A Review of Single-Use and Reusable Gowns and Drapes in Health Care

Gowns and drapes are used widely in healthcare facilities. Gowns have been used to minimize the risk of disease acquisition by healthcare providers, to reduce the risk of patient-to-patient transmission, and during invasive procedures to aid in maintaining a sterile field. Drapes have been used during invasive procedures to maintain the sterility of environmental surfaces, equipment, and patients. This article reviews the use of gowns and drapes in healthcare facilities, including the characteristics, costs, benefits, and barrier effectiveness of single-use and reusable products. Currently, gowns protect healthcare personnel performing invasive procedures from contact with bloodborne pathogens. Although gowns have been recommended to prevent patient-to-patient transmission in certain settings (eg, neonatal intensive care unit) and for certain patients (eg, those infected with vancomycin-resistant enterococci), scientific studies have produced mixed results of their efficacy. While appropriate use of drapes during invasive procedures is recommended widely as an aid in minimizing contamination of the operative field, the efficacy of this practice in reducing surgical-site infections has not been assessed by scientific studies. Based on an evaluation of the functional requirements, environmental impact, and economics of gowns and drapes, clear superiority of either reusable or single-use gowns and drapes cannot be demonstrated. The selection of particular gowns and drapes by individual healthcare facilities requires an assessment of the facility's requirements, available products, and costs and should be based on the desired characteristics of an ideal gown or drape as defined in this paper

Efficacy of a Washer-Disinfector in Eliminating Healthcare-Associated Pathogens from Surgical Instruments

This study was designed to test the efficacy of a washer-disinfector in eliminating selected healthcare-associated pathogens from surgical instruments. Our results showed that a washer-disinfector was extremely effective in eliminating microorganisms (>7-log 10 reduction), including vegetative and spore-forming bacteria, from experimentally contaminated instruments. The washer-disinfector remained effective in eliminating microorganisms in the absence of enzymatic cleaners and detergents. Infect Control Hosp Epidemiol 2014;35(7):883–88

Effectiveness of a hydrogen peroxide mist (Trophon) system in inactivating healthcare pathogens on surface and endocavitary probes

they are considered noncritical and require at least low-level disinfection between patients. Endocavitary probes (eg, transvaginal, transrectal, or transesophageal probes) are considered semicritical because they have direct contact with mucous membranes (eg, vagina, rectum, or pharynx) or nonintact skin. While one could argue that the use of the probe cover changes the category for the endocavitary probe, the Centers for Disease Control and Prevention (CDC) guideline for disinfection and sterilization recommends that a new condom/probe cover should be used for each patient, and because condoms/probe covers and low-level disinfection may fail, high-level disinfection of the probe should be performed. The relevance of this recommendation is reinforced by the finding that sterile ultrasound probe covers and condoms can have a perforation rate from 0% to 81% before and after use. These studies underscore the need for high-level disinfection of endocavitary probes between examinations.Ultrasound probes are used in sonographic scanning and are commonly used as either surface probes or endocavitary probes. Surface probes are used on intact skin, such as the abdome

‘No touch’ technologies for environmental decontamination: focus on ultraviolet devices and hydrogen peroxide systems

PURPOSE OF REVIEW: This article reviews 'no touch' methods for disinfection of the contaminated surface environment of hospitalized patients' rooms. The focus is on studies that assessed the effectiveness of ultraviolet (UV) light devices, hydrogen peroxide systems, and self-disinfecting surfaces to reduce healthcare-associated infections (HAIs). RECENT FINDINGS: The contaminated surface environment in hospitals plays an important role in the transmission of several key nosocomial pathogens including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus spp., Clostridium difficile, Acinetobacter spp., and norovirus. Multiple clinical trials have now demonstrated the effectiveness of UV light devices and hydrogen peroxide systems to reduce HAIs. A limited number of studies have suggested that 'self-disinfecting' surfaces may also decrease HAIs. SUMMARY: Many studies have demonstrated that terminal cleaning and disinfection with germicides is often inadequate and leaves environmental surfaces contaminated with important nosocomial pathogens. 'No touch' methods of room decontamination (i.e., UV devices and hydrogen peroxide systems) have been demonstrated to reduce key nosocomial pathogens on inoculated test surfaces and on environmental surfaces in actual patient rooms. Further UV devices and hydrogen peroxide systems have been demonstrated to reduce HAI. A validated 'no touch' device or system should be used for terminal room disinfection following discharge of patients on contact precautions. The use of a 'self-disinfecting' surface to reduce HAI has not been convincingly demonstrated

Healthcare Outbreaks Associated With a Water Reservoir and Infection Prevention Strategies

Hospital water may serve as a reservoir of healthcare-associated pathogens, and contaminated water can lead to outbreaks and severe infections. The clinical features of waterborne outbreaks and infections as well as prevention strategies and control measures are reviewed. The common waterborne pathogens were bacteria, including Legionella and other Gram-negative bacteria, and nontuberculous mycobacteria, although fungi and viruses were occasionally described. These pathogens caused a variety of infections, including bacteremia, invasive and disseminated diseases, particularly among immunocompromised hosts and critically ill adults as well as neonates. Waterborne outbreaks occurred in healthcare settings with emergence of new reported reservoirs, including electronic faucets (Pseudomonas aeruginosa and Legionella), decorative water wall fountains (Legionella), and heater-cooler devices used in cardiac surgery (Mycobacterium chimaera). Advanced molecular techniques are useful for achieving a better understanding of reservoirs and transmission pathways of waterborne pathogens. Developing prevention strategies based on water reservoirs provides a practical approach for healthcare personnel

New Disinfection and Sterilization Methods

New disinfection methods include a persistent antimicrobial coating that can be applied to inanimate and animate objects (Surfacine), a high-level disinfectant with reduced exposure time (ortho-phthalaldehyde), and an antimicrobial agent that can be applied to animate and inanimate objects (superoxidized water). New sterilization methods include a chemical sterilization process for endoscopes that integrates cleaning (Endoclens), a rapid (4-hour) readout biological indicator for ethylene oxide sterilization (Attest), and a hydrogen peroxide plasma sterilizer that has a shorter cycle time and improved efficacy (Sterrad 50)

Reply to Randal W. Eveland regarding comparative evaluation of the microbicidal activity of low-temperature sterilization technologies to steam sterilization

To the Editor—We thank Dr Randal Eveland, Steris Corporation, for his letter regarding our paper that compared the microbicidal activity of low-temperature sterilization technologies (ie, vaporized hydrogen peroxide [VHP], ethylene oxide [ETO], and hydrogen peroxide gas plasma [HPGP]) to steam sterilization in the presence of salt and serum to simulate inadequate precleaning. As noted in our paper, the literature contains a paucity of information on the comparative microbicidal activity of the sterilization technologies cleared by the Food and Drug Administration (FDA) for sterilizing medical and surgical devices. We believe that the data from this study will help clinicians in infection prevention assess the robustness of healthcare sterilization technologies and the risk of infection to patients when an uncleaned instrument is unintentionally brought into the operating room or used on a patient