What Healthcare Workers Should Know about Environmental Bacterial Contamination in the Intensive Care Unit

Abstract

Intensive care unit- (ICU-) acquired infections are a major health problem worldwide. Inanimate surfaces and equipment contamination may play a role in cross-transmission of pathogens and subsequent patient colonization or infection. Bacteria contaminate inanimate surfaces and equipment of the patient zone and healthcare area, generating a reservoir of potential pathogens, including multidrug resistant species. Traditional terminal cleaning methods have limitations. Indeed patients who receive a bed from prior patient carrying bacteria are exposed to an increased risk (odds ratio 2.13, 95% confidence intervals 1.62–2.81) of being colonized and potentially infected by the same bacterial species of the previous patient. Biofilm formation, even on dry surfaces, may play a role in reducing the efficacy of terminal cleaning procedures since it enables bacteria to survive in the environment for a long period and provides increased resistance to commonly used disinfectants. No-touch methods (e.g., UV-light, hydrogen peroxide vapour) are under investigation and further studies with patient-centred outcomes are needed, before considering them the standard of terminal cleaning in ICUs. Healthcare workers should be aware of the role of environmental contamination in the ICU and consider it in the broader perspective of infection control measures and stewardship initiatives.

Epidemiology of bacterial contamination of inert hospital surfaces and equipment in critical and non-critical care units: a Brazilian multicenter study

“…Bacterial pathogens can survive and remain viable on inert surfaces and equipment due to their ability to form biofilms and to environmental factors such as surface porosity and humidity [7,25]. This ability to adapt to environmental stress works as a major factor driving pathogen thriving and dissemination.…”

“…Surfaces and equipment can be contaminated and, if not are properly disinfected, re-contaminate sanitized hands during the interruption of patient care to touch the surfaces and equipment such as keyboards, tables, door knobs, stethoscopes etc. The surfaces become permanently contaminated by pathogens [5,7,19] and the hospital environment turns into a reservoir of highly transmissible microorganisms.…”

“…In the hospital setting, patients, staff and visitors represent the main reservoir of microorganisms, whereas secondary reservoirs include all environments where nutrients, moisture, and temperature are suitable for microbial survival, such as air humidifiers and nebulizers [5,6]. In addition, dry and inanimate surfaces can also serve as a reservoir of pathogens [3,5,7-9], as in mattresses and bed frames [4,10,11], door knobs [11,12], and even in medical equipment such as stethoscopes and ultrasound devices [7-11]. Contamination of these surfaces contributes to pathogen spreading and, as a result, development of horizontal infections [13-14].…”

Genomic Analysis of Carbapenemase-Producing Extensively Drug-Resistant Klebsiella pneumoniae Isolates Reveals the Horizontal Spread of p18-43_01 Plasmid Encoding blaNDM-1 in South Africa

“…This reiterates the need for further circularization and annotation of the plasmid DNA using sequencing techniques that provide long-read sequences to offer insights into its evolution and spread [74]. Moreover, further larger epidemiological studies should be conducted in the province to trace the primary source(s) of their spread, possibly through frequent contact with healthcare workers and the movement of colonized patients among different healthcare settings [75,76].…”

Screening and Prevention of Nosocomial Infections in Neonatal Intensive Care Unit (NICU)

“… The healthcare workers'(HCWs') hands. Therefore, HCWs' hands contaminate frequently from inanimate surfaces and direct contact with patients [37], [38].…”