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

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

Use of germicides in health care settings—is there a relationship between germicide use and antimicrobial resistance: A concise review

Despite the widespread use of disinfectants and antiseptics in hospitals, acquired resistance to current disinfectants has rarely been reported. Germicides, as with medications, should only be used when their benefit as demonstrated by scientific studies exceeds possible risks to human health or the environment

Sustainability of a well-established hand hygiene program during the coronavirus disease 2019 (COVID-19) pandemic

Overall, engagement and compliance from the crowd-sourced hand hygiene observation program, Clean-In-Clean-Out (CICO), were similar between 2019 (96.6%) and 2020 (96.7%) despite fluctuations within 2020 that reflected our hospital's coronavirus disease 2019 (COVID-19) experience. Shared responsibility and just-in-time reminders can allow manual hand hygiene observation models to be sustainable

High Levels of Hand-Hygiene Compliance Are a Worthwhile Pursuit

To the Editor—We read with great interest the excellent review of evidence-based recommendations for the prevention of Clostridium difficile infection (CDI) by Louh et al.1 In this article, the authors reviewed 4 studies that assessed the impact of hand-hygiene campaigns to reduce CDI. Based on these papers, the authors did not recommend any hand-hygiene interventions to reduce CDI

Descriptive Analysis of Healthcare-Associated Infections Other than Bloodstream, Respiratory, Urinary Tract, or Surgical Site Infections, 2001–2011

It is estimated that healthcare-associated infections (HAIs) account for approximately 1.7 million infections and 99,000 deaths in US hospitals each year. The Centers for Disease Control and Prevention (CDC) and the National Healthcare Safety Network (NHSN) have developed standardized surveillance definitions of HAIs including surgical site infection (SSI), pneumonia, bloodstream infection (BSI), and urinary tract infection (UTI).2 All HAIs except for these "big four" infection types are categorized as "other" types of HAI. Of the estimated numbers of total HAIs (1,195,142) and deaths associated with HAI (98,987) in US hospitals among adults and children outside of intensive care units (ICUs), other types of HAI accounted for 22% (263,810) and 11% (11,062) of deaths, respectively, which suggests that other HAIs represent a substantial burden in US healthcare facilities

What's in A Name? A Cluster of Hospital Epidemiologists

To the Editor—To paraphrase an African proverb, it takes a village to successfully reduce a healthcare facility’s rate of healthcare-associated infections.1 Most people are aware of terms used for common groups of animals such as a “pack” of dogs, “school” of fish, “flock” of birds, and “herd” of horses.2,3 Less common terms include a “scourge” of mosquitoes, a “parliament” of owls, a “crash” of rhinoceroses, a “dazzle” of zebras, a “murder” of crows, and a “tower” of giraffes.2,3 Collective terms for groups of humans have also been used such as a “hastiness” of cooks, a “stalk” of foresters, a “bevy” of ladies, and a “pity” of prisoners.

Filtration Efficiency of Hospital Face Mask Alternatives Available for Use during the COVID-19 Pandemic

Importance: Procuring respiratory protection for clinicians and other health care workers has become a major challenge of the coronavirus disease 2019 (COVID-19) pandemic and has resulted in nonstandard practices such as the use of expired respirators and various decontamination processes to prolong the useful life of respirators in health care settings. In addition, imported, non-National Institute for Occupational Safety and Health (NIOSH)-approved respirators have been donated or acquired by hospitals as a potential replacement for limited NIOSH-approved N95 respirators. Objective: To assess fitted filtration efficiencies (FFEs) for face mask alternatives used during the COVID-19 pandemic. Design, Setting, and Participants: For this quality-improvement study conducted between April and June 2020, we used the Occupational Safety and Health Administration's Quantitative Fit Testing Protocol for Filtering Facepiece Respirators in a laboratory atmosphere supplemented with sodium chloride particles to assess the FFEs of a variety of respirators worn by a male volunteer and female volunteer. Main Outcomes and Measures: The FFEs of respirators commonly worn by clinicians and other health care workers and available respirator alternatives during the COVID-19 pandemic. Results: Of the 29 different fitted face mask alternatives tested on 1 man and 1 woman, expired N95 respirators with intact elastic straps and respirators subjected to ethylene oxide and hydrogen peroxide sterilization had unchanged FFE (>95%). The performance of N95 respirators in the wrong size had slightly decreased performance (90%-95% FFE). All of the respirators not listed as approved in this evaluation (n = 6) failed to achieve 95% FFE. Neither of the 2 imported respirators authorized for use by the Centers for Disease Control and Prevention that were not NIOSH-approved tested in this study achieved 95% FFE, and the more effective of the 2 functioned at approximately 80% FFE. Surgical and procedural face masks had filtering performance that was lower relative to that of N95 respirators (98.5% overall FFE), with procedural face masks secured with elastic ear loops showing the lowest efficiency (38.1% overall FFE). Conclusions and Relevance: This quality-improvement study evaluating 29 face mask alternatives for use by clinicians interacting with patients during the COVID-19 pandemic found that expired N95 respirators and sterilized, used N95 respirators can be used when new N95 respirators are not available. Other alternatives may provide less effective filtration

What's new in reprocessing endoscopes: Are we going to ensure “the needs of the patient come first” by shifting from disinfection to sterilization?

Millions of gastrointestinal endoscopes are performed each year in the United States. Gastrointestinal endoscopes become highly contaminated during use (ie, internal channels contain 7-10-log10 enteric microorganisms). Currently, endoscopes (eg, bronchoscopes and gastrointestinal endoscopes) are classified as semicritical items because they contact intact mucous membranes and most commonly undergo cleaning followed by high-level disinfection, which may result in as little as a 6 -log10 reduction of microorganisms. Therefore, and not surprisingly, in recent years there have been multiple reports that have documented that endoscopes, especially duodenoscopes, frequently remain contaminated with bacterial pathogens after proper cleaning and disinfection. Multiple outbreaks of multidrug-resistant organisms from contaminated duodenoscopes have resulted in substantial death and morbidity. Because duodenoscopes commonly contact nonintact mucous membranes and sterile tissue, such endoscopes should be considered critical items. We propose that to ensure patient safety, we follow the Spaulding scheme and move from high-level disinfection to sterilization of reusable endoscopes or use an alternative diagnostic/therapeutic method (eg, disposable sterile endoscopes)

New and emerging infectious diseases (Ebola, Middle Eastern respiratory syndrome coronavirus, carbapenem-resistant Enterobacteriaceae, Candida auris): Focus on environmental survival and germicide susceptibility

In the recent past, we have witnessed the emergence of many new infectious diseases, some of which are major public health threats. The public health threats posed by emerging diseases have been well described in 2 reports from the Institute of Medicine, 1 in 1992 and 1 in 2001.1,2 Since the outbreak of Legionella in 19763,4 and AIDS in 19815,6 later demonstrated to be due to HIV in 1983,7 many emerging infectious diseases have had important infection control implications. This review will focus on several of the most important current infection prevention threats including Ebola virus, Middle Eastern respiratory syndrome (MERS) coronavirus (CoV), carbapenem-resistant Enterobacteriaceae (CRE), and Candida auris with a focus on mechanisms of transmission, environmental contamination and stability, and germicide susceptibility. Germicides that will be discussed include chemical sterilants used to process critical equipment and devices (eg, surgical instruments, implants), high-level disinfectants that are used to disinfect semicritical equipment and devices (ie, medical equipment or devices that come into contact with nonintact skin or mucous membranes), low-level disinfectants used for disinfection of surfaces or shared equipment that come into contact with intact skin (eg, blood pressure cuffs, room surfaces), and antiseptics (ie, germicides used on skin or mucous membranes to reduce the microbial flora).8,9 This review updates a previous article that reviewed Ebola and MERS and also reviews CRE and C auris