A study just published by scientists from University Hospital Birmingham evaluated the impact of introducing the one-step Clinell Universal Wipes (which both clean and disinfect) to replace a two-step detergent wipe cleaning followed by alcohol wipe disinfection for nurse-led cleaning tasks. The change in disinfection approach was associated with a significant 55% reduction in the rate of MRSA acquisition.
Despite the widespread use of disinfectant wipes in hospitals, there are few studies with a clinical outcome showing that they reduce transmission of pathogens than can cause HCAI. The study focused on cleaning of ward areas and patient equipment performed by nursing staff (as opposed to cleaning of the general healthcare environment by cleaners). In the baseline period of the study, from April 2013 to April 2016, a two-step system was used by nurses for these tasks. Firstly, a detergent wipe was used to clean the surface following by disinfection using an alcohol wipe. During the intervention phase of the study, from May 2016 to December 2017, Clinell Universal wipes were used as single-step cleaning and disinfection process. The switch to Universal wipes was accompanied by an educational package spanning one month, to ensure that staff understood the switch from a two-step to a one-step process correctly.
Following the introduction of the Universal wipes, the number of MRSA acquisitions decreased from 20.7 to 9.4 per 100,000 patient bed days (p <0.005). A Poisson regression model found that the average rate of MRSA acquisition per 100,000 patient bed days reduced by 6.3% per month after the introduction of the new wipes. Importantly, compliance with MRSA screening was high (>90%) and audits revealed no significant changes in hand hygiene compliance, the appropriate use of personal protective equipment (PPE), or environmental cleanliness during the study. The impact of switching to Universal wipes was all the more impressive because the reduction was achieved despite the cessation of universal decolonisation using chlorhexidine during the baseline period.
This study is important because it’s one of the first to demonstrate that switching to Universal wipes results in a significant reduction in the acquisition of MRSA. The findings underline the importance of cleaning and disinfection tasks performed by nursing staff, because by improving the efficacy of these tasks without intervening to improve general cleaning, a 55% reduction in MRSA acquisition was achieved. The study didn’t evaluate the time that it took nursing staff to perform these cleaning and disinfection tasks in the baseline period or during the intervention, but it seems likely that the single-step process would have been quicker and less resource- intensive than the two-step process. It seems likely that these findings would be transferable to other organisms that survive for extend periods in the healthcare environment such as CPE, VRE, and Acinetobacter species.
We enjoyed the recent Healthcare Infection Society's 2018 conference in Liverpool, and thought we'd share a few highlights. You can view all of the submitted abstracts here and the invited abstracts here. The role of the environment in the transmission of HCAI was a strong theme throughout the conference, with key speakers discussing the relative importance of contaminated surfaces and water in transmission compared with other routes. There was even an entire submitted oral presentation session on water-related transmission of Gram-negative bacteria! Some highlights include:
The conference also featured a debate on decontamination and environment: high vs low technology. Dr Curtis Donskey argued for high technologies, and Prof Stephanie Dancer argued that low technologies will always be required. Dr Donskey stressed the importance of manual cleaning before the deployment of automated systems, arguing that the speed, efficacy and non-corrosive nature of such systems made them an attractive adjunct to manual cleaning. Dr Donskey also discussed the results from the BETR-D study and evidence for automated systems in reducing rates of healthcare associated infections (HAIs), when compared to traditional methods. Prof Dancer argued that we can use all the 'hot air' high technologies available but they can't physically remove dirt and that cleaning is essential with one wipe, one site, one direction and elbow grease. Prof Dancer presented evidence on numerous 'cleaning' studies and used the latest evidence from the REACH cleaning initiative study to show the impact on MRSA and VRE rates. At the end of the debate Dancer 'wiped' the smile of Donskey's face, because the audience voted for low technology! If you'd like to hear more about any of the above, please get in touch.