INFECTION PREVENTION they become a problem
2 Accurate: must have a level of confidence that the results are correct within an acceptable margin of error
3 Simple: ideally staff can test their own areas of work responsibility. Whilst specialist equipment is required, it should be simple to learn to use
4 Inexpensive: if tests are expensive, they will not be used regularly. From a global perspective, in countries where they are cost prohibitive, it unlikely they will be done at all.
In addition, for each of the currently available test methods, there are no standards to determine acceptable levels of bioburden for surfaces. These would obviously be different dependent on the risks associated with the area being tested, the bacterial species and numbers of live microbes. There would of course be a different standard in a hospital operating theatre, as compared to a general ward, or the hospital administration offices. The cost of testing, with a low
expectation of a result, and especially in light of the time taken to get a result from already busy laboratories, has proven to be enough to ignore the obvious need to understand surface contamination levels and the efficacy of cleaning regimes. For the moment then, without any
definitive study data, the common-sense approach should be to assume that the lower the bioburden in both air and on surfaces, the beter it is for patients and staff. In light of the recent publication of data showing a clear correlation between air contamination and surface contamination,5,6
which indicates
The common-sense approach is to assume that the lower the bioburden in both air and on surfaces, the beter it is for patients and staff.
to air particle counts between 0.5 and 1 micron). This is sufficiently accurate to be able to check using the RCCC test. If contamination is sufficient to warrant further investigation, it will be simple and inexpensive to identify the areas of highest contamination, which will therefore indicate the areas where a surface culture swab is most likely to produce a result. The flow chart in Figure 1 shows the
and with the addition of
a new testing technology, Rapid Chemical Colour Change (RCCC),9
levels of live bacterial contamination, it is now possible to fulfil most of the ideal test criteria set out above.
Proposed new regular testing regime We are now able to test the air 20cm above surfaces to get an approximate value for the microbial contamination on a surface (10:1 surface CFU counts
newly recommended testing regime for hospitals and food manufacturing. The fact is it can be adapted for any environment, based on the risk assessment of the area to be cleaned. As the individual tests are simple to
perform, low in cost, and the results are in real time; when compared to what has previously been available, the questions that now require your own answers are: 1 Which surfaces should be tested? 2 How often should surfaces be tested? 3 What results are acceptable? 4 When should the test results be a cause for concern/ intervention?
5 Who in your team will conduct tests and maintain the results log?
Discussion and conclusions It has never been in the chemical industry’s interest to develop tests for surface disinfectants; the status quo suits it. This means there is a minimal impetus to research and develop new, more effective products, the old cash cows keep the money rolling in year on year. This situation has not been challenged by the healthcare industry or government regulators, possibly because many of the largest chemical manufacturers ‘help’ the regulators to write and police the industry.10
This allows the status
quo to be maintained and makes it extremely expensive and difficult for new technologies to emerge. It is in effect, the fox being left in charge of the chicken coup.
In the recent past there has been an
opportunity for the UK government to help improve the requirements for surface testing, especially in critical high-risk areas. The resultant NHS Improvement document11
does recommend cleaning
Given the year-on-year significant increase in antibiotic resistance linked to disinfectant resistance, why has there been little or no improvement in testing for the build-up of disinfectant resistance?
audits. However, even without the knowledge of what was about to become available for surface testing, this would have been significantly improved by recommending external auditors who examine not only visual standards, but the cleaning protocols and equipment used. The recommended practice in the document is, at best, of no clinical value, and is not based on any data or evidence. In short, it was a poor atempt at producing guidance by the department of NHS Improvement, probably due to it collaborating with large industrial cleaning companies. This was then, a missed opportunity to produce something
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