- Email: [email protected]
P9.01 Susceptibility of Germinating Clostridium difficile Spores to 70% Ethanol
Poster Presentations P9.01 Susceptibility of Germinating Clostridium difficile Spores to 70% Ethanol L.J. Wheeldon1 *, T. Worthington1 , A.C. Hilton1 , P.A. Lambert1 , T.S.J. Elliott2 . 1 Aston University, UK, 2 Queen Elizabeth Hospital, Birmingham, UK Background: The number of cases of Clostridium difficile associated disease has risen significantly over the past decade and C. difficile is now the leading cause of nosocomial diarrhoea. One contributing factor to the increasing incidence is the persistence of C. difficile spores in the clinical environment which is associated with their resistance to many common disinfectants (e.g. alcohol-based products). Many disinfectants that eliminate C. difficile spores, including bleach, iodine and aldehydes are hazardous to the healthcare worker. However, it is well recognized that germination of bacterial spores is associated with increased susceptibility to many antimicrobials, including disinfectants. Aims: The aim of this investigation was to determine if germination of C. difficile spores increased their susceptibility to 70% ethanol. Methods: A carrier test system was designed comprising germination of C. difficile spores with 0.1% (w/v) sodium taurocholate in thioglycolate medium for 30 minutes followed by exposure to 70% (v/v) ethanol. Viability of C. difficile spores was subsequently determined by culturing suspensions on Fastidious Anaerobic agar. Two control carrier systems comprising saline replacing either 0.1% sodium taurocholate prior to germination or 70% ethanol post germination were also included. Results: A 2-log reduction in germinating C. difficile spores was achieved within 60 minutes following exposure to 70% ethanol. There was no reduction in the number of C. difficile spores in control carrier test systems. Discussion: These preliminary results suggest that germination of C. difficile spores increases their susceptibility to 70% ethanol and therefore potentially other disinfectants commonly used in the clinical setting. A two-stage cleaning process comprising germination followed by disinfection may offer an alternative approach to reducing C. difficile spores. Additional studies are required to further investigate these initial findings. P9.02 Decontamination of Hospital Linens Through the Wash Cycle: Quantitative and Qualitative Analysis of the Bacterial Load S. De Lorenzi *, G. Salvatorelli. University of Ferrara, Italy Background: Thermo-chemical processes involved in washing with a tunnel washer and washer extractor plus heat dryingironing restore the sensorial quality and hygiene to hospital linens. Aims: 13 wash cycles in a tunnel washer (on cotton items) and 10 in a washer extractor (high-tech items) were examined to evaluate the microbe count in the waters and on the items after the washing and drying process was completed. Materials and Methods: The quantitative evaluation was performed by mass insemination on a non selective medium. The qualitative evaluation was performed by surface insemination on a non selective medium, Gram dying, subculturing in a selective medium and API identification. Results: (1) The initial microbial load in the water was higher in the tunnel washer (6.01±0.76 log cfu/ml) than in the washer extractor (3.53±1.28 log UFC/ml); in both cases, a 3 log reduction was seen in the rinse. In the tunnel washer, during soaking the predominant bacterial families found were Enterobatteriaceae, Pseudomonadaceae and Aeromonadaceae, while Pseudomonadaceae and Micrococcaceae dominated in the rinse. An increase in enterobacteria was found at pressing and molds and non Candida yeasts, were frequent. In the washer extractor, the wash water most frequently presented
S47 Micrococcaceae, in particular staphylococcus. In both wash processes, unfermented Gram negative bacteria of uncertain systemic origin were present. (2) At the end of the wash process, the items presented 2 log bacterial loads and after drying the cfu number was nearly always <10 cfu/50 cm2. On moist cotton, the contamination was mainly made up of enterobacteria and mold. In the high tech items and all dried items, contamination mainly involved staphylococcus and mold. On the finished products, pathogens were never found. Conclusion: The wash and drying cycles would appear to guarantee good decontamination of the items. P9.03 The Effect of Construction Work on Clostridium difficile Following Short-Term Reallocation of Hospital Cleaning Teams M. Kiernan *, J.A. Bowley, C. Jukka. Southport and Ormskirk Hospital NHS Trust, UK Background: Clostridium difficile infection results in significant morbidity and mortality. A high incidence of cases is often related to antibiotic prescribing practices and hygiene standards in the healthcare environment. Although data is collected in the UK mandatorily, no risk factors or associated practices are examined. Southport and Ormskirk Hospital NHS Trust adopted a ‘Task Team’ approach to cleaning ward equipment in November 2001 as a way of tackling the problem of unclean ward equipment identified during hygiene audits. Due to the potential risks of environmental contamination during major construction works, this team was reallocated to other duties for an eight-month period during the winter 2004–5. Objective: To examine the effect of the temporary removal of teams normally designated to clean ward equipment during building works. Methods: Data has been collected on paper forms completed by the Infection Control nursing team. These forms are scanned using FORMIC data capture software anad analysed using Microsoft Excel. Statistical Process Control (SPC) methods were used to examine the periods before, during and after the building works had taken place. Results: The average number of cases of nosocomial Clostridium difficile cases rose from 4.08 per month to 11.75 during the construction phase. Following the works, the average numer of cases per month fell back to 5.74. In the pre-building phase the upper control limit was 10.74. This rose to 20.97 during the work and reduced to 10.54 following a return to pre-building work cleaning duties. Discussion: No change was made to the antibiotic policy during this time and prescribing patterns also did not change. Our results suggest that the removal of the Task Team had a major impact on the number of cases of nosocomial Clostridium difficile cases. Organisations undertaking building work should consider carefully the impact of redeployment of cleaning teams. P9.04 Performance of a New 14-Day Water Filter During Daily Use in Clinical Routine at Two University Medical Center S. Harpel1 *, S. Engelhart2 , T. Eikmann1 , M. Exner2 , C. Herr1 . 1 Institute of Hygiene and Environmental Medicine, University Medical Center Giessen and Marburg, Germany, 2 Institute of Hygiene and Public Health, University of Bonn, Germany Background: In the scope of preventing nosocomial infection one relevant focus is to prevent water borne infections. Feasible concepts of infection control are asked for. Aims: Aim of the study was to test a newly developed terminal filter (point-of-use sterile filtration) for up to 14 days use (tap filter Pall-Aquasafe AQ14F1S) during daily use in clinical routine.
S47 Micrococcaceae, in particular staphylococcus. In both wash processes, unfermented Gram negative bacteria of uncertain systemic origin were present. (2) At the end of the wash process, the items presented 2 log bacterial loads and after drying the cfu number was nearly always <10 cfu/50 cm2. On moist cotton, the contamination was mainly made up of enterobacteria and mold. In the high tech items and all dried items, contamination mainly involved staphylococcus and mold. On the finished products, pathogens were never found. Conclusion: The wash and drying cycles would appear to guarantee good decontamination of the items. P9.03 The Effect of Construction Work on Clostridium difficile Following Short-Term Reallocation of Hospital Cleaning Teams M. Kiernan *, J.A. Bowley, C. Jukka. Southport and Ormskirk Hospital NHS Trust, UK Background: Clostridium difficile infection results in significant morbidity and mortality. A high incidence of cases is often related to antibiotic prescribing practices and hygiene standards in the healthcare environment. Although data is collected in the UK mandatorily, no risk factors or associated practices are examined. Southport and Ormskirk Hospital NHS Trust adopted a ‘Task Team’ approach to cleaning ward equipment in November 2001 as a way of tackling the problem of unclean ward equipment identified during hygiene audits. Due to the potential risks of environmental contamination during major construction works, this team was reallocated to other duties for an eight-month period during the winter 2004–5. Objective: To examine the effect of the temporary removal of teams normally designated to clean ward equipment during building works. Methods: Data has been collected on paper forms completed by the Infection Control nursing team. These forms are scanned using FORMIC data capture software anad analysed using Microsoft Excel. Statistical Process Control (SPC) methods were used to examine the periods before, during and after the building works had taken place. Results: The average number of cases of nosocomial Clostridium difficile cases rose from 4.08 per month to 11.75 during the construction phase. Following the works, the average numer of cases per month fell back to 5.74. In the pre-building phase the upper control limit was 10.74. This rose to 20.97 during the work and reduced to 10.54 following a return to pre-building work cleaning duties. Discussion: No change was made to the antibiotic policy during this time and prescribing patterns also did not change. Our results suggest that the removal of the Task Team had a major impact on the number of cases of nosocomial Clostridium difficile cases. Organisations undertaking building work should consider carefully the impact of redeployment of cleaning teams. P9.04 Performance of a New 14-Day Water Filter During Daily Use in Clinical Routine at Two University Medical Center S. Harpel1 *, S. Engelhart2 , T. Eikmann1 , M. Exner2 , C. Herr1 . 1 Institute of Hygiene and Environmental Medicine, University Medical Center Giessen and Marburg, Germany, 2 Institute of Hygiene and Public Health, University of Bonn, Germany Background: In the scope of preventing nosocomial infection one relevant focus is to prevent water borne infections. Feasible concepts of infection control are asked for. Aims: Aim of the study was to test a newly developed terminal filter (point-of-use sterile filtration) for up to 14 days use (tap filter Pall-Aquasafe AQ14F1S) during daily use in clinical routine.