Contamination of the Hospital Environmental by Pathogenic Bacteria and Infection Control

Ah Kim Young; Lee Hyukmin; Lee Kyungwon

doi:10.14192/kjnic.2015.20.1.1

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Young, Hyukmin, and Kyungwon: Contamination of the Hospital Environmental by Pathogenic Bacteria and Infection Control

Original Article

J Nosocomial Infect Control 2013;20(1):1-6.

Published online: 3 May 2013

DOI: https://doi.org/10.14192/kjnic.2015.20.1.1

Contamination of the Hospital Environmental by Pathogenic Bacteria and Infection Control

Ah Kim Young, Lee Hyukmin, Lee Kyungwon

¹Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea

²Department of Laboratory Medicine, Catholic Kwandong University College of Medicine, Incheon, Korea

³Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea

⁴Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea

Address reprint requests to Kyungwon Lee, Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea Tel: 02-2228-2446, Fax: 02-313-0908 E-mail: leekcp@yuhs.ac

Received 11 May 2014 Accepted 21 July 2014

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Healthcare-associated infections (HAIs) have increased rapidly, and the wide spread of multidrug resistant (MDR) bacteria has made the control of HAIs a challenging health problem. Transmission of common pathogens from a colonized or infected patient to a susceptible patient has been reported to occur via the hands of healthcare personnel. Therefore, the priority of infection control policy has been allocated in hand hygiene program, contact precautions, and isolation. However, the transmission routes of pathogens are complicated. Furthermore, recent data suggest that the hospital environment could play a role as an important reservoir, and contaminated hospital surfaces, medical equipment, water, and air could be directly or indirectly involved in the transmission pathways. Therefore, we should reconsider the role of hospital environment control in the management of HAIs as well as developing strategies to reduce the contamination of hospital environment.

Keywords: Healthcare-associated infection, Hospital environment, Infection control

References

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Table 1.

Studies investigating the significance of hospital environment control in hospital infection

Organisms	Key findings	Reference
MRSA and	Molecular typing identified similar strains from the environment, patients and hands	12 (2013)
Acinetobacter
MRSA and Acinetobacter	Hydrogen peroxide vapor disinfection and cohorting of colonized or infected patients reduced nosocomial MRSA and A. baumannii in burns unit	13 (2013)
MRSA and C. difficile	In patient rooms and the ward environment, the contamination of specific materials and locations were identified	14 (2013)
MRSA	MRSA was isolated from the environment and hands, indicating the existence of a secondary reservoir	15 (2013)
VRE	Unrecognized colonization and/or the aerosolization of enterococci with inadequate cleaning lead to environmental contamination	8 (2013)
C. difficile	Evidence that the contaminated surface environment is important in transmission of C. difficile	16 (2013)
Acinetobacter	A baumannii infection rate in the renovated ICU significantly decreased	17 (2013)
Bacteria resistant to β-lactams	Identical strains carrying the same resistance genes were present in both patients and the hospital environment	18 (2013)
P. aeruginosa	Genotyping of isolates revealed a clonal relationship between patient and water isolates	19 (2014)
P. aeruginosa	Hospital waste systems act as a reservoir	20 (2012)

Table 2.

Recommendations for environmental infection control-air

Item	Recommendations
Air-Handling Systems	Ensure that heating, ventilation, air conditioning (HVAC) filters are properly installed and maintained to prevent air leakages and dust overloads
	Prevent dust accumulation by cleaning air-duct grilles in accordance with facility specific procedures
	No use of natural ventilation in protective environment (PE) room
Construction and Repair of Health-Care Facilities	Implement infection-control measures relevant to construction and repair Educate both the construction team and the health-care staff in immunocompromised patient-care areas regarding the airborne infection risks associated with construction projects, dispersal of fungal spores during such activities, and methods to control the dissemination of fungal spores
	Surveillance for airborne environmental disease during construction to ensure the health and safety of immunocompromised patients
Infection-Control for PE Rooms	Minimize exposures of severely immunocompromised patients (solid organ transplant patients or allogeneic neutropenic patients) to activities that might cause aerosolization of fungal spores (vacuuming or disruption of ceiling tiles)
	Minimize the time that immunocompromised patients in PE are outside their rooms for diagnostic procedures and other activities
	Incorporate ventilation engineering specifications and dust-controlling processes in construction of new PE units

Table 3.

Recommendations for environmental infection control-water

Items	Recommendations
Controlling Legionnaires Disease	Apply sterile water to breathing therapy and no use of humidifier for the long time to avoid creating infectious aerosols
	Surveillance to detect health-care–associated Legionnaires disease, use of disinfected water for respiratory system and routine culture of water systems
	Use an effective biocide on a regular basis (2-4/year) and infection-control procedures for operational cooling towers
	Water treatment: chlorine dioxide, superheat water, UV, ozone, heavy-metal ions (copper or silver)
Control of Hemodialysis centers	Test regularly water in dialysis settings and repeat the test when chemical or microbiological contamination is observed
	Disinfect water distribution systems in dialysis settings on a regular schedule
	Ensure that water does not exceed the limits for microbial counts and endotoxin concentrations Storage tanks should be routinely drained and disinfected

Table 4.

Summary of major disinfectants for noncritical items or surfaces

Method	Level	Uses
Alcohol	Intermediate	External surfaces of equipment, such as stethoscopes, ventilators, manual ventilation bags
Chlorine and Chlorine Compounds	Intermediate	1:10–1:100 dilution of 5.25–6.15% sodium hypochlorite for decontaminating blood spills
Iodophors	Intermediate	Medical equipment, such as hydrotherapy tanks, thermometers, and endoscopes
Phenolics	Low	Environmental surfaces, such as bedside tables, bedrails, and laboratory surfaces
Quaternary Ammonium Compounds	Low	Ordinary environmental sanitation of noncritical surfaces, such as floors, furniture, and walls.
		Medical equipment that contacts intact skin, such as blood pressure cuffs

Table 5.

Methods for monitoring hospital cleanliness

Type	Method	Restriction
Visual Inspection	Visually assessed before and after cleaning by checklist. Evidence of visual dirt, rubbish, smears, dust, grease, blood, fingerprints, clinical waste, etc.	Subjective and only removal of dirty material Impossible to check the presence of bacteria or virus
Microbiological Screening	Culture for microbial hygiene assessment of environment Culture for detecting bacterial pathogens in the environment	Time and resource consuming Difference with regard to methods and interpretation criteria
Fluorescent Marker	Invisible fluorescent marker applied to target standardized high-touch surface in hospital rooms before cleaning	Inadequate correlation of optimal cleaning when fluorescent marker is over-dried
Adenosine Triphosphate (ATP) Bioluminescence	Measurement of the amount of light generated by ATP, which organic material contains	Require Luminometer False positive by Food and drink residues, disinfectant, microfiber, dead bacteria Standardization required

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