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 .
The emergence of Candida auris in the New York City metropolitan area , a multidrugresistant fungus with extended environmental viability , has made a standardized assessment of cleaning protocols even more urgent for multi-hospital academic health systems , researchers say .
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• one site contaminated , with an overall contamination rate of 14 percent ( 28 of 200 samples ). Environmental contamination was not associated with day of illness , ventilatory mode , aerosol-generating procedures , or viral load . The frequency of environmental contamination was lower in the ICU than in general ward rooms . Eight samples from the common area were positive , though all were negative on cell culture . The researchers concluded that , “ Environmental contamination in the ICU was lower than in the general wards . The use of mechanical ventilation or highflow nasal oxygen was not associated with greater surface contamination , supporting their use and safety from an infection control perspective . Transmission risk via environmental surfaces in the ICUs is likely to be low . Nonetheless , infection control practices should be strictly reinforced , and transmission risk via droplet or airborne spread remains .”
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Contaminated surfaces within patient rooms and on shared equipment is a major driver of healthcare-acquired infections ( HAIs ). The emergence of Candida auris in the New York City metropolitan area has made a standardized assessment of cleaning protocols even more urgent for multi-hospital academic health systems , researchers say . Solomon , et al . ( 2020 ) sought to create an environmental surveillance protocol to detect C . auris and to assess patient room contamination after discharge cleaning by different chemicals and methods , including touch-free application using an electrostatic sprayer . The researchers say that surfaces disinfected using touch-free methods may not appear disinfected when assessed by fluorescent tracer dye or ATP bioluminescent assay . They focused on surfaces within the patient zone which are touched by the patient or healthcare personnel prior to contact with the patient . Their protocol sampled the over-bed table , call button , oxygen meter , privacy curtain , and bed frame using nylon-flocked swabs dipped in non-bacteriostatic sterile saline . They swabbed a 36-cm2 surface area on each sample location shortly after the room was disinfected , immediately inoculated the swab on a blood agar 5 percent TSA plate , and then incubated the plate for 24 hours at 36 ° C . The contamination with common environmental bacteria was calculated as CFU per plate over swabbed surface area and a cutoff of 2.5 CFU / cm2 was used to determine whether a surface passed inspection . Limited data exist on acceptable microbial limits for healthcare settings , but the aforementioned cutoff has been used in food preparation . Over a year-long period , the researchers found that terminal cleaning had an overall fail rate of 6.5 percent for 413 surfaces swabbed . The researchers used the protocol to compare the normal application of either peracetic acid / hydrogen peroxide or bleach using microfiber cloths to a new method using sodium dichloroisocyanurate ( NaDCC ) applied with microfiber cloths and electrostatic sprayers . The normal protocol had a fail rate of 9 percent , and NaDCC had a failure rate of 2.5 percent . The oxygen meter had the highest normal method failure rate ( 18.2 percent ), whereas the curtain had the highest NaDCC method failure rate ( 11 percent ). In addition , the researchers swabbed seven rooms previously occupied by C . auris-colonized patients for C . auris contamination of environmental surfaces , including the mobile medical equipment of the four patient care units that contained these rooms they did not find any C . auris , and the researchers say they will continue their data collection . The researchers emphasize that a systematic environmental surveillance system is critical for healthcare systems to assess touch-free disinfection and identify MDRO contamination of surfaces .
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In an interrupted-time series conducted in an 865-bed academic medical center , Doll , et al . ( 2020 ) sought to assess the impact of major interventions targeting infection control and diagnostic stewardship in efforts to decrease Clostridioides difficile hospital onset rates over a six-year period . Monthly hospital-onset C . difficile infection ( HO-CDI ) rates from January 2013 through January 2019 were analyzed five major interventions : ( 1 ) a two-step cleaning process in which an initial quaternary ammonium product was followed with 10 percent bleach for daily and terminal cleaning of rooms of patients that have tested positive for C . difficile ; ( 2 ) UV-C device for all terminal cleaning of rooms of C . difficile patients ; ( 3 ) “ contact plus ” isolation precautions ; ( 4 ) sporicidal
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The researchers found that environmental cleaning interventions and enhanced “ contact plus ” isolation did not impact HO-CDI rates .
peroxyacetic acid and hydrogen peroxide cleaning in all patient areas ; and ( 5 ) electronic medical record ( EMR ) decision support tool to facilitate appropriate C . difficile test ordering . The researchers found that environmental cleaning interventions and enhanced “ contact plus ” isolation did not impact HO-CDI rates . Diagnostic stewardship via EMR decision support decreased the HO-CDI rate by 6.7 per 10,000 patient days . When adjusting rates for test volume , the EMR decision support significance was reduced to a difference of 5.1 case reductions per 10,000 patient days , according to the researchers , who concluded