nebulizers and suction apparatus
leading to infections caused by pathogens such as
Acinetobacter baumannii, Burkholderia cepacian,
Klebsiella oxytoca, Pseudomonas cepacia, MDR
Pseudomonas aeruginosa, S. maltophilia, MDR
january 2020 • www.healthcarehygienemagazine.com