DECONTAMINATION
Infection risks and the environment
The healthcare environment continues to present a risk of infection transmission, so what can we do to protect patients in a post-pandemic era? The Central Sterilising Club’s 60th anniversary annual scientific meeting showcased the latest evidence for best practice, highlighting some of the potential threats that need to be addressed.
Environmental decontamination was high on the agenda at the Central Sterilising Club’s 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. But do we give this the training or recognition it deserves?
Dr. Mark Garvey, consultant clinical scientist in microbiology and deputy director of infection prevention and 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 hospitals 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 patients for microorganisms,” he commented. Eliminating these microorganisms in the environment is key to patient safety. Garvey
highlighted 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. 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, 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 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 cubical. The virus spread to 58% of ward sampling sites within seven days of inoculation – spreading to all five other cubicles, contaminating the doorhandles first. A paper by Otter et al (2013)4 highlighted an increased risk of acquiring
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