Airborne bacterial dispersal during and after dressing and bed changes on burns patients

Abstract

This version is available at https://strathprints.strath.ac.uk/53682/ Strathprints is designed to allow users to access the research output of the University of Strathclyde. Unless otherwise explicitly stated on the manuscript, Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Please check the manuscript for details of any other licences that may have been applied. You may not engage in further distribution of the material for any profitmaking activities or any commercial gain. You may freely distribute both the url (https://strathprints.strath.ac.uk/) and the content of this paper for research or private study, educational, or not-for-profit purposes without prior permission or charge. Department to which this work should be attributed:Burns Unit, Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84-106 Castle Street, Glasgow G4 0SF, United Kingdom. *Denotes corresponding author 2 ABSTRACTBackground: It is acknowledged that activities such as dressing changes and bed sheet changes are high-risk events; creating surges in levels of airborne bacteria. Burns patients are particularly high dispersers of pathogens; due to their large, often contaminated, wound areas.Prevention of nosocomial cross-contamination is therefore one of the major challenges faced by the burns team. In order to assess the contribution of airborne spread of bacteria, air samples were taken repeatedly throughout and following these events, to quantify levels of airborne bacteria.Methods: Air samples were taken at three minute intervals before, during and after a dressing and bed change on a burns patient using a sieve impaction method. Following incubation, bacterial colonies were enumerated to calculate bacterial colony forming units per m 3 (cfu/m 3 ) at each time point. Statistical analysis was performed, whereby the period before the high-risk event took place acted as a control period. The periods during and after the dressing and bed sheet changes were examined for significant differences in airborne bacterial levels relative to the control period. The study was carried out four times, on three patients with burns between 35% total burn surface area (TBSA) and 51% TBSA.Results: There were significant increases in airborne bacteria levels, regardless of whether the dressing change or bed sheet change took place first. Of particular note, is the finding that significantly high levels (up to 2614 cfu/m 3 ) of airborne bacteria were shown to persist for up to approximately one hour after these activities ended.Discussion: This is the most accurate picture to date of the rapidly changing levels of airborne bacteria within the room of a burns patient undergoing a dressing change and bed change. The novel demonstration of a significant increase in the airborne bacterial load during these events has implications for infection control on burns units. Furthermore, as these increased levels remained for approximately one hour afterwards, persons entering the room...

Continuous monitoring of aerial bioburden within intensive care isolation rooms and identification of high-risk activities

“…Previous studies have recorded similar results whereby mean counts of airborne MRSA from infected patients increased from 4.7 cfu/m 3 to 116 cfu/m 3 during bed sheet changes, and remained elevated for some time after the event [25]. Similarly, air counts of up to 2614 cfu/m 3 were recorded in response to bed changes in a burns unit, with elevated levels persisting for up to 60 min [14].…”

“…However, to date, few studies have characterized levels of airborne micro-organisms within an ICU over extended time periods. Previous clinical air studies have focused on short time periods or specific activities of interest [14,16,17]. This study has significantly expanded this information by successfully demonstrating the levels and fluctuations of airborne bacteria within an ICU during different patient and environmental scenarios over 10-and 24-h periods.…”

“…Data were analysed using statistical control charts (Minitab v17) to determine data points classed as 'out of control' from the overall dataset of each case study based on rationale by previous work [14]. 'Out-of-control' observations (flagged in red) are data points >3 standard deviations above the mean, and are significantly greater than the mean of the dataset.…”

Vacuum-assisted closure (VAC®) systems and microbiological isolation of infected wounds

“…The change of wound dressing represents a risk for environment contamination as well as the interhuman one [ 15 – 17 ]. Some of the pathogens isolated in the wounds are probably only contaminating bacteria; however, the percentages would suggest that this kind of dressing is not a risk factor for healthcare-associated infections.…”

Decontamination of the Hospital Environment: New Technologies for Infection Control

“…However, with this benefit, comes the inherent limitation that inactivation using this low irradiance light is much slower than that of UVClight, requiring exposure times in the order of hours [66] rather than minutes, as is the case with most of the UV and chemical-based systems. This however, means that the system is optimally deployed for continuous decontamination where it can continuously impact on the release of microbial pathogens associated with major bioburden dispersal activities such as bandage changing and bed-making [67], rather than for intense, short-time terminal cleaning. An additional benefit resulting from the use of these longer, lower energy photons, is that there will be significantly less material degradation compared to the UV and chemical-based systems [55].…”