Hostname: page-component-848d4c4894-xfwgj Total loading time: 0 Render date: 2024-06-21T12:42:42.920Z Has data issue: false hasContentIssue false
  • English
  • Français

Identification of Clostridium difficile Reservoirs in The Patient Environment and Efficacy of Aerial Hydrogen Peroxide Decontamination

Published online by Cambridge University Press:  16 November 2017

Samuel Yui ,
Shanom Ali ,
Monika Muzslay ,
Annette Jeanes  and
A. Peter R. Wilson
Samuel Yui
Affiliation:
Environmental Microbiology Research Laboratory, University College London Hospitals, London, United Kingdom
Shanom Ali
Affiliation:
Environmental Microbiology Research Laboratory, University College London Hospitals, London, United Kingdom
Monika Muzslay
Affiliation:
Environmental Microbiology Research Laboratory, University College London Hospitals, London, United Kingdom
Annette Jeanes
Affiliation:
Department of Infection Control, University College London Hospitals, London, United Kingdom
A. Peter R. Wilson*
Affiliation:
Department of Microbiology, University College London Hospitals, London, United Kingdom
*
Address correspondence to A. Peter R. Wilson, MD, Department of Clinical Microbiology & Virology, University College London Hospitals, 60 Whitfield Street, London W1T 4EU, UK. Tel. +44 2034479516; fax: +44 02034479211; peter.wilson@uclh.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To identify, using a novel enhanced method of recovery, environmental sites where spores of Clostridium difficile persist despite cleaning and hydrogen peroxide aerial decontamination.

DESIGN

Cohort study.

SETTING

Tertiary referral center teaching hospital.

METHODS

In total, 16 sites representing high-frequency contact or difficult-to-clean surfaces in a single-isolation room or bed area in patient bed bays were sampled before and after terminal or hydrogen peroxide disinfection using a sponge swab. In some rooms, individual sites were not present (eg, there were no en-suite rooms in the ICU). Swab contents were homogenized, concentrated by membrane-filtration, and plated onto selective media. Results of C. difficile sampling were used to focus cleaning.

RESULTS

Over 1 year, 2,529 sites from 146 rooms and 44 bays were sampled. Clostridium difficile was found on 131 of 572 surfaces (22.9%) before terminal cleaning, on 105 of 959 surfaces (10.6%) after terminal cleaning, and on 43 of 967 surfaces (4.4%) after hydrogen peroxide disinfection. Clostridium difficile persisted most frequently on floor corners (97 of 334; 29.0%) after disinfection. Between the first and third quarters, we observed a significant decrease in the number of positive sites (25 of 390 vs 6 of 256). However, no similar change in the number of isolates before terminal cleaning was observed.

CONCLUSION

Persistence of C. difficile in the clinical environment was widespread. Although feedback of results did not improve the efficacy of manual disinfection, numbers of C. difficile following hydrogen peroxide gradually declined.

Infect Control Hosp Epidemiol 2017;38:1487–1492

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 12 , December 2017 , pp. 1487 - 1492
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Zhang, S, Palazuelos-Munoz, S, Balsells, EM, Nair, H, Chit, A, Kyaw, MH. Cost of hospital management of Clostridium difficile infection in United States—a meta-analysis and modelling study. BMC Infect Dis 2016;16:447.CrossRefGoogle ScholarPubMed
2. Ali, S, Moore, G, Wilson, APR. Spread and persistence of Clostridium difficile spores during and after cleaning with sporicidal disinfectants. J Hosp Infect 2011;79:93–98.Google Scholar
3. Ali, S, Muzslay, M, Bruce, M, Jeanes, A, Moore, G, Wilson, AP. Efficacy of two hydrogen peroxide vapour aerial decontamination systems for enhanced disinfection of meticillin-resistant Staphylococcus aureus, Klebsiella pneumoniae and Clostridium difficile in single isolation rooms. J Hosp Infect 2016;93:70–77.Google Scholar
4. Ali, S, Muzslay, M, Wilson, P. A Novel quantitative sampling technique for detection and monitoring of Clostridium difficile contamination in the clinical environment. J Clin Microbiol 2015;53:2570–2574.Google Scholar
5. Humphreys, PN, Finan, P, Rout, S, et al. A systematic evaluation of peracetic acid–based high performance disinfectant. J Infect Prevent 2013;14:126–131.CrossRefGoogle Scholar
6. Ali, S, Yui, S, Muzslay, M, Wilson, APR. Response to letter of Singh K ‘Role of silver nitrate in the efficacy of hydrogen peroxide aerial decontamination systems’ regarding S Ali et al. ‘Efficacy of two hydrogen peroxide vapour aerial decontamination systems for enhanced disinfection of methicillin-resistant Staphylococcus aureus, Klebsiella pneumoniae and Clostridium difficile in single isolation rooms. J Hosp Infect 2017;pii: S0195-6701(17):30398–30405.Google Scholar
7. Otter, JA, Yezli, S, Salkeld, JA, French, GL. Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings. Am J Infect Control 2013;41(5 Suppl):S6–S11.Google Scholar
8. Mitchell, BG, Dancer, SJ, Anderson, M, Dehn, E. Risk of organism acquisition from prior room occupants: a systematic review and meta-analysis. J Hosp Infect 2015;91:211–217.Google Scholar
9. Freedberg, DE, Salmasian, H, Cohen, B. Receipt of antibiotics in hospitalized patients and risk for Clostridium difficile infection in subsequent patients who occupy the same bed. JAMA Intern Med 2016;176:1801–1808.Google Scholar
10. Eyre, DW, Cule, ML, Wilson, DJ, et al. Diverse sources of C. difficile infection identified on whole-genome sequencing. N Engl J Med 2013;369:1195–1205.Google Scholar
11. Pegues, DA, Han, J, Gilmar, C, McDonnell, B, Gaynes, S. Impact of ultraviolet germicidal irradiation for no-touch terminal room disinfection on Clostridium difficile infection incidence among hematology-oncology patients. Infect Control Hosp Epidemiol 2017;38:39–44.Google Scholar
12. McCord, J, Prewitt, M, Dyakova, E, Mookerjee, S, Otter, JA. Reduction in Clostridium difficile infection associated with the introduction of hydrogen peroxide vapour automated room disinfection. J Hosp Infect 2016;94:185–187.Google Scholar
13. Anderson, DJ, Chen, LF, Weber, DJ, et al. Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study. Lancet 2017;389:805–814.Google Scholar
14. Effective health care program. Environmental cleaning for the prevention of healthcare-associated infections. Technical Brief No. 22. Agency for Healthcare Research and Quality website. https://www.effectivehealthcare.ahrq.gov/ehc/products/592/2103/healthcare-infections-report-150810.pdf. Published 2015. Accessed October 16, 2017.Google Scholar
15. Smith, A, Taggart, LR, Lebovic, G, Zeynalova, N, Khan, A, Muller, MP. Clostridium difficile infection incidence: impact of audit and feedback programme to improve room cleaning. J Hosp Infect 2016;92:161–166.CrossRefGoogle ScholarPubMed
16. Moore, G, Smyth, D, Singleton, J, Wilson, P. The use of adenosine triphosphate bioluminescence to assess the efficacy of a modified cleaning program implemented within an intensive care setting. Am J Infect Control 2010;38:617–622.CrossRefGoogle ScholarPubMed
17. Gray, JJ. Cleaning up after carbapenemase-producing organisms. J Hosp Infect 2016;93:135.Google Scholar
18. Boyce, JM. Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals. Antimicrob Resist Infect Control 2016;5:10.Google Scholar
19. Otter, JA, French, GL. Survival of nosocomial bacteria and spores on surfaces and inactivation by hydrogen peroxide vapor. J Clin Microbiol 2009;47:205–207.Google Scholar
20. Blazejewski, C, Wallet, F, Rouzé, A, et al. Efficiency of hydrogen peroxide in improving disinfection of ICU rooms. Crit Care 2015;19:30.Google Scholar