portable equipment as a vector for pathogen dissemination 1249
played a major role in transfer of the DNA marker from the contaminated equipment to other sites. Our results demonstrate the potential for contaminated portable equipment to serve as a vector for dissemination of pathogens in ICU settings. Our findings have important implications for infection
control. First, there is a need for effective strategies for routine disinfection of portable equipment shared among patients. Although our infection control policies recommend cleaning of equipment shared among patients, with the exception of day 6 in the MICU, there was no evidence that the inoculated portable equipment had been cleaned based on the lack of fluorescent marker removal. Second, hand hygiene after contact with shared portable equipment could also be beneficial to reduce the risk for transmission of pathogens. Hand hygiene after contact with portable equip- ment would be consistent with the recommendation that hand hygiene should be performed after contact with a patient’s surroundings.8 Our study has some limitations. We only studied
dissemination in intensive care units. Additional studies are needed in other settings. It is unclear how well the dissemination of the DNA marker correlates with pathogen dissemination. However, in laboratory testing we found excellent correlation between hand transfers of cauliflower mosaic virus DNA, bacteriophage MS-2 and non-toxigenic Clostridium difficile spores (authors’ unpublished data). The concentration of the DNA marker applied to the portable equipment was high, so our results are likely to reflect a worst- case scenario. Although the marker is rendered nondetectable by bleach, it remained detectable after exposure to 70% ethanol and a quaternary ammonium disinfectant. Thus, our findings may not correlate well with dissemination of pathogens that are killed by alcohol or quaternary ammonium disinfectants. Finally, the assay used to detect the DNA marker was qualitative and did not provide a quantitative assessment of the amount of DNA present. In summary, our findings suggest that shared portable
equipment might be an underappreciated vector for pathogen transmission in healthcare settings. Effective use of personal protective equipment, hand hygiene, and environmental disinfection may be useful to reduce the risk of transmission, but would be dependent on compliance of healthcare staff. Further research is needed to evaluate alternate methods of disinfection of portable equipment that would allow for adequate disinfection without interfering with workflow.
acknowledgments
Financial support: This work was supported by a Merit Review grant from the Department of Veterans Affairs to C.J.D. Potential conflicts of interest: C.J.D. has received research grants from Merck,
Gojo, Steris, and EcoLab. He also serves on an advisory board for 3M. All other authors report no conflicts of interest relevant to this article.
Affiliations: 1. Department of Medicine, Division of Infectious Diseases and
HIV Medicine, University Hospitals Case Medical Center, Cleveland, Ohio; 2. Research Service, LouisStokesCleveland VeteransAffairsMedical Center, Cleveland, Ohio; 3. Geriatric Research, Education and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; 4. Case Western Reserve University School of Medicine, Cleveland, Ohio.
Address correspondence to Curtis J. Donskey, MD, Geriatric Research, Education, and Clinical Center, Cleveland Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, Ohio 44106 (
curtisd123@yahoo.com).
Received March 16, 2017; accepted June 29, 2017; electronically published
August 7, 2017 © 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2017/3810-0017. DOI: 10.1017/ice.2017.160
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