Infection Control & Hospital Epidemiology


215


Fig. 1. Transfer of a viral DNA surrogate marker from inoculated portable equipment on a medical ward to environmental surfaces on other wards or other sites in the hospital during a 3-day period. The DNA marker was inoculated onto 6 items of portable equipment on the index ward including 3 bladder scanners, an electrocardiogram machine, a portable vital signs unit, and a cardiac monitor. Observations were conducted to identify episodes when the contaminated equipment was shared by other wards or used on the index ward by personnel who subsequently moved to other areas of the hospital. Swabs were used to sample environmental surfaces, prioritizing sites observed to be contacted by personnel or equipment. (A) A contaminated cardiac monitor (1) and electrocardiogram (EKG) machine (2) were used while caring for a patient who was then transferred with the cardiac monitor attached (3) to ward 2 (4) and then without the monitor to the intensive care unit (ICU) (5 and 6), resulting in detection of DNA marker on surfaces on each ward. (B) A bladder scanner (1) was borrowed by a nurse from another ward (2) resulting in transfer to 3 patient rooms where it was used (3). (C) A physician used contaminated equipment on ward 1 (1) and DNA marker was subsequently recovered from the sleeves of the physician’s white coat that was hung in a physicians’ work room on ward 2 (2). (D) Personnel on the index ward used contaminated equipment (1) and then went to the cafeteria for break, resulting in recovery of DNA marker from a table top (2).


patients were not aware of the study. A fluorescent marker was placed on the equipment adjacent to the marker to allow an assessment of cleaning. For a 3-day period after inoculation, research personnel con-


ducted observations to identify episodes when the contaminated equipment was shared by other wards or used by personnel who subsequently moved to other areas of the hospital. If such epi- sodes were observed, cotton-tipped swabs were used to sample 5×10-cm areas of surfaces, prioritizing sites observed to be contacted by personnel or equipment. Additional swabs were collected from physician call rooms and nursing stations on other wards. To further assess the potential for ward-to-ward transmission by contaminated equipment, we inoculated mobile wound-care


carts on 3 separate days and a phlebotomy cart on 1 day. Per- sonnel using these items were observed and swabs were collected to identify sites of marker transfer.


Results


During the 3-day study, each inoculated device was observed being used at least once, but the fluorescent marker was removed from only 1 of 6 devices (17%). Two inoculated devices were used on other wards, including a cardiac monitor that moved with a transferred patient and a borrowed bladder scanner. Transfer of the DNA marker to surfaces on the other wards occurred with both episodes of equipment sharing (Fig. 1A and 1B). The DNA


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100  |  Page 101  |  Page 102  |  Page 103  |  Page 104  |  Page 105  |  Page 106  |  Page 107  |  Page 108  |  Page 109  |  Page 110  |  Page 111  |  Page 112  |  Page 113  |  Page 114  |  Page 115  |  Page 116  |  Page 117  |  Page 118  |  Page 119  |  Page 120  |  Page 121  |  Page 122  |  Page 123  |  Page 124  |  Page 125  |  Page 126  |  Page 127  |  Page 128  |  Page 129  |  Page 130  |  Page 131  |  Page 132  |  Page 133  |  Page 134  |  Page 135  |  Page 136  |  Page 137  |  Page 138  |  Page 139  |  Page 140  |  Page 141  |  Page 142  |  Page 143  |  Page 144  |  Page 145  |  Page 146  |  Page 147  |  Page 148  |  Page 149  |  Page 150  |  Page 151  |  Page 152  |  Page 153  |  Page 154  |  Page 155  |  Page 156