Environmental contamination by carbapenem-resistant Acinetobacter baumannii: The effects of room type and cleaning methods

Abstract

Objective: We evaluated environmental contamination by carbapenem-resistant Acinetobacter baumannii (CRAB), the effectiveness of cleaning practices, the performance of aerosolized hydrogen-peroxide (aHP) technology, and the correlation between measures of cleaning and environmental contamination. Design: Serial testing of environmental contamination during a 7-month period. Setting: Single-patient rooms in intensive care units (ICUs) and multipatient step-up and regular rooms in internal medicine wards in a tertiary-care hospital with endemic CRAB. Methods: CRAB environmental contamination was determined semiquantitatively using sponge sampling. Results: In step-up rooms, 91% of patient units (56% of objects) were contaminated, and half of them were heavily contaminated. In regular rooms, only 21% of patient units (3% of objects) were contaminated. In ICUs, 76% of single-patient rooms (24% of objects) were contaminated. Cleaning did not reduce the number of contaminated objects or patient units in step-up rooms. After refresher training, cleaning reduced the proportion of contaminated objects by 2-fold (P = .001), but almost all patient units remained contaminated. Using aerosolized hydrogen peroxide (aHP) disinfection after discharge of a known CRAB-carrier decreased room contamination by 78%, similar to the reduction achieved by manual hypochloride cleaning. Measuring cleaning efficacy using fluorescent gel did not correlate with recovery of CRAB by sponge cultures. Conclusions: In step-up rooms, the high number of objects contaminated combined with poor efficacy of cleaning resulted in failure to eliminate CRAB in patient units. Fluorescent gel is a poor detector of CRAB contamination. The role of aHP is still unclear. However, its use in multipatient rooms is limited because it can only be used in unoccupied rooms.

Genetic Diversity of OXA Producing Carbapenem-Resistant Acinetobacter baumannii from Environment of Tertiary Hospitals in Central Iran

“…A. baumannii might first spread from infected patients or colonized personnel/visitors and then contaminate surfaces, thereby acting as prolonged sources for HAIs. Several studies suggested that A. baumannii could colonize different medical equipment and surfaces (11,21,22) and also could persist for years in patients (23) with the ability of biofilm formation (11). In the present study, we observed a significant MDR (21.9%) and XDR (18.8%) frequency.…”

Evidence Map and Systematic Review of Disinfection Efficacy on Environmental Surfaces in Healthcare Facilities

“…Vapor disinfection includes systems described as producing and dispersing vapors, aerosols, or droplets of disinfectants through spray, mist, or fogging machines. Hydrogen peroxide vapor was identified in 18% of studies [ 70 , 72 , 77 , 85 , 86 , 99 , 111 , 117 , 122 , 125 , 129 , 130 , 141 , 142 , 193 , 194 , 195 , 196 , 197 , 198 , 199 , 200 , 201 , 202 , 203 , 204 , 205 , 206 , 207 , 208 , 209 , 210 , 211 ]. Other vaporized disinfection methods, which included chlorine dioxide, sodium hypochlorite, essential oils, formalin, QACs, glutaral, beta propiolactone, steam, acidic electrolytic water, ozone, and steam, were identified in 10% of studies [ 70 , 84 , 137 , 203 , 212 , 213 , 214 , 215 , 216 , 217 , 218 , 219 , 220 , 221 , 222 , 223 ].…”

“…Some antimicrobial coatings may not bind appropriately to target surfaces, and this may decrease the apparent efficacy. Training environmental services staff before and during interventions were identified as important for both adherence to protocol and to the appropriate application of the disinfectant (see, e.g., [ 20 , 78 , 120 , 125 ]). Few studies mentioned costs although some reported monetary or time costs associated with a disinfectant type (see, e.g., [ 69 , 70 , 92 , 114 , 126 , 131 , 137 , 141 , 160 , 197 , 201 , 223 ]).…”

Review of decontamination protocols for shared non-critical objects in 35 policies of UK NHS acute care organizations

“…Assessing how and when a specific object should be decontaminated is thus not an easy task and should not be left to the discretion of untrained operators, but codified in clear policies [13,41] A robust regimen of best practice, training, feedback and auditing positively impacts the outcome of the process [42][43][44][45].…”