Microbial transmission in an outpatient clinic and impact of an intervention with an ethanol-based disinfectant

Reynolds, Kelly A.; Sexton, Jonathan D.; Pivo, Trevor; Humphrey, Kyle; Leslie, Rachel A.; Gerba, Charles P.

doi:10.1016/j.ajic.2018.06.017

Cited by 32 publications

(24 citation statements)

References 34 publications

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“…Initial swabs showed no background contamination of sampled surfaces or hands. For subsequent time points, MS2 was detected on sampled surfaces and hands 59% (47/79) of the time (Reynolds et al., ). Patient‐related surfaces, such as patient door handles and the waiting room check‐in computer mouse, were the most contaminated sites along with patient hands (Reynolds et al., ).…”

Section: Resultsmentioning

confidence: 99%

“…For subsequent time points, MS2 was detected on sampled surfaces and hands 59% (47/79) of the time (Reynolds et al., ). Patient‐related surfaces, such as patient door handles and the waiting room check‐in computer mouse, were the most contaminated sites along with patient hands (Reynolds et al., ). Due to variability in nurse work schedules and loads, the same nurses were not necessarily swabbed at each time point and no identifying information was collected to connect a specific nurse to a sample.…”

Section: Resultsmentioning

confidence: 99%

“…Although the tracer study included interventions conducted in duplicate, the baseline tracer results, used in this study, were from a single trial. The palm‐side of four nurses’ hands were sampled, with an approximate surface area of 100 cm 2 (Reynolds et al., ). Where possible, 100 cm 2 was sampled for surfaces, where entire door handles (50 cm 2 ) and computer mice (30 cm 2 ) were exceptions.…”

Section: Methodsmentioning

confidence: 99%

“…Swabs were transported to the laboratory on ice and processed within 24 hours. MS2 was analyzed using the double‐layer agar technique with an E. coli C‐3000 (ATCC 15597) host, where samples were plated in duplicate and over a million‐fold dilution series with a target detection limit of 10 PFU per area sampled (Reynolds et al., ).…”

Section: Methodsmentioning

confidence: 99%

“…Per model iteration, a different sequence of activities for 6 hours (21,600 seconds) was generated. This was the length of time between seeding and the last sampling time in the bacteriophage tracer study (Reynolds et al., ). During contacts with porous or nonporous surfaces, a concentration was sampled from the log‐normal distribution of virus concentrations on surfaces.…”

Section: Methodsmentioning

confidence: 99%

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Validation of a Stochastic Discrete Event Model Predicting Virus Concentration on Nurse Hands

et al. 2019

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Understanding healthcare viral disease transmission and the effect of infection control interventions will inform current and future infection control protocols. In this study, a model was developed to predict virus concentration on nurses' hands using data from a bacteriophage tracer study conducted in Tucson, Arizona, in an urgent care facility. Surfaces were swabbed 2 hours, 3.5 hours, and 6 hours postseeding to measure virus spread over time. To estimate the full viral load that would have been present on hands without sampling, virus concentrations were summed across time points for 3.5-and 6-hour measurements. A stochastic discrete event model was developed to predict virus concentrations on nurses' hands, given a distribution of virus concentrations on surfaces and expected frequencies of hand-to-surface and orifice contacts and handwashing. Box plots and statistical hypothesis testing were used to compare the model-predicted and experimentally measured virus concentrations on nurses' hands. The model was validated with the experimental bacteriophage tracer data because the distribution for model-predicted virus concentrations on hands captured all observed value ranges, and interquartile ranges for model and experimental values overlapped for all comparison time points. Wilcoxon rank sum tests showed no significant differences in distributions of model-predicted and experimentally measured virus concentrations on hands. However, limitations in the tracer study indicate that more data are needed to instill more confidence in this validation. Next model development steps include addressing viral concentrations that would be found naturally in healthcare environments and measuring the risk reductions predicted for various infection control interventions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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