The Key to Controlling HAIs: Focus on the Environment and New Technologies
Many heath care-associated pathogens are a result of environment, according to a paper about controlling Hospital-Acquired Infections (HAIs), Stephanie J. Dancer, of the Department of Microbiology at Hairmyres Hospital, Scotland, United Kingdom. Dangerous pathogens are spread inadvertently by staff and patients within a hospital setting. They can contaminate surfaces for several days and spread to other patients or staff members. “Recent studies suggest that the risk of acquiring VRE, MRSA Acinetobacter spp., Pseudomonas spp., or C. difficile is increased if a new admission is placed in a room previously occupied with one of these pathogens,” according to the paper. In an investigation that followed a sudden increase in patient acquiring Acinetobacter in a pediatric burn unit, it was discovered that frequently touched clinical equipment were an “outbreak reservoir.” The outbreak took place soon after computers were installed at the bedside of each patient. When the rooms were cleaned, it was discovered that pathogens were present on many surfaces throughout the rooms, including the plastic keyboard covers.
The installation of computers at every bedside in a pediatric burn ward resulted in an outbreak of Acinetobacter.
“It appears that even stringent manual cleaning with disinfection does not necessarily eliminate Acinetobacter completely from the environment. The reasons for this are unknown but probably include poor cleaning practices, missing high-risk sites, overwhelming bioburden, and tolerance to, or misuse of, disinfectants,” according to the paper. Surfaces fall into two categories: critical and noncritical. Noncritical include places like doors, wall fixtures, floors and furniture. Critical areas include surfaces that are handled frequently like buttons, switches, bed controls and keyboards. “Repeated handling increases the risk of contamination by pathogens, which then leads to hand-based transmission. THese items are likely to benefit from enhanced cleaning, including disinfection.” It is true to say that cleaning is not the same as disinfection, although the two terms are habitually interchanged.
Acinetobacter is multi-drug resistant and is responsible for outbreaks in many hospitals.
“Current cleaning specifications may not be targeting the correct sites, or, if they are, they may not be applied frequently enough,” according to the paper. “Cleaning and disinfection should be focused on routine decontamination of high-risk surfaces, i.e., the sites more likely to harbor pathogens from handles, switches, buttons, knobs, and other frequently touched (and often forgotten) sites is more likely to have an impact on patient transmission than cleaning inaccessible surfaces such as high shelves, ledges, or ceilings or low-touch surfaces such as walls and window panes…Cleaning specifications should encompass the fact that overall cleaning quality is determined not only by the applied method but also by the appropriateness of the method for the type of surface being treated.
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