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Decreasing Operating Room Environmental Pathogen Contamination through Improved Cleaning Practice

  • L. Silvia Munoz-Price (a1) (a2) (a3), David J. Birnbach (a2) (a4), David A. Lubarsky (a4), Kristopher L. Arheart (a2) (a5), Yovanit Fajardo-Aquino (a3), Mara Rosalsky (a3), Timothy Cleary (a6), Dennise DePascale (a3), Gabriel Coro (a3), Nicholas Namias (a7) and Philip Carling (a8) (a9)...

Abstract

Objective.

Potential transmission of organisms from the environment to patients is a concern, especially in enclosed settings, such as operating rooms, in which there are multiple and frequent contacts between patients, provider's hands, and environmental surfaces. Therefore, adequate disinfection of operating rooms is essential. We aimed to determine the change in both the thoroughness of environmental cleaning and the proportion of environmental surfaces within operating rooms from which pathogenic organisms were recovered.

Design.

Prospective environmental study using feedback with UV markers and environmental cultures.

Setting.

A 1,500-bed county teaching hospital.

Participants.

Environmental service personnel, hospital administration, and medical and nursing leadership

Results.

The proportion of UV markers removed (cleaned) increased from 0.47 (284 of 600 markers; 95% confidence interval [CI], 0.42-0.53) at baseline to 0.82 (634 of 777 markers; 95% CI, 0.77-0.85) during the last month of observations (P < .0001). Nevertheless, the percentage of samples from which pathogenic organisms (gram-negative bacilli, Staphylococcus aureus, and Enterococcus species) were recovered did not change throughout our study. Pathogens were identified on 16.6% of surfaces at baseline and 12.5% of surfaces during the follow-up period (P = .998). However, the percentage of surfaces from which gram-negative bacilli were recovered decreased from 10.7% at baseline to 2.3% during the follow-up period (P = .015).

Conclusions.

Feedback using Gram staining of environmental cultures and UV markers was successful at improving the degree of cleaning in our operating rooms.

Copyright

Corresponding author

Park Plaza West L-302, 1611 NW 12th Avenue, Miami, FL 33136 (smunozprice@med.miami.edu)

References

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1. Hayden, MK, Bonten, MJ, Blom, DW, Lyle, EA, van de Vijver, DA, Weinstein, RA. Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 2006;42:15521560.
2. Duckro, AN, Blom, DW, Lyle, EA, Weinstein, RA, Hayden, MK. Transfer of vancomycin-resistant enterococci via health care worker hands. Arch Intern Med 2005;165:302307.
3. Hota, B. Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection? Clin Infect Dis 2004;39:11821189.
4. Otter, JA, Yezli, S, French, GL. The role played by contaminated surfaces in the transmission of nosocomial pathogens. Infect Control Hosp Epidemiol 2011;32:687699.
5. Bhalla, A, Pultz, NJ, Gries, DM, et al. Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients. Infect Control Hosp Epidemiol 2004;25:164167.
6. Boyce, JM, Potter-Bynoe, G, Chenevert, C, King, T. Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications. Infect Control Hosp Epidemiol 1997;18:622627.
7. Munoz-Price, LS, Weinstein, RA. Acinetobacter infection. N Engl J Med 2008;358:12711281.
8. Huang, SS, Datta, R, Platt, R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006;166:19451951.
9. Dancer, SJ. Importance of the environment in methicillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning. Lancet Infect Dis 2008;8:101113.
10. Jefferson, J, Whelan, R, Dick, B, Carling, P. A novel technique for identifying opportunities to improve environmental hygiene in the operating room. AORN J 2011;93:358364.
11. Carling, PC, Parry, MM, Rupp, ME, et al. Improving cleaning of the environment surrounding patients in 36 acute care hospitals. Infect Control Hosp Epidemiol 2008;29:10351041.
12. Loftus, RW, Koff, MD, Burchman, CC, et al. Transmission of pathogenic bacterial organisms in the anesthesia work area. Anesthesiology 2008;109:399407.
13. Loftus, RW, Muffly, MK, Brown, JR, et al. Hand contamination of anesthesia providers is an important risk factor for intraoperative bacterial transmission. Anesth Analg 2011;112:98105.
14. Munoz-Price, LS, Ariza-Heredia, E, Adams, S, et al. Use of UV powder for surveillance to improve environmental cleaning. Infect Control Hosp Epidemiol 2011;32:283285.
15. Recommended practices for environmental cleaning in the perioperative setting. In: Perioperative Standards and Recommended Practices. Denver: AORN, 2012:237250.
16. Baillie, JK, Sultan, P, Graveling, E, Forrest, C, Lafong, C. Contamination of anaesthetic machines with pathogenic organisms. Anaesthesia 2007;62:12571261.
17. Goodman, ER, Platt, R, Bass, R, Onderdonk, AB, Yokoe, DS, Huang, SS. Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intensive care unit rooms. Infect Control Hosp Epidemiol 2008;29:593599.
18. Mulvey, D, Redding, P, Robertson, C, et al. Finding a benchmark for monitoring hospital cleanliness. J Hosp Infect 2011;77:2530.
19. Sherlock, O, O'Connell, N, Creamer, E, Humphreys, H. Is it really clean? an evaluation of the efficacy of four methods for determining hospital cleanliness. J Hosp Infect 2009;72:140146.
20. Boyce, JM, Havill, NL, Havill, HL, Mangione, E, Dumigan, DG, Moore, BA. Comparison of fluorescent marker systems with 2 quantitative methods of assessing terminal cleaning practices. Infect Control Hosp Epidemiol 2011;32:11871193.
21. Carling, PC, Parry, MF, Von Beheren, SM; Healthcare Environmental Hygiene Study Group. Identifying opportunities to enhance environmental cleaning in 23 acute care hospitals. Infect Control Hosp Epidemiol 2008;29:17.
22. Sulis, C, Estanislao, R, Wedel, S, Carling, R Completeness of Cleaning of Critical Care Transport Vehicles. Poster presented at: 5th Decennial International Conference on Health-care Associated Infections, March 10, 2010, Atlanta, GA. Poster 648.
23. Weber, DJ, Rutala, WA. The role of the environment in transmission of Clostridium difficile infection in healthcare facilities. Infect Control Hosp Epidemiol 2011;32:207209.
24. Munoz-Price, LS, Fajardo-Aquino, Y, Arheart, KL. Ultraviolet powder versus ultraviolet gel for assessing environmental cleaning. Infect Control Hosp Epidemiol 2012;33:192195.
25. Boyce, JM, Havill, NL, Lipka, A, Havill, H, Rizvani, R. Variations in hospital daily cleaning practices. Infect Control Hosp Epidemiol 2010;31:99101.
26. Nseir, S, Blazejewski, C, Lubret, R, Wallet, F, Courcol, R, Durocher, A. Risk of acquiring multidrug-resistant gram-negative bacilli from prior room occupants in the intensive care unit. Clin Microbiol Infect 2011;17:12011208.

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Decreasing Operating Room Environmental Pathogen Contamination through Improved Cleaning Practice

  • L. Silvia Munoz-Price (a1) (a2) (a3), David J. Birnbach (a2) (a4), David A. Lubarsky (a4), Kristopher L. Arheart (a2) (a5), Yovanit Fajardo-Aquino (a3), Mara Rosalsky (a3), Timothy Cleary (a6), Dennise DePascale (a3), Gabriel Coro (a3), Nicholas Namias (a7) and Philip Carling (a8) (a9)...

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