There's been some fascinating data published in recent years using micro cultures to evaluate the chances of healthcare workers (HCW) acquiring hand contamination with pathogens from surface contact. Surprisingly, the chances of hand contamination are just about equal regardless of whether you touch a patient direct, or their surrounding surfaces for MRSA, VRE and C. difficile. A new study uses modelling to evaluate the interplay between contamination of air, surfaces, and hands in a simulated single room and four bed bay.
The main finding is that the type of care delivered is the most important factor in determining hand contamination, with personal care resulting in most contamination. The number of surface contacts and surface distribution of microbes were also important factors, but less so than the type of care delivered. A reduction in ventilation rate from an already low 6 air changes per hour to an even lower 4 air changes per hour made little difference. As you may expect, the single room was considerably better at containing contamination than the four bed bay.
Although personal care was the most important factor in predicting HCW hand contamination, there's not a lot that can be done about this. Hospital patients will always need this level of close physical contact. Clearly this does underline the need for rigorous hand hygiene following patient contact. But the other factors identified can be addressed: improvements in surface disinfection would reduce the risk of hand contamination. And this may be doubly important because HCWs are less likely to perform hand hygiene after contact with a surface than after contact with a patient. It may also be feasible to reduce the number of surface contacts during patient care through a process of re-education. If HCW had at the forefront of their mind that surfaces around patients are likely to be heavily contaminated, would they touch these surfaces as much? Probably not. Finally, although the number of air changes in a room could be increased, this study suggests that this would not have a great deal of impact on HCW hand contamination rates.
This is an important study, which highlights the links between air, surface and hand contamination, and suggests that improving surface disinfection would reduce the rate of HCW hand contamination and the risk of onward transmission.
p>Infection Control Today (ICT) recently released a new report on wipes. The concise report neatly outlines the key benefits of wipes over traditional "mop and bucket" methods, namely assurance of correct dosage, no need to repeatedly dip into an in-use solution (which risks contamination of the solution), and perhaps most importantly, convenience. This can lead to better compliance with cleaning protocols, improved staff satisfaction, faster room turnaround, improved impact in terms of microbial reduction, and, in some circumstances, cost savings.
The report highlighted a recent study that performed a useful cost effectiveness study, accounting for the time taken to clean the room with wipes vs. a traditional bucket method. Cleaning the room using wipes took an average of 178 seconds vs. 231 seconds with the traditional method, resulting in a cost saving per employee day of $38.58 (around Â£25). This doesn't sound much, but multiply this by all of the cleaners in the hospital (let's say there are 100) and all the days in the year, and you get to almost Â£1m! So, even if the material cost for the wipes is higher than for the traditional bucket method, time savings may make the process cost-saving (in addition to the other benefits).
The ICT report covers some useful technical aspects about how good wipes function, including their loading ratio, and disinfectant absorbance and release. But which wipe to choose? There is no shortage of choice in the marketplace, from detergent wipes with no disinfectant activity at all to sporicidal wipes with efficacy against C. difficile spores. Which wipe you choose will depend on your intended purpose. There are probably three key uses of surface wipes in hospitals: cleaning a surface (with no need for disinfection), disinfecting a surface (without inactivating C. difficile spores) and disinfecting a surface (inactivating C. difficile spores). Now that good quality disinfectant / detergent wipes are available (such as the Green Clinell Universal Wipes), the use of detergent only wipes is declining sharply. Meanwhile, the continued problems caused by C. difficile necessitates the use of a sporocial wipe on occasion (such as the Red Clinell Sporicidal Wipes, or a chlorine wipe).
But how to choose between the wipes from various manufacturers with similar and overlapping claims? One of the key factors is efficacy and published data, and, for example, a recent Cardiff study put a range of detergent wipes through their paces, concluding that some did not do what they said on the tin. Efficacy will not be the only factor in deciding which wipe to purchase, but it's a start!