Healthcare Hygiene magazine January 2020 | Page 28

High-touch
surfaces in
the hospital
environment,
such as bed rails,
tray tables, and
supply carts,
are considered
important in the
epidemiology of
transmission
of healthcare-
associated
infections (HAIs).
28
decontamination interventions for norovirus
and rhinovirus may need to be more frequent
(more than once a day), tailored to the specific
context, and timed early in outbreaks to interrupt
transmission. These differences were driven by the
interaction between multiple properties of the
pathogens. Because of its low transfer efficiency,
high inactivation rates on hands, and relatively
short duration of infectiousness, influenza had
the lowest R0 for the fomite route, making
fomite-mediated transmission easier to control
despite its high shedding rate. Both rhinovirus
and norovirus were more efficiently transferred,
had high persistence on both hands and fomites,
and produce longer periods of shedding, making
the transmission potential high for both pathways
and consequently more difficult to control, even
with frequent surface decontamination.”
They conclude, “Fomite-mediated transmission
introduces both challenges and opportunities for
infection control due to interactions between the
properties of pathogens and venues. Our analysis
has shown that fomites can be an important source
of risk for pathogens that are often considered
to be, primarily, directly transmitted. We found
that fomite-mediated transmission is dependent
on both behavioral factors influencing contact
with fomites as well as the physical environment
and surfaces available for contamination in each
venue. This result underscores the need to think
critically about how a venue is characterized from
a transmission perspective in order to design
interventions that can appropriately target key
stages in the transmission process.”
The criticality of cleaning and disinfecting
fomites is underscored when considering the
ubiquitous use of portable medical equipment
(PME) in the hospital setting. Who cleans PME and
how often was investigated by Chetan Jinadatha,
MD, MPH, clinical associate professor at the Texas
A&M Health Science Center College of Medicine
and chief of infectious diseases at the Central
Texas Veterans Health Care System in Temple,
Texas, who, with his co-authors, examined the
patterns and sequence of touch events among
healthcare workers, patients, surfaces and
equipment in the hospital environment to better
inform their understanding of potential infection
transmission pathways.
As Jinadatha, et al. (2017) explain, “High-touch
surfaces in the hospital environment, such as bed
rails, tray tables, and supply carts, are considered
important in the epidemiology of transmission
of healthcare-associated infections (HAIs). If not
removed adequately, pathogens can remain viable
on fomites for months, serving as a source of
transmission on a number of susceptible patients.”
Jinadatha, et al. (2017) conducted their study
on six inpatient units, performing continuous 24-
hour observation separately on each unit by two
research team members observing for eight-hour
sessions. Observations of healthcare workers’
touches of surfaces, patient, and objects were
recorded in sequence. The researchers found that
almost all the items touched were connected to at
least a few other items in a sequence of touches.
The patient, the most commonly touched item,
had a potential for contamination from other
surfaces as well as a potential for transmitting
pathogens to other surfaces.
The study data included the surface/medical
equipment touched; the order of touches; what
the equipment was used for in that interaction
(such as a surface work area for IV fluids or
medications); whether equipment entered or
exited the room – to determine if the equipment
is patient dedicated or shared; if disinfection of
equipment or surfaces took place at any time
during this interaction; and if hand hygiene
was performed.
Jinadatha and colleagues note that their results
demonstrated that PME such as a computer on
wheels and IV pump were two of the most highly
touched items during patient care. Even with
proper hand sanitization and personal protective
equipment, this sequence analysis reveals the
potential for contamination from the patient and
environment, to a vector such as portable medical
equipment, and ultimately to another patient in
the hospital.
As Jinadatha, et al. (2017) note, “Most PME
falls under the noncritical patient care device
category of the Spaulding Classification Scheme
for infection risk. The disinfection of equipment,
along with room high-touch surfaces, is one of the
highest priorities in the current Joint Commission
scores with high non-compliance issues. The CDC
recommends that noncritical patient-care devices
be cleaned on a regular basis but the recommen-
dations are based on time since the last cleaning
rather than how frequently the PME is touched/
used. For example, the CDC recommends that a
computer on wheels (COW) be cleaned once a day
or as needed, or an IV pump cleaned following
patient discharge or disuse. If contact events or
‘touches’ are a means of spreading contamination
across surfaces in the environment, then cleaning
recommendations based on number of touches
may be more effective than those based on the
passage of time. However, while existing data on
touch frequency have helped to identify high-
touch surfaces in the patient care environment,
it is difficult to continuously track the patterns of
touches. Further research is necessary to quantify
the degree of surface contamination associated
with touch activity.”
Other researchers are equally concerned
about the role that PME may play in transmitting
january 2020 • www.healthcarehygienemagazine.com