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INFECTION PREVENTION AND CONTROL


infection, 2.5x for a Vancomycin Resistant Enterococcus (VRE) infection, and 2.5x increased risk for a Clostridium difficile infection.5-11


Setting a standard How do we determine if a room is clean enough? It all starts with a standard of cleanliness that can be measured. Research is ongoing to determine a standard for environmental cleanliness.12 However, Dr Stephanie Dancer of the National Health Service in Scotland, noted that hospitals should maintain a low microbial bioburden to ensure patient safety. Dr Dancer proposed that hospitals monitor the bioburden on surfaces and maintain a bioburden that is <5 bacteria per square centimetre.13 ,14


This would allow


hospitals to achieve the same cleanliness standards as food establishments. As such, hospitals should, at a minimum, be monitoring compliance with disinfection and cleaning practices to ensure adherence to established protocols. This can be accomplished by visual monitoring over time, chemical monitoring (ie ATP or newly developed monitoring techniques) or cleanliness indicators (ie Dazo dye). The incorporation of monitoring into a routine cleaning programme allows accountability and provides and incentive for adherence to established protocols. This provides an extra level of protection for both patients and healthcare staff.


Maintaining a low microbial bioburden Current disinfection products allow for discontinuous killing of problematic microorganisms. In fact, once a surface has been disinfected, the microbial population can rebound within a few hours.15 Therefore, the disinfection of a surface does not equate to reduced microbial transmission. In fact, one study from the University of Cardiff demonstrated that the improper utilisation of disinfection wipes led to the spread of microbes across multiple surfaces.16


The patient


environment needs a continuous microbial reduction intervention that would work around-the-clock to reduce microbial bioburden on the surface, thereby minimising the risk of an infection. There are two main technologies that can deliver continuous microbial reduction: continuously active disinfectants and embedded antimicrobials. Continuously active disinfectants are


a new line of products that, once applied to a surface, can continue to reduce any new microbial bioburden. Continuously active disinfection fits into a normal cleaning regimen, without the need for increased training or protocol changes. These new products are currently under clinical investigation, globally, to substantiate claims and efficacy.


IFHE DIGEST 2020


Hand washing compliance is estimated to be just 40%. Embedded antimicrobials are a proven


and safe way for hospitals to address surface microbial contamination within the patient environment. The safety and efficacy of embedded antimicrobials are reviewed through the EU Biocidal Products Regulation (BPR) and the United States’ Environmental Protection Agency (EPA). Each antimicrobial is vetted for toxicological hazards, ecological impact, and microbial efficacy. The antimicrobials are then approved for use in various product types that range from disinfection to water treatment. Embedded antimicrobials must be approved for ‘product type 9’ in order to be utilised and meet regulatory standards.


Embedded antimicrobials vs. antibiotic resistance Embedded antimicrobials can be incorporated into polymer-based substrates such as bed rails, high frequency touch points such as light switches, powder coated door handles, nurses’ stations and textile-based materials such as bedding and gowns. Additionally, embedded antimicrobials can be utilised on single-use, disposable, nonwoven products such as absorbent bed protectors and privacy curtains. Many of these applications are in intimate contact with the patient throughout the duration of their hospital stay, without being changed or cleaned. Embedded antimicrobials are designed


to provide the needed protection for a specific end use. For example, a hospital bed rail may utilise an antimicrobial that targets bacteria to reduce inherent


bacterial load on the surface of the bed rail. However, a grout-based material may incorporate an antimicrobial that targets mould growth to prevent discoloration of the grout surface. The integration of embedded


technologies can reduce bioburden on surfaces without causing concern for resistance development or negative health implications. Typically, patients that have bacterial or fungal infections will be prescribed antibiotics. Antibiotics are a type of antimicrobial that act upon very specific areas of the microbial cell. The specificity of the antibiotic to one cell component makes the development of resistance relatively easy for microbes that can reproduce within minutes and hours. Embedded antimicrobials that are utilised for building materials, textiles, furnishings and a range of other applications are very different. Safe, embedded antimicrobials are not


meant for human consumption. Built-in technologies are meant to act within the environment of the article to target multiple cellular components at the same time. In addition, this class of antimicrobials targets multiple organisms and sites on those organisms. This makes it very difficult for the organisms to develop resistance. Academic, peer-reviewed literature supports that embedded antimicrobials do not cause a concern for microbial resistance development and propagation. A study conducted by the University of Manchester indicated that the use of quaternary ammonium detergents at sub-


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