A key review article has been published in the Journal of Hospital Infection summarising the accumulating evidence that the status of the prior room occupant can influence the chances of the incoming occupant picking up an MDRO. The bottom line is that if you are admitted to a room previously occupied by a patient with an MDRO (including MRSA, VRE, C. difficile and Acinetobacter sp.), you are twice as likely to acquire that MDRO. The impact of these findings is clear: we need to improve standards of discharge disinfection to protect the incoming occupant. So how can we do this? There are several paths to follow towards the same end - and these are not mutually exclusive:
Improve the cleaning / disinfection process
The advent of fluorescent markers and other similar approaches has provided the tools for us to "demystify" the cleaning / disinfection process, and provide hard evidence as to whether or not surfaces are being cleaned. 'Performance managing' this process can result in impressive improvements (although data are awaited eagerly on improved patient outcomes).
Developing new modalities to make cleaning / disinfection easier
The emergence of disinfectant wipes solves a number of important challenges to cleaning and disinfection: correct formulation, no risk of contaminating a cleaning solution, and - perhaps most importantly - convenience.
Producing novel disinfectants
As our understanding of the importance of biofilms on hospital surfaces evolves, the need for disinfectants formulated specifically with anti-biofilm activity in mind is clear. Gama is working towards this end through a partnership with Cardiff University.
Poorly designed hospital surfaces that are difficult (or impossible!) to clean can be addressed through improved design (check out Gama's easy-clean commodes and keyboards).
Reduced patient shedding
One way to reduce the level of environmental contamination is to control the shedding of MDROs from patients through regular chlorhexidine bathing. This has been shown to reduce the level of skin and environmental contamination, and improve patient outcomes.
An attractive approach is to somehow make surfaces antimicrobial to continuously reduce the levels of contamination. There are various options to achieve a similar aim, and some evidence that patient outcomes may be improved.
Automated room decontamination (ARD)
ARD systems reduce or remove reliance on the operator to assure adequate distribution and contact time of the active agent. There is accumulating evidence that these systems (both HPV and UV) protect incoming occupants from the increased risk from the prior room occupant. In high risk settings, it is becoming increasingly clear that these systems will become the standard of care in coming years.
It is difficult to know which of the above approaches to prioritise since comparative data on the relative impact of these methods is almost non-existent. But we need to find a way to improve the standards of discharge disinfection one way or another!