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The Efficacy of an Automated Ultrasound Probe Disinfector Against High-Risk Human Papillomavirus Type 16
Poster Abstracts / American Journal of Infection Control 43 (2015) S18-S73
transmission of pathogens; however, proper disinfection protocols are lacking to address sensitive surfaces and equipment that can be permanently damaged by disinfectants used in the healthcare setting. We tested commercially available disinfectant wipes on touch screens and mobile devices to examine any damaging effects. METHODS: Samples were taken before and after use of a disinfectant wipe from touch screens, at 4 Long Term Care facilities across the Greater Toronto Area. Samples were cultured to isolate bacteria and fungi. Touch screens were wiped approximately every hour for two months with various disinfectant wipes and examined for any changes in appearance or damage. RESULTS: All surfaces sampled at the LTC facilities showed marked contamination with bacterial and fungal organisms prior to disinfection. After wiping with Product T, the samples were cleared of contamination. Touch screens showed no damaging effects after repeated wiping with Products S and T; however, discoloration and damage were observed with Products C, V, and P. CONCLUSIONS: This study further illustrates that shared surfaces and devices can be contaminated with potentially harmful bacteria and fungi, thereby stressing the importance of disinfection of these surfaces to reduce transmission. Sensitive clinical surfaces present a challenge to disinfection; however, we have demonstrated that there are products available that can effectively disinfect sensitive surfaces without causing harmful and costly damage.
Presentation Number 2-108 Coming to the Light: Impact of Ultraviolet Technology on Incidence of Pseudomonas in a Neonatal Intensive Care Unit
S21
CONCLUSIONS: After implementation of UVD, a dramatic decrease in the incidence of Pseudomonas was noted, potentially avoiding numerous infants from becoming colonized or infected. Despite not always being used routinely, the use of UVD is a worthwhile adjunct to terminal cleaning in the NICU.
Presentation Number 2-109 The Efficacy of an Automated Ultrasound Probe Disinfector Against High-Risk Human Papillomavirus Type 16
Sonya Mauzey RN, BS, CIC, Infection Preventionist, The Women’s Hospital
Eric Ryndock, Student, Penn State College of Medicine; Jonathan Burdach PhD, Clinical Research Consultant, Nanosonics Ltd; Ron Weinberger PhD, President Technology Development/ Commercialisation, NanoSonics Limited; Richard Robison PhD, Professor, Brigham Young University; Craig Meyers PhD, Distinguished Professor, Penn State College of Medicine
BACKGROUND: There have been numerous publications and presentations on the effectiveness of ultraviolet light disinfection (UVD). Most of them focus on the impact of multidrug resistant organisms and Clostridium difficile spores in the environment. Pseudomonas aeruginosa, a ubiquitous organism, can be found on a multitude of surfaces in the healthcare environment, including respiratory equipment in critical care units. With such a pervasive organism, the exposure risk and potential transmission to vulnerable patients makes it a leading cause of healthcare acquired respiratory tract infections. The purpose of this abstract is to describe the effects of UVD on the incidence of Pseudomonas in a Neonatal Intensive Care Unit (NICU). METHODS: A retrospective review of the incidence of positive Pseudomonas lab cultures was done beginning in 2012, the year prior to implementing UVD. The aim was to use UVD as an adjunct to periodic terminal cleaning on a quarterly and as-needed basis. Incidence rates were calculated based on the number of positive lab results as well as on the number of impacted patients, as some infants had repeated positive cultures with long hospitalizations, requiring extensive ventilator support. RESULTS: From January 2012 through June of 2013 there were 32 total positive Pseudomonas cultures (3.17 per 1,000 patient days) which involved 13 infants (2.34% of total admissions). From July 2013, when UVD was implemented, through November 2014, there was only one positive Pseudomonas culture (0.10 per 1,000 patient days) involving one infant (0.17% of total admissions). Further review also revealed UVD was not used during the 3rd quarter of 2014, due to high census.
BACKGROUND: Human papilloma virus (HPV16) is a leading causative agent of cervical, anogenital and oropharyngeal cancers. We have recently shown that native HPV16 virions are highly resistant to the high level disinfectants (HLDs) glutaraldehyde and ortho-pthalaldehyde (OPA), even with extended contact times of up to 48h. This presents a problem especially for procedures such as trans-vaginal, trans-rectal and trans-esophageal ultrasound where these disinfectants are commonly used and where HPV16 exerts some of its most pathogenic effects. In this study, we have investigated the efficacy of an automated device which is FDA-cleared for the HLD ultrasound probes to determine if it can inactivate HPV16 in a hard surface carrier test. METHODS: Native HPV16 virions were generated by electroporating primary keratinocytes with HPV16 and by culturing organotypic raft cultures. Filtered viral lysates were dried onto test carriers in the presence of a 5% (v/v) FBS soil with sufficient virions to recover >104 infective units. Efficacy tests were performed against the automated device in quadruplicate with matched input, neutralization and cytotoxicity controls. For the present studies 0.55% OPA and 0.87% hypochlorite were used as negative and positive disinfectant controls respectively. Infectivity was determined by the abundance (qRT-PCR) of the spliced E1 E4 transcript in infected recipient cells. RESULTS: Over 70% of the virus was recovered following drying onto the plastic carriers. There was no evidence of cytotoxicity and neutralization was effective. The automated HLD device was able to completely deactivate HPV16 with a greater than 7 log10 reduction in infectivity in a standard 7-minute cycle. ˇ
APIC 42nd Annual Educational Conference & International Meeting j Nashville, TN j June 27-29, 2015
S22
Poster Abstracts / American Journal of Infection Control 43 (2015) S18-S73
CONCLUSIONS: Healthcare professionals should consider these results when selecting appropriate disinfection methods for semicritical devices. The present studies suggest that a review of disinfection standards as related to HLD may be warranted.
Presentation Number 2-110 A Laboratory Study of the Synergistic Effect of Chlorhexidine and Silver Kristina Blom PhD, CEO, Medibiome AB; Maria Werthen PhD, Senior scientist, Mölnlycke Health Care AB BACKGROUND: This poster describes the results of a study that was undertaken to evaluate in vitro the antimicrobial activity of a combination of two antimicrobial agents, chlorhexidine diacetate (CHA) and silver sulphate, against five different strains of bacteria. METHODS: A Minimum Inhibitory Concentration (MIC) assay was used to determine the effect of CHA and silver sulphate on four different strains of Pseudomonas aeruginosa (ATCC 15442, ATCC 15692 and two clinical isolates) and one strain of methicillinresistant Staphylococcus aureus (CCUG 31966). The synergy of CHA and silver sulphate was evaluated by means of a checkerboard assay to determine the fractional inhibitory concentration index (FICI). Synergy was defined as an FICI of 0.5. RESULTS: The checkerboard microdilution assay showed a synergistic or enhanced interaction between the paired antibacterial agents CHA and silver sulphate (i.e., FICI 0.5) against all bacterial strains tested. For example, in one strain of Pseudomonas aeruginosa (ATCC 15692), CHA gave an MIC value of 22 mg/ml when assayed in isolation however, combined with silver sulphate the MIC value fell to 0.14 mg/ml. A similar trend was seen for CHA and MRSA (0.7 mg/ml alone and reducing to 0.05 mg/ml in combination). CONCLUSIONS: The combination of chlorhexidine diacetate and silver sulphate has synergistic, enhanced antibacterial activity. This observation is of relevance to clinical practice, particularly in relation to the use of cover dressings incorporating antimicrobial agents.
Presentation Number 2-111 Ensuring Competency of High-level Disinfection (HLD) Practices in Non-Central Processing Department (CPD) locations Susy L. Rettig RN, BSN, CIC, Infection Preventionist, Children’s Hospital of Philadelphia; Cindy L. Hoegg RN, BSN, CIC, Infection Preventionist, Children’s Hospital of Philadelphia; Eva Teszner RN, CIC, Infection Preventionist, Children’s Hospital of Philadelphia; Sarah A. Smathers MPH, CIC, Infection Preventionist, Children’s Hospital of Philadelphia; Lauren Satchell BA, Data Analyst, Children’s Hospital of Philadelphia; Julia Sammons MD, MSCE, Medical Director, Infection Prevention and Control, Assistant Professor, Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, and Division of Infectious Diseases and Department of Infection Prevention and Control, Children’s Hospital of Philadelphia BACKGROUND: Adherence to guidelines for HLD of semi-critical medical devices is essential to prevent transmission of pathogens. Staff competency is achieved and maintained through education,
including return demonstration (RD). Infection Prevention & Control (IPC) departments play an important role in ensuring compliance with reprocessing protocols. Diversity of staff roles presents challenges for oversight of HLD practices in non-CPD locations. METHODS: A mock accreditation survey was conducted to assess HLD practices in non-CPD locations at a pediatric hospital network in October 2012. Following this survey, IPC initiated an audit program of HLD practices at 15 locations, including Specialty Care Centers, Respiratory Therapy, and Ambulatory Surgical Facilities. Prior to audits, staff were trained by a CPD educator. IPC audit tools were developed using manufacturer’s guidelines specific to reprocessing activities for channeled and non-channeled scopes and tranesophageal and vaginal ultrasound probes. Initial audits were performed by certified Infection Preventionists (IP) over a 2 month period and scored as pass, needs remediation, or fail. Remedial assessments required just in time education by the IP, competency training by the CPD educator including RD, and a repeat audit by the IP. Staff who failed were immediately excluded from further reprocessing activities pending retraining by CPD educator followed by a repeat IPC audit. RESULTS: Fifteen staff underwent initial IPC audits over a period of two months. Sixty percent of staff passed initial IPC audits (see table). It was identified that RD was not consistently included in competency training. Repeat training by the CPD educator with RD resulted in successful repeat IPC audits.
CONCLUSIONS: Non-CPD staff proficiencies with HLD practices can be achieved with regularly scheduled competency training that includes RD. Proficiency can be confirmed and reinforced with IPC audits. Collaboration between CPD educators and IPC staff are important in maintaining high reliability HLD programs in non-CPD locations.
Presentation Number 2-112 Differences in Hand Hygiene Performance between an Ambulatory Surgical Center and Inpatient Adult Medical-Surgical and Critical Care Nursing Units Karolina Mlynek MD, MBA, Plastic Surgery Research Fellow, Cleveland Clinic; Maria Madajka PhD, Research Associate, Cleveland Clinic; Susan Orra BA, Plastic Surgery Research Fellow, Cleveland Clinic; Bahar Bassiri-Gharb MD, PhD, Plastic Surgeon, Head of Plastic Surgery Research, Cleveland Clinic; Mark Roshon, President, Tornado Technologies, Inc; Byron Clayton, Vice President, Nortech; Frank Papay MD, Chairman, Dermatology & Plastic Surgery Institute, Cleveland Clinic
APIC 42nd Annual Educational Conference & International Meeting j Nashville, TN j June 27-29, 2015
transmission of pathogens; however, proper disinfection protocols are lacking to address sensitive surfaces and equipment that can be permanently damaged by disinfectants used in the healthcare setting. We tested commercially available disinfectant wipes on touch screens and mobile devices to examine any damaging effects. METHODS: Samples were taken before and after use of a disinfectant wipe from touch screens, at 4 Long Term Care facilities across the Greater Toronto Area. Samples were cultured to isolate bacteria and fungi. Touch screens were wiped approximately every hour for two months with various disinfectant wipes and examined for any changes in appearance or damage. RESULTS: All surfaces sampled at the LTC facilities showed marked contamination with bacterial and fungal organisms prior to disinfection. After wiping with Product T, the samples were cleared of contamination. Touch screens showed no damaging effects after repeated wiping with Products S and T; however, discoloration and damage were observed with Products C, V, and P. CONCLUSIONS: This study further illustrates that shared surfaces and devices can be contaminated with potentially harmful bacteria and fungi, thereby stressing the importance of disinfection of these surfaces to reduce transmission. Sensitive clinical surfaces present a challenge to disinfection; however, we have demonstrated that there are products available that can effectively disinfect sensitive surfaces without causing harmful and costly damage.
Presentation Number 2-108 Coming to the Light: Impact of Ultraviolet Technology on Incidence of Pseudomonas in a Neonatal Intensive Care Unit
S21
CONCLUSIONS: After implementation of UVD, a dramatic decrease in the incidence of Pseudomonas was noted, potentially avoiding numerous infants from becoming colonized or infected. Despite not always being used routinely, the use of UVD is a worthwhile adjunct to terminal cleaning in the NICU.
Presentation Number 2-109 The Efficacy of an Automated Ultrasound Probe Disinfector Against High-Risk Human Papillomavirus Type 16
Sonya Mauzey RN, BS, CIC, Infection Preventionist, The Women’s Hospital
Eric Ryndock, Student, Penn State College of Medicine; Jonathan Burdach PhD, Clinical Research Consultant, Nanosonics Ltd; Ron Weinberger PhD, President Technology Development/ Commercialisation, NanoSonics Limited; Richard Robison PhD, Professor, Brigham Young University; Craig Meyers PhD, Distinguished Professor, Penn State College of Medicine
BACKGROUND: There have been numerous publications and presentations on the effectiveness of ultraviolet light disinfection (UVD). Most of them focus on the impact of multidrug resistant organisms and Clostridium difficile spores in the environment. Pseudomonas aeruginosa, a ubiquitous organism, can be found on a multitude of surfaces in the healthcare environment, including respiratory equipment in critical care units. With such a pervasive organism, the exposure risk and potential transmission to vulnerable patients makes it a leading cause of healthcare acquired respiratory tract infections. The purpose of this abstract is to describe the effects of UVD on the incidence of Pseudomonas in a Neonatal Intensive Care Unit (NICU). METHODS: A retrospective review of the incidence of positive Pseudomonas lab cultures was done beginning in 2012, the year prior to implementing UVD. The aim was to use UVD as an adjunct to periodic terminal cleaning on a quarterly and as-needed basis. Incidence rates were calculated based on the number of positive lab results as well as on the number of impacted patients, as some infants had repeated positive cultures with long hospitalizations, requiring extensive ventilator support. RESULTS: From January 2012 through June of 2013 there were 32 total positive Pseudomonas cultures (3.17 per 1,000 patient days) which involved 13 infants (2.34% of total admissions). From July 2013, when UVD was implemented, through November 2014, there was only one positive Pseudomonas culture (0.10 per 1,000 patient days) involving one infant (0.17% of total admissions). Further review also revealed UVD was not used during the 3rd quarter of 2014, due to high census.
BACKGROUND: Human papilloma virus (HPV16) is a leading causative agent of cervical, anogenital and oropharyngeal cancers. We have recently shown that native HPV16 virions are highly resistant to the high level disinfectants (HLDs) glutaraldehyde and ortho-pthalaldehyde (OPA), even with extended contact times of up to 48h. This presents a problem especially for procedures such as trans-vaginal, trans-rectal and trans-esophageal ultrasound where these disinfectants are commonly used and where HPV16 exerts some of its most pathogenic effects. In this study, we have investigated the efficacy of an automated device which is FDA-cleared for the HLD ultrasound probes to determine if it can inactivate HPV16 in a hard surface carrier test. METHODS: Native HPV16 virions were generated by electroporating primary keratinocytes with HPV16 and by culturing organotypic raft cultures. Filtered viral lysates were dried onto test carriers in the presence of a 5% (v/v) FBS soil with sufficient virions to recover >104 infective units. Efficacy tests were performed against the automated device in quadruplicate with matched input, neutralization and cytotoxicity controls. For the present studies 0.55% OPA and 0.87% hypochlorite were used as negative and positive disinfectant controls respectively. Infectivity was determined by the abundance (qRT-PCR) of the spliced E1 E4 transcript in infected recipient cells. RESULTS: Over 70% of the virus was recovered following drying onto the plastic carriers. There was no evidence of cytotoxicity and neutralization was effective. The automated HLD device was able to completely deactivate HPV16 with a greater than 7 log10 reduction in infectivity in a standard 7-minute cycle. ˇ
APIC 42nd Annual Educational Conference & International Meeting j Nashville, TN j June 27-29, 2015
S22
Poster Abstracts / American Journal of Infection Control 43 (2015) S18-S73
CONCLUSIONS: Healthcare professionals should consider these results when selecting appropriate disinfection methods for semicritical devices. The present studies suggest that a review of disinfection standards as related to HLD may be warranted.
Presentation Number 2-110 A Laboratory Study of the Synergistic Effect of Chlorhexidine and Silver Kristina Blom PhD, CEO, Medibiome AB; Maria Werthen PhD, Senior scientist, Mölnlycke Health Care AB BACKGROUND: This poster describes the results of a study that was undertaken to evaluate in vitro the antimicrobial activity of a combination of two antimicrobial agents, chlorhexidine diacetate (CHA) and silver sulphate, against five different strains of bacteria. METHODS: A Minimum Inhibitory Concentration (MIC) assay was used to determine the effect of CHA and silver sulphate on four different strains of Pseudomonas aeruginosa (ATCC 15442, ATCC 15692 and two clinical isolates) and one strain of methicillinresistant Staphylococcus aureus (CCUG 31966). The synergy of CHA and silver sulphate was evaluated by means of a checkerboard assay to determine the fractional inhibitory concentration index (FICI). Synergy was defined as an FICI of 0.5. RESULTS: The checkerboard microdilution assay showed a synergistic or enhanced interaction between the paired antibacterial agents CHA and silver sulphate (i.e., FICI 0.5) against all bacterial strains tested. For example, in one strain of Pseudomonas aeruginosa (ATCC 15692), CHA gave an MIC value of 22 mg/ml when assayed in isolation however, combined with silver sulphate the MIC value fell to 0.14 mg/ml. A similar trend was seen for CHA and MRSA (0.7 mg/ml alone and reducing to 0.05 mg/ml in combination). CONCLUSIONS: The combination of chlorhexidine diacetate and silver sulphate has synergistic, enhanced antibacterial activity. This observation is of relevance to clinical practice, particularly in relation to the use of cover dressings incorporating antimicrobial agents.
Presentation Number 2-111 Ensuring Competency of High-level Disinfection (HLD) Practices in Non-Central Processing Department (CPD) locations Susy L. Rettig RN, BSN, CIC, Infection Preventionist, Children’s Hospital of Philadelphia; Cindy L. Hoegg RN, BSN, CIC, Infection Preventionist, Children’s Hospital of Philadelphia; Eva Teszner RN, CIC, Infection Preventionist, Children’s Hospital of Philadelphia; Sarah A. Smathers MPH, CIC, Infection Preventionist, Children’s Hospital of Philadelphia; Lauren Satchell BA, Data Analyst, Children’s Hospital of Philadelphia; Julia Sammons MD, MSCE, Medical Director, Infection Prevention and Control, Assistant Professor, Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, and Division of Infectious Diseases and Department of Infection Prevention and Control, Children’s Hospital of Philadelphia BACKGROUND: Adherence to guidelines for HLD of semi-critical medical devices is essential to prevent transmission of pathogens. Staff competency is achieved and maintained through education,
including return demonstration (RD). Infection Prevention & Control (IPC) departments play an important role in ensuring compliance with reprocessing protocols. Diversity of staff roles presents challenges for oversight of HLD practices in non-CPD locations. METHODS: A mock accreditation survey was conducted to assess HLD practices in non-CPD locations at a pediatric hospital network in October 2012. Following this survey, IPC initiated an audit program of HLD practices at 15 locations, including Specialty Care Centers, Respiratory Therapy, and Ambulatory Surgical Facilities. Prior to audits, staff were trained by a CPD educator. IPC audit tools were developed using manufacturer’s guidelines specific to reprocessing activities for channeled and non-channeled scopes and tranesophageal and vaginal ultrasound probes. Initial audits were performed by certified Infection Preventionists (IP) over a 2 month period and scored as pass, needs remediation, or fail. Remedial assessments required just in time education by the IP, competency training by the CPD educator including RD, and a repeat audit by the IP. Staff who failed were immediately excluded from further reprocessing activities pending retraining by CPD educator followed by a repeat IPC audit. RESULTS: Fifteen staff underwent initial IPC audits over a period of two months. Sixty percent of staff passed initial IPC audits (see table). It was identified that RD was not consistently included in competency training. Repeat training by the CPD educator with RD resulted in successful repeat IPC audits.
CONCLUSIONS: Non-CPD staff proficiencies with HLD practices can be achieved with regularly scheduled competency training that includes RD. Proficiency can be confirmed and reinforced with IPC audits. Collaboration between CPD educators and IPC staff are important in maintaining high reliability HLD programs in non-CPD locations.
Presentation Number 2-112 Differences in Hand Hygiene Performance between an Ambulatory Surgical Center and Inpatient Adult Medical-Surgical and Critical Care Nursing Units Karolina Mlynek MD, MBA, Plastic Surgery Research Fellow, Cleveland Clinic; Maria Madajka PhD, Research Associate, Cleveland Clinic; Susan Orra BA, Plastic Surgery Research Fellow, Cleveland Clinic; Bahar Bassiri-Gharb MD, PhD, Plastic Surgeon, Head of Plastic Surgery Research, Cleveland Clinic; Mark Roshon, President, Tornado Technologies, Inc; Byron Clayton, Vice President, Nortech; Frank Papay MD, Chairman, Dermatology & Plastic Surgery Institute, Cleveland Clinic
APIC 42nd Annual Educational Conference & International Meeting j Nashville, TN j June 27-29, 2015