INFECTION PREVENTION AND CONTROL


The ‘science’ of effective cleaning in focus


The risks to patients from pathogens commonly found in hospital environments, and the need for those tasked with cleaning such facilities to be both adequately trained, and equipped with the latest technology, were highlighted in an interesting address by Dr Mark Garvey, consultant clinical scientist in Microbiology, and Deputy director of Infection Prevention & Control at University Hospitals Birmingham NHS Foundation Trust (UHB), at the Central Sterilising Club’s 60th Anniversary Annual Scientific Meeting in Stratford-Upon- Avon. Louise Frampton, editor of HEJ’s sister publication, The Clinical Services Journal, reports.


Environmental decontamination was high on the agenda at the Central Sterilising Club’s 60th Anniversary Annual Scientific Meeting – the pandemic has intensified interest in technologies that tackle airborne pathogens, but the familiar foes of Methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (C. difficile), and vancomycin-resistant enterococci (VRE) (to name just a few), still remain a challenge. While technologies such as hydrogen peroxide vapour (HPV) and ultraviolet (UV) have an important role in helping to prevent healthcare-associated infections, cleaning is still fundamental to ensure patient safety, and to reduce the risk of environmental transmission. However, do we give this the training or recognition it deserves? Dr. Mark Garvey, consultant clinical


scientist in Microbiology, and deputy director of Infection Prevention & Control at University Hospitals Birmingham NHS Foundation Trust (UHB), tackled this issue in a presentation on ‘Wiping out Infections’. “In healthcare, we are undertaking


increasingly complicated work, especially at the University Hospitals Birmingham, one of the largest hospital Trusts in the UK – with over 2,500 beds. We perform transplants every day, and put lots of devices into patients, which can provide potential routes into them for microorganisms,” he commented.


The key to patient safety Eliminating these microorganisms in the environment is key to patient safety. Dr. Garvey referred to a Ted Talk by Jack Gilbert on ‘The microbiome revolution: why microbes control your life’,1


which


highlights just how many microorganisms we expel into the environment at any one time. Jack Gilbert points out that around 100 trillion cells in your body are bacterial, and only 10 trillion are human – which means you are ‘outnumbered 10:1 by microbial cells’. Presenting some worrying examples


of infection risks in healthcare settings, Dr. Garvey commented that it is easy to see how the environment can play an important role in the transmission of microorganisms. Some of the photos presented during his talk showed evidence of visible faecal matter in healthcare settings, underscoring the importance of environmental cleaning. He explained that pathogens can survive


for long periods in the environment – for example, S. aureus (including MRSA) can last from 7 days to >12 months; Enterococcus spp. (including VRE) for 5 days to >48 months; C. difficile (spore form) for >5 months, and Acinetobacter spp. for 3 days to 11 months (Dancer et al, 2014).2


Dr. Garvey added that some


microorganisms can also survive in ‘protective’ biofilms in the environment, making them even more challenging. Various studies have looked at


organism transfer in clinical environments. One study, by Oelberg et al (2000),3 involved the inoculation of non-infectious cauliflower mosaic virus DNA into a phone in a neonatal unit ICU cubicle. The virus spread to 58 per cent of ward sampling sites within seven days of inoculation – spreading to all five other cubicles, contaminating the door handles first.


Infection from the prior room occupant A paper by Otter et al (2013)4


highlighted


an increased risk of acquiring an infection from the prior room occupant (as high as 71 per cent, if the prior patient had A. baumannii). In addition, a prospective cohort study in an ICU, by Nseir et al (2011),5


also found that successive


occupiers of a room are at risk from organisms from previous occupants. Quality audits showed that 56% of rooms


August 2022 Health Estate Journal 51


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