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Efficacy of disinfectants and detergents for cleaning hospital environmental surfaces as part of documented cleaning protocols
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Vol. 33 No. 5
K Feigenbaum D Henderson National Institutes of Health Clinical Center, Bethesda, Maryland ISSUE: Our clinical center (CC) strives to provide a consistent standard of care across its continuum of clinical services. At the time of our last accreditation survey in 2003, questions were raised about the consistent use of OPA. PROJECT: As part of its mission, the CC must address standards of practice for high-level disinfection including documentation standards. The CC already had in place an OPA education system. Because of the concern raised by accreditation surveyors, the hospital epidemiology service worked with the 11 users of OPA and hospital central supply to design and implement a flow sheet to facilitate documentation. We developed infection control guidelines for the use of OPA test strips based on recommendations from the manufacturer and the available literature. RESULTS: We convened a small task force to identify where documentation was inadequate. This group met in person initially, but subsequently only by e-mail. The group crafted a three-page flowchart that followed the manufacturer’s recommendations and CDC guidelines, but which was tailored to the unique needs of our existing infrastructure. This process was reviewed by: 1) hospital infections committee, 2) hospital central supply, and 3) an expert in hospital epidemiology. Detailed follow-up sessions were conducted with all product users. To ensure compliance with new documentation requirements, a detailed check sheet for monitoring OPA documentation and process was also developed. LESSONS LEARNED: To ensure standard care across the continuum, development of a hospital-wide documentation system requires constant monitoring and detailed ongoing assessment to ensure both understanding and compliance. Monitoring use of OPA in our organization created a dialogue with our ancillary services and improved the compliance for documentation but also served as a model for improving organizational communication.
Abstract ID 52436 Tuesday, June 21
Efficacy of disinfectants and detergents for cleaning hospital environmental surfaces as part of documented cleaning protocols P Obee C Griffith RZ Greten UWIC, Cardiff, Great Britain BACKGROUND: Concern over increasing nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection rates in the United Kingdom has led to discussion of routine environmental surface cleaning in hospitals. Documented cleaning protocols ensure better compliance and describe in detail the steps needed to clean specific surfaces and may specify the use of a detergent or disinfectant. Although disinfectants have antimicrobial activity, concerns have been expressed about antibiotic resistance, risks to human health from prolonged exposure, and wider environmental issues. Detergents are better at detaching soil from surfaces. However, if the detached soil is not removed, reattachment and recolonization can occur. The aim of the investigation was to assess the ability of cleaning protocols, with and without disinfectants, to reduce microbial counts on hospital environmental surfaces. METHODS: A general surgical ward of a 500-bed hospital was selected. After existing cleaning practices had been completed, surface counts were taken from eight designated environmental surfaces, using direct contact methods. This was repeated every day for 14 days to obtain baseline contamination levels. Existing cleaning protocols were evaluated and modified in accordance with best practice. The 14-day sampling cycle was repeated
June 2005
E39
using modified protocols with existing non-ionic detergent. This was followed by another 14-day cycle, using a quaternary ammonium compound (QAC) disinfectant in place of the existing detergent. Surface counts for each site were compared using ANOVA with Tukey comparisons (p=0.05). RESULTS: Compared to the existing protocol, the modified cleaning significantly reduced contamination on 7/8 surfaces using the existing detergent and 8/8 using QAC. No significant difference was seen between modified protocols using detergent and QAC disinfectant on any surface. The most contaminated site was the patient’s toilet sink handle (mean 9.3 cfu/cm2, range 1.8–25 cfu/cm2 using existing protocols), but both modified protocols reduced this figure to .0.5 cfu/cm2. The least contaminated site with existing cleaning protocols was the ward sink handles (0.9 cfu/cm2, range 0.1–6.5 cfu/cm2). Both modified protocols reduced this figure to .0.5 cfu/cm2. CONCLUSIONS: Optimizing cleaning methods can significantly reduce surface counts and may be more important in microbial removal than the requirement to use a disinfectant.
Abstract ID 53988 Tuesday, June 21
The clinical application of hazard analysis critical control points (HACCP) C Griffith P Obee R Cooper UWIC, Cardiff, Great Britain BACKGROUND/OBJECTIVES: In the United Kingdom, healthcare-associated infections (HAIs) continue to attract media and consumer attention, to impact upon healthcare delivery, and to cause morbidity and mortality. ‘‘Winning ways’’ (a UK hospital action plan) has identified seven action areas, including one that recommends use of hazard analysis critical control points (HACCP), although little guidance on its application is provided. This study applies approaches and strategies based upon HACCP and relevant prerequisite programs (PRPs) (an approach used in the food industry) to the decontamination of endoscopes. METHODS: The reprocessing of endoscopes in two hospitals was audited, including observations of practices combined with examination of the documentation. The procedures used were compared to the British Society of Gastroenterology guidelines and the seven HACCP principles and 12 logic sequences outlined by the Codex Alimentarius. RESULTS: Endoscope reprocessing was conducted in accordance with the British Society of Gastroenterology guidelines in both hospitals. A process flow diagram was produced as part of the HACCP approach. Comparison of in-use practices with HACCP principles indicated that neither unit implemented all HACCP steps and that there was variability between units. One unit partially implemented two logic sequence steps, the other partially implemented seven. Monitoring (as defined by the Codex Alimentarius) indicated that cleaning, an essential step prior to decontamination, was often not adequately performed. CONCLUSION: Guidelines exist on the principles for reprocessing endoscopes, although the way these are to be implemented and managed is not so clearly articulated. The HACCP and PRP approach can be applied to reprocessing endoscopes and could help to provide a more structured approach to managing the process. Suggestions are also provided on how HACCP could be applied to other clinical procedures.
Vol. 33 No. 5
K Feigenbaum D Henderson National Institutes of Health Clinical Center, Bethesda, Maryland ISSUE: Our clinical center (CC) strives to provide a consistent standard of care across its continuum of clinical services. At the time of our last accreditation survey in 2003, questions were raised about the consistent use of OPA. PROJECT: As part of its mission, the CC must address standards of practice for high-level disinfection including documentation standards. The CC already had in place an OPA education system. Because of the concern raised by accreditation surveyors, the hospital epidemiology service worked with the 11 users of OPA and hospital central supply to design and implement a flow sheet to facilitate documentation. We developed infection control guidelines for the use of OPA test strips based on recommendations from the manufacturer and the available literature. RESULTS: We convened a small task force to identify where documentation was inadequate. This group met in person initially, but subsequently only by e-mail. The group crafted a three-page flowchart that followed the manufacturer’s recommendations and CDC guidelines, but which was tailored to the unique needs of our existing infrastructure. This process was reviewed by: 1) hospital infections committee, 2) hospital central supply, and 3) an expert in hospital epidemiology. Detailed follow-up sessions were conducted with all product users. To ensure compliance with new documentation requirements, a detailed check sheet for monitoring OPA documentation and process was also developed. LESSONS LEARNED: To ensure standard care across the continuum, development of a hospital-wide documentation system requires constant monitoring and detailed ongoing assessment to ensure both understanding and compliance. Monitoring use of OPA in our organization created a dialogue with our ancillary services and improved the compliance for documentation but also served as a model for improving organizational communication.
Abstract ID 52436 Tuesday, June 21
Efficacy of disinfectants and detergents for cleaning hospital environmental surfaces as part of documented cleaning protocols P Obee C Griffith RZ Greten UWIC, Cardiff, Great Britain BACKGROUND: Concern over increasing nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection rates in the United Kingdom has led to discussion of routine environmental surface cleaning in hospitals. Documented cleaning protocols ensure better compliance and describe in detail the steps needed to clean specific surfaces and may specify the use of a detergent or disinfectant. Although disinfectants have antimicrobial activity, concerns have been expressed about antibiotic resistance, risks to human health from prolonged exposure, and wider environmental issues. Detergents are better at detaching soil from surfaces. However, if the detached soil is not removed, reattachment and recolonization can occur. The aim of the investigation was to assess the ability of cleaning protocols, with and without disinfectants, to reduce microbial counts on hospital environmental surfaces. METHODS: A general surgical ward of a 500-bed hospital was selected. After existing cleaning practices had been completed, surface counts were taken from eight designated environmental surfaces, using direct contact methods. This was repeated every day for 14 days to obtain baseline contamination levels. Existing cleaning protocols were evaluated and modified in accordance with best practice. The 14-day sampling cycle was repeated
June 2005
E39
using modified protocols with existing non-ionic detergent. This was followed by another 14-day cycle, using a quaternary ammonium compound (QAC) disinfectant in place of the existing detergent. Surface counts for each site were compared using ANOVA with Tukey comparisons (p=0.05). RESULTS: Compared to the existing protocol, the modified cleaning significantly reduced contamination on 7/8 surfaces using the existing detergent and 8/8 using QAC. No significant difference was seen between modified protocols using detergent and QAC disinfectant on any surface. The most contaminated site was the patient’s toilet sink handle (mean 9.3 cfu/cm2, range 1.8–25 cfu/cm2 using existing protocols), but both modified protocols reduced this figure to .0.5 cfu/cm2. The least contaminated site with existing cleaning protocols was the ward sink handles (0.9 cfu/cm2, range 0.1–6.5 cfu/cm2). Both modified protocols reduced this figure to .0.5 cfu/cm2. CONCLUSIONS: Optimizing cleaning methods can significantly reduce surface counts and may be more important in microbial removal than the requirement to use a disinfectant.
Abstract ID 53988 Tuesday, June 21
The clinical application of hazard analysis critical control points (HACCP) C Griffith P Obee R Cooper UWIC, Cardiff, Great Britain BACKGROUND/OBJECTIVES: In the United Kingdom, healthcare-associated infections (HAIs) continue to attract media and consumer attention, to impact upon healthcare delivery, and to cause morbidity and mortality. ‘‘Winning ways’’ (a UK hospital action plan) has identified seven action areas, including one that recommends use of hazard analysis critical control points (HACCP), although little guidance on its application is provided. This study applies approaches and strategies based upon HACCP and relevant prerequisite programs (PRPs) (an approach used in the food industry) to the decontamination of endoscopes. METHODS: The reprocessing of endoscopes in two hospitals was audited, including observations of practices combined with examination of the documentation. The procedures used were compared to the British Society of Gastroenterology guidelines and the seven HACCP principles and 12 logic sequences outlined by the Codex Alimentarius. RESULTS: Endoscope reprocessing was conducted in accordance with the British Society of Gastroenterology guidelines in both hospitals. A process flow diagram was produced as part of the HACCP approach. Comparison of in-use practices with HACCP principles indicated that neither unit implemented all HACCP steps and that there was variability between units. One unit partially implemented two logic sequence steps, the other partially implemented seven. Monitoring (as defined by the Codex Alimentarius) indicated that cleaning, an essential step prior to decontamination, was often not adequately performed. CONCLUSION: Guidelines exist on the principles for reprocessing endoscopes, although the way these are to be implemented and managed is not so clearly articulated. The HACCP and PRP approach can be applied to reprocessing endoscopes and could help to provide a more structured approach to managing the process. Suggestions are also provided on how HACCP could be applied to other clinical procedures.