A multicentre US study has shown that hospital floors can be a source of pathogens that can cause HCAI. Floors were heavily contaminated, high-touch items were in frequent contact with floors, and hands became contaminated with hospital pathogens as a result of contact with these items. Anybody who dismissed hospital floors as a potential transmission risk are missing a trick!
Historically, floors have been considered a minor risk in terms of transmitting hospital pathogens, and the focus has been on the disinfection of high-touch surfaces. In order to assess the potential for cross-transmission, a group of five hospitals collaborated to study the frequency of contamination of hospital floors and whether high-risk objects could be a contaminated as a result of contact. Around half of the 318 floors sampled in 159 patient rooms were contaminated with C. difficile (regardless of if the patient had C. difficile infection or not, and whether or not the patient had been discharged and terminal disinfection performed), and between 10 and 30% of floors were contaminated with MRSA and VRE. Amazingly, a point prevalence survey found that 41% of the rooms had one or more high-touch surface in contact with the floor. These objects transferred C. difficile to 3%, VRE to 6%, and MRSA to 18% of researcher hands following contact.
What we need now is a good quality intervention study to show that enhanced disinfection of floors (perhaps using our Sporicidal Granules) reduces the transmission of hospital pathogens. Any takers?
A randomised controlled study with a clinical outcome compared the impact of chlorhexidine, octenidine, and povidone iodine used for cutaneous antisepsis for preventing line infections associated with intravascular catheters. Chlorhexidine knocked spots off the competition, with patients randomised to chlorhexidine significantly less likely to develop line-relates sepsis or bacterial contamination when compared with octenidine or povidone iodine.
57 patients were randomised to either 4% chlorhexidine gluconate, octenidine hydrochlorodine, or 10% povidone iodine for cutaneous antisepsis prior to insert and during the use of intravascular cathethers. 1 in 10 patients randomised to octenidine and povidone iodine developed cathether-related sepsis, compared with none in the chlorhexidine group (p<0.001) (see Table below). Also, catheter-related colonisation occurred in 26% of patients in the povidone iodine group, 21% in the octenidine group, and none of the patients in the chlorhexidine group. Importantly, there were no significant differences between baseline characteristics of the patients randomised to the three different antiseptics.
Table: Clinical outcomes associated with 57 patients randomised to three difference cutaneous antiseptics.
This study supports the use of chlorhexidine as the antiseptic of choice for preventing catheter-line associated infections.