Clostridium difficile Infection Reservoirs Within an Acute Rehabilitation Environment

Abstract

Objective Clostridium difficile infection is a common hospital-associated infection spread via patient contact or contaminated environments. The risk for spread of C difficile may be greater in inpatient rehabilitation units than in some hospital units as patients are not confined to their rooms and often share equipment. Environmental disinfection is challenging in shared medical equipment, especially in equipment with complex designs. The study aimed to examine the presence of C difficile spores within an acute rehabilitation environment and to evaluate disinfection effectiveness. Design Cultures were performed on 28 rehabilitation rooms, 28 rehabilitation floor surfaces, and 80 shared devices and equipment. Two disinfection interventions were implemented, and environmental cultures then were repeated postintervention. Results Environmental cultures positive for CD spores were rehabilitation rooms (1/28), rehabilitation floors (13/28), and wheelchairs (3/20). After the implementation of new disinfection methods, repeat cultures were obtained and produced negative results. Conclusions Nonsporicidal disinfectant was not effective on hospital floors. Sporicidal disinfection of the floor is important when rates of C difficile infection are increased. Wheelchairs are complex devices and difficult to properly clean. The hospital purchased an ultraviolent device for wheelchair cleaning with a subsequent reduction in spores on repeat cultures. To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article, the reader should be able to: (1) Recognize the impact of Clostridium difficile infections on the healthcare system; (2) Describe potential reservoirs of Clostridium difficile in the inpatient rehabilitation environment; and (3) Discuss interventions that may be implemented to reduce the reservoirs of Clostridium difficile on the rehabilitation unit. Level Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Nosokomiale Infektionsgefährdung und Prävention in der neurologisch-neurochirurgischen Frührehabilitation

“…In Umgebungsuntersuchungen waren Rehabilitationsräume, Fußböden und Rollstühle mit C.-difficile -Sporen kontaminiert. Nach Einführung sporozid wirksamer Flächendesinfektion erbrachten Wiederholungskulturen negative Ergebnisse 30 .…”

“…In Umgebungsuntersuchungen waren Rehabilitationsräume, Fußböden und Rollstühle mit C.-difficile-Sporen kontaminiert. Nach Einführung sporozid wirksamer Flächendesinfektion erbrachten Wiederholungskulturen negative Ergebnisse[30].In Auswertung der Datenlage besteht ein hohes Kolonisationsrisiko für MRSA/MRGN bei besiedeltem Tracheostoma und besiedeltem Nasen-/Rachenraum bei gleichzeitig bestehender rhino-, broncho-oder pulmonaler Infektion, ebenso bei nicht abdeckbarer MRSA-/MRGN-besiedelter Wunde im Gegensatz zum ausschließlichen Vorkommen im Urin bei Kontinenz oder liegendem Blasenverweilkatheter, ebenso bei unkooperativen Patienten (z. B. schwere kognitive Störung) oder mangelnder persönlicher Hygiene im Gegensatz zu rollstuhlpflichtigen Patienten mit reduzierter selbstständiger Mobilität[8].In einer multizentrischen Beobachtungsstudie wurden in der stationären Neurorehabilitation Patient*innen mit schwerer erworbener Hirnverletzung bei Aufnahme und Entlassung der Gruppe "infiziert" (n = 119) bzw.…”