Ultraviolet-C decontamination of hand-held tablet devices in the healthcare environment using the Codonics D6000™ disinfection system

Mobile phones and tablet computers may be contaminated with micro-organisms and become a potential reservoir for cross-transmission of pathogens between healthcare workers and patients. There is no generally accepted guidance on how to reduce contamination on mobile devices in healthcare settings. Our aim was to determine the efficacy of the Codonics D6000™ UV-C disinfection device. Daily disinfection reduced contamination on screens and on protective cases (test) significantly, but not all cases (control) could be decontaminated. The median aerobic colony count on the control and the test cases was 52 cfu/25 cm2 (interquartile range: 33-89) and 22 cfu/25 cm2 (10.5-41), respectively, before disinfection

ESBL-producing Gram-negative organisms in the healthcare environment as a source of genetic material for resistance in human infections

BACKGROUND: The increasing prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in the healthcare setting and in the community despite established infection control guidelines indicates that these microorganisms may possess survival strategies that allow them to persist in the environment. AIMS: To determine the extent and variation in endemic ESBL-carrying species in different ward environments, and to investigate the potential for cephalosporin resistance to be transferred from environmental isolates to human pathogens. METHODS: Conventional microbiological methods were used to sample 1436 environmental surfaces for ESBL-producing bacteria. Transconjugation assays (broth mating experiments) were performed using environmental ESBL-producing isolates as donors and streptomycin-resistant Escherichia coli (NCTC 50237) as the recipient. FINDINGS: The prevalence of ESBL-producing bacteria on surfaces in a non-outbreak setting was low (45/1436; 3.1%). The sites most likely to be contaminated were the drains of handwash basins (28/105; 26.7%) and floors (14/160; 8.8%). Fifty-nine ESBL-carrying organisms were isolated. Of these, Klebsiella spp. (33.9%), Enterobacter spp. (20.3%), Pantoea spp. (15.3%) and Citrobacter spp. (13.6%) were the most common isolates. ESBL determinants were transferred successfully from three representative environmental isolates (Pantoea calida, Klebsiella oxytoca, Raoultella ornithinolytica) to the human pathogen E. coli. CONCLUSIONS: ESBL-producing Gram-negative isolates were recovered from the hospital environment in the absence of any ESBL infection on the wards. The drains of handwash basins should be considered potential long-term reservoirs of multi-drug-resistant bacteria and drug resistance genes. These genes can reside in various genera of hardy environmental organisms and be a potential source of ESBL for more common human pathogens

Keypad mobile phones are associated with a significant increased risk of microbial contamination compared to touch screen phones

The use of mobile phones in the clinical environment by healthcare workers has become widespread. Despite evidence that these devices can harbour pathogenic micro-organisms there is little guidance on how to reduce contamination. Recently touchscreen phones with a single flat surface have been introduced. We hypothesise that bacterial contamination of phones used in hospitals will be lower on touchscreen devices compared to keypad devices. Sixty seven mobile phones belonging to health care workers were sampled. The median colony count for touchscreen phones and keypad devices was 0·09 colony forming units (cfu)/cm2 (interquartile range (IQR) 0.05–0·14) and 0·77 cfu/cm2 (IQR range 0·45–3.52) respectively. Colony counts were significantly higher on the keypad phones (Fisher’s exact test p<0.001). Multivariate analysis showed the type of phone (keypad vs. touch screen) was associated with increased colony counts (F-statistic 14.13: p<0.001). Overall, nine (13%) phones grew either meticillin resistant Staphylococcus aureus or vancomycin resistant enterococci. Eight (24%) keypad phones were contaminated with these organisms compared with one touch screen phone (3%). Our data indicate that touchscreen mobile phones are less contaminated than their keypad counterparts, and they are less likely to harbour pathogenic bacteria in the clinical setting

Comparison of Two Whole-Room UV-Irradiation Systems for Enhanced Disinfection of Patient Rooms Contaminated with MRSA, carbapenemase-producing Klebsiella pneumoniae and Clostridium difficile spores

BACKGROUND: Ultraviolet light decontamination systems are being used increasingly to supplement terminal disinfection of patient rooms. However efficacy may not be consistent in the presence of soil particularly against Clostridium difficile spores. AIM: To demonstrate in-use efficacy of two whole-room UV decontamination systems against three hospital pathogens with and without soil. METHODS: For each system, six patient rooms were decontaminated with UV-irradiation (enhanced-disinfection) following manual terminal cleaning. Total aerobic colony counts of surface contamination were determined by spot-sampling 15 environmental sites before and after terminal disinfection and after UV-irradiation. Efficacy against biological indicator coupons (stainless-steel discs) was performed for each system using test bacteria (10(6) cfu EMRSA-15 variant A, carbapenemase-producing K. pneumoniae) or spores (10(5) cfu C. difficile 027), incorporating low soiling (0.03% bovine serum albumin [BSA]), heavy soiling (10%BSA) or synthetic faeces (C. difficile only) placed at five locations in the room. FINDINGS: UV disinfection eliminated contamination after terminal cleaning in 8/14 (57%) and 11/14 (79%) sites. Both systems demonstrated 4 to 5 log10 reductions in MRSA and Klebsiella pneumoniae at low soiling. Lower and more variable log10 reductions were achieved when heavy soiling present. Between 0.1 and 4.8 log10 reductions in Clostridium difficile spores were achieved with low but not heavy soil challenge. CONCLUSION: Terminal disinfection should be performed on all surfaces prior to UV decontamination. In-house validation studies should be considered to ensure optimal positioning in each room layout and sufficient cycle duration to eliminate target pathogens

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

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

Best practice in healthcare environment decontamination

There is now strong evidence that surface contamination is linked to healthcare-associated infections (HCAIs). Cleaning and disinfection should be sufficient to decrease the microbial bioburden from surfaces in healthcare settings, and, overall, help in decreasing infections. It is, however, not necessarily the case. Evidence suggests that there is a link between educational interventions and a reduction in infections. To improve the overall efficacy and appropriate usage of disinfectants, manufacturers need to engage with the end users in providing clear claim information and product usage instructions. This review provides a clear analysis of the scientific evidence supporting the role of surfaces in HCAIs and the role of education in decreasing such infections. It also examines the debate opposing the use of cleaning versus disinfection in healthcare settings