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SYMPOSIUM


by sanitation of “high-touch” surfaces as a commonly accepted critical step in preventing HAIs.44


Manual disin-


fection can significantly reduce envi- ronmental spore counts of pathogenic microbes. Studies have been able to show how improved surface disinfec- tion can decrease environmental con- tamination of health care-associated pathogens and decrease the likelihood of patients acquiring an HAI.8,45-47 Favorable results have been shown


by adopting diluted bleach to clean and disinfect contaminated rooms housing significant colony counts of health care-associated pathogens.47 But manual disinfection alone gener- ally has been shown to be inadequate, sometimes leaving residual contami- nation.6-8


There are several possible


reasons for residual contamination in spite of manual disinfection. They include lack of proper staff training, using the wrong disinfectants for the microorganisms present, inadequate contact time, cross-contamination, and human error.41


As a result, novel


no-touch disinfection (NTD) tech- nologies have recently been incorpo- rated into cleaning protocols in hos- pital settings. NTD that utilizes ultra- violet light (mercury or pulsed xenon based) has been shown to be effective at reducing microbial burden, possi- bly with greater consistency than is achieved with manual methods.8,42,45-47 On the other hand, UV lacks the abil- ity to reach around corners and be- neath beds and tables where light does not fall. In addition, it cannot be used when the patient is present and is not useful for treating linens.48 Hydrogen peroxide vapor (HPV)


deployed as NTD has yielded favor- able results in its ability to disinfect medical equipment that is difficult to clean with bleach; HPV can also reach surfaces that UV light cannot.48 However, although various NTD tech- nologies have shown promise, they still have disadvantages.48


Usually,


implementation is difficult. Convinc- ing housekeeping staff to use novel units regularly is a challenge because


46 TEXAS MEDICINE February 2017


Edward J. Septimus, MD, is medical di- rector of infection prevention and epi- demiology at the Hospital Corporation of America and clinical professor of in- ternal medicine Texas A&M Health Sci- ence Center College of Medicine


REFERENCES


1. Jain R, Kralovic SM, Evans ME, Ambrose M, Simbartl LA, Obrosky DS, et al. Veter- ans Affairs initiative to prevent methicil- lin-resistant Staphylococcus aureus in- fections. N Engl J Med. 2011;364(15):1419– 1430.


2. Klein E, Smith DL, Laxminarayan R. Hos- pitalizations and deaths caused by meth- icillin-resistant Staphylococcus aureus, United States, 1999–2005. Emerg Infect Dis. 2007;13(12):1840–1846.


3. de Kraker ME, Davey PG, Grundmann H. Mortality and hospital stay associated with resistant Staphylococcus aureus and Escherichia coli bacteremia: estimating the burden of antibiotic resistance in Eu- rope. PLoS Med. 2011;8(10):e1001104.


4. Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370(13):1198–1208.


5. Sherwood J, Park M, Robben P, Whitman T, Ellis MW. USA300 methicillin-resistant


of quick room turnaround pressure or lack of an adequate number of devices. Overall, NTD technologies used in terminal cleaning are not well suited to daily disinfection or keeping the bio- burden low continuously. Copper-em- bedded surfaces have been efficacious with regards to some of the most im- portant antibiotic-resistant organisms, including VRE, carbapenem-resistant Klebsiella pneumoniae, and multidrug- resistant Acinetobacter; copper-clad or brass surfaces have shown efficacy against these, as well as the specifically mentioned C. difficile.49-53 In summary, HAI prevention is im-


portant because it is a patient safety issue and has potentially severe finan- cial implications to a hospital. HAI prevention is everyone’s responsibility.


Chetan Jinadatha, MD, is chief of infec- tious diseases at the Central Texas Vet- erans Health Care System in Temple and is an associate professor of medicine at Texas A&M Health Science Center.


Staphylococcus aureus emerging as a cause of bloodstream infections at mili- tary medical centers. Infect Control Hosp Epidemiol. 2013;34(4):393–399.


6. Tuma G. The Impact of healthcare-asso- ciated infections in Pennsylvania, 2010. News release. Harrisburg, PA: Pennsylva- nia Health Care Cost Containment Coun- cil; 2012. http://www.phc4.org/reports/ hai/10/nr022412.htm. Accessed August 24, 2015.


7. Weber DJ, Rutala WA, Miller MB, Hus- lage K, Sickbert-Bennett E. Role of hospi- tal surfaces in the transmission of emerg- ing health care-associated pathogens: norovirus, Clostridium difficile, and Aci- netobacter species. Am J Infect Control. 2010;38(5 Suppl 1):S25–S33.


8. Otter JA, Yezli S, French GL. The role played by contaminated surfaces in the transmission of nosocomial patho- gens. Infect Control Hosp Epidemiol. 2011;32(7):687–699.


9. Jinadatha C, Quezada R, Huber TW, Wil- liams JB, Zeber JE, Copeland LA. Evalu- ation of a pulsed-xenon ultraviolet room disinfection device for impact on con- tamination levels of methicillin-resistant Staphylococcus aureus. BMC Infect Dis. 2014;14:187.


10. Hospital-Acquired Condition (HAC) Re- duction Program. https://www.cms.gov/ Medicare/Medicare-Fee-for-Service- Payment/AcuteInpatientPPS/HAC-Re duction-Program.html. Accessed August 24, 2015.


11. Hospital-Acquired Conditions (Present on Admission Indicator). https://www


.cms.gov/Medicare/Medicare-Fee-for- Service-Payment/HospitalAcqCond/in dex.html. Accessed August 24, 2015.


12. Hospital Value-Based Purchasing. https:// www.cms.gov/Medicare/Quality-Initia tives-Patient-Assessment-Instruments/ hospital-value-based-purchasing/index. html. Accessed August 24, 2015.


13. Umscheid CA, Mitchell MD, Doshi JA, et al. Estimating the proportion of health- care-associated infections that are reason- ably preventable and the related mortality and costs. Infect Control Hosp Epidemiol. 2011;32(2):101–114.


14. Hooton TM, Bradley SF, Cardenas DD, et al; Infectious Diseases Society of Ameri- cal. Diagnosis, prevention, and treatment of catheter-associated urinary tract infec- tion in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(5):625–663.


15. CDC/NHSN surveillance definitions for specific types of infections. At- lanta, GA: Centers for Disease Con- trol and Prevention; January 2016:1– 24. http://www.cdc.gov/nhsn/pdfs/


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