29 research outputs found
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
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.
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
Reply to Saliou et al
TO THE EDITOR—We thank Saliou et al [1]
for their comments and interest in our review
article [2].Fungal outbreaks and infections
can occur in healthcare settings with
or without construction, renovation, or
demolition. Our review uniquely focused
on human fungal outbreaks and infections
in healthcare settings during construction,
renovation, or demolition, avoiding the
combined analysis of infections and contamination
[2]. Eckmanns et al reviewed
the efficacy of high-efficiency particulate
air (HEPA) filtration in the prevention of
fungal infection and mortality in patients
who received a bone marrow transplant
[3]. Their study is not relevant because
they assessedHEPA filtration as part of routine
care and not during hospital construction,
renovation, or demolition (only 1 of
the 16 articles they reviewed assessed protection
during hospital construction
Antimicrobial activity of a continuously active disinfectant against healthcare pathogens
A novel disinfectant studied using an EPA protocol demonstrated sustained antimicrobial activity (ie, 3-5 log10 reduction) in 5 minutes after 24 hours for Staphylococcus aureus, vancomycin-resistant Enterococcus, Candida auris, carbapenem-resistant Escherichia coli and antibiotic-susceptible E. coli, and Enterobacter spp. Only ∼2 log10 reduction occurred with carbapenem-resistant Enterobacter spp and K. pneumoniae, and antibiotic-susceptible K. pneumoniae