environment , and that transmission from contaminated environments to patients occurs . van der Schoor , et al . ( 2020 ) report on a medical center that transitioned from a hospital with mostly multiple-occupancy rooms to a new hospital with 100 percent single-patient rooms with private bathrooms . This move provided the unique opportunity to determine environmental contamination before the new hospital was open for admissions and thereafter and to compare the environmental contamination to the number of patients colonized with HRMOs . Environmental sampling was conducted twice in the old building and 12 times in the new building , from two weeks before to 15 months after relocating patients . At each moment , about 306 samples were taken from 13 locations ( e . g ., nightstands , sinks ) in 40
Studies have shown that patients colonized with highly resistant microorganisms
( HRMO ) contaminate the hospital environment , and that transmission from contaminated environments to patients occurs .
• patient rooms . Samples were screened for Staphylococcus aureus ( methicillin-susceptible [ MSSA ] and methicillin resistant [ MRSA ]) and highly resistant Pseudomonas aeruginosa , Acinetobacter baumannii , Enterococcus faecium , and Enterobacteriales . During the study period , all clinical samples positive for HRMOs were included . Environmental sampling revealed that 29 of 724 ( 4 percent ) locations were positive for HRMOs in the old building , whereas four of 3,358 ( 0.1 percent ) samples in the new building were positive for HRMOs ( P < . 001 ). In the old building , 14 of 29 locations were positive for extended-spectrum β-lactamase ( ESBL ) -producing bacteria and 15 were positive for carbapenemase-producing bacteria . In the new building , three of four positive samples were positive for vancomycin-resistant E . faecium ( VRE ), one was positive for ESBL-producing K . pneumoniae . For both HRMOs , no carriers were detected . In the old building , 145 of 12,256 adult patients ( 1.2 percent ) had clinical samples positive for HRMOs , compared to 561 of 38,397 ( 1.5 percent ) in the new building , a small but significant increase ( P = . 02 ). As the researchers concluded , “ The transition from mainly two- and four-person rooms to 100 percent single-patient rooms resulted in a significant decrease in environmental contamination , even though the number of patients colonized with HRMOs slightly increased . No molecular typing to determine transfer from environment to patients and vice versa has yet been performed . Future sampling is needed to determine whether the low environmental contamination is a long-term effect of the transition to single rooms .”
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Despite ongoing efforts over the past three decades , hospital-onset Clostridioides difficile infection ( HO-CDI ) continues to challenge interventions aimed at its prevention and control . Carling , et al . ( 2020 ) describe the impact of a model environmental services ( EVS ) program on the incidence of HO-CDI across eight hospitals that are part of a nationwide integrated health system . In this study , eight acute-care hospitals with 44 to 532 beds ( average of 263 beds ) in six states with stable endemic HO-CDI incidence densities independently implemented identical sporicidal environmental hygiene interventions in 2017 . The program combined the use of a hydrogen peroxide / peroxyacetic acid surface disinfectant for all patient-zone hygienic cleaning combined with a structured model EVS cleaning program that included optimized cleaning and disinfection technique , staff training , and auditing with objective performance feedback , which aligned with 2008 HICPAC / CDC categories I and II as well as 2010 CDC Guidance Level II monitoring program recommendations . After a three-month phase-in , the researchers compared NHSN-reported LabID HO-CDI SIRs for 18 months before and 12 months after implementation of the program . Results were not shared between sites and data were not collated by the authors until a year after the post-intervention results were initially available . Multiple possible confounding factors were evaluated and determined not to have identifiably affected the outcome . Mean preintervention HO-CDI SIRs over the 18 months measured ranged from 0.5 to 1.4 ( average of 1.0 for the group ). Following the wash-in period , SIRs decreased in all sites to an average of 0.42 for the group by the end of 12 months of the intervention . The researchers report that Individual site improvement ranged from 20 percent to 92 percent ( average of 57 percent ). As the researchers concluded , “ Overall , HO-CDI SIRs decreased almost 60 percent in the study hospitals following daily sporicidal disinfection cleaning of all patient-zone surfaces in association with ongoing programmatic optimization of cleaning practice . As predicted by earlier single-site studies reporting a favorable impact of sporicidal disinfectant cleaning in outbreak settings , this multisite quasi-experimental study has illustrated the substantial potential impact of hospital-wide sporicidal disinfection integrated with objectively sustained optimized thoroughness of cleaning to decrease the incidence of HO-CDI .”
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Overall , HO- CDI SIRs decreased almost 60 percent in the study hospitals following daily sporicidal disinfection cleaning of all patientzone surfaces in association with ongoing programmatic optimization of cleaning practice .”
The risk of environmental contamination by severe acute respiratory coronavirus virus 2 ( SARS-CoV-2 ) in the intensive care unit ( ICU ) is unclear , researchers suggest . Ong , et al . ( 2020 ) evaluated the extent of environmental contamination in the ICU and correlated this with patient and disease factors , including the impact of different ventilatory modalities . In this observational study , surface environmental samples collected from ICU patient rooms and common areas were tested for SARS-CoV-2 by polymerase chain reaction ( PCR ). Select samples from the common area were tested by cell culture . Clinical data were collected and correlated to the presence of environmental contamination . Results were compared to historical data from a previous study in general wards . In total , 200 samples from 20 patient rooms and 75 samples from common areas and the staff pantry were tested . The results showed that 14 rooms had at least