An Environmental Disinfection Odyssey: Evaluation of Sequential Interventions to Improve Disinfection of Clostridium difficile Isolation Rooms

Abstract

OBJECTIVE. Effective disinfection of hospital rooms after discharge of patients with Clostridium difficile infection (CDI) is necessary to prevent transmission. We evaluated the impact of sequential cleaning and disinfection interventions by culturing high-touch surfaces in CDI rooms after cleaning. DESIGN. Prospective intervention. SETTING. A Veterans Affairs hospital. INTERVENTIONS. During a 21-month period, 3 sequential tiered interventions were implemented: (1) fluorescent markers to provide monitoring and feedback on thoroughness of cleaning facility-wide, (2) addition of an automated ultraviolet radiation device for adjunctive disinfection of CDI rooms, and (3) enhanced standard disinfection of CDI rooms, including a dedicated daily disinfection team and implementation of a process requiring supervisory assessment and clearance of terminally cleaned CDI rooms. To determine the impact of the interventions, cultures were obtained from CDI rooms after cleaning and disinfection. RESULTS. The fluorescent marker intervention improved the thoroughness of cleaning of high-touch surfaces (from 47% to 81% marker removal; P < .0001). Relative to the baseline period, the prevalence of positive cultures from CDI rooms was reduced by 14% (P=.024), 48% (P <.001), and 89% (P=.006) with interventions 1, 2, and 3, respectively. During the baseline period, 67% of CDI rooms had positive cultures after disinfection, whereas during interventions periods 1, 2, and 3 the percentages of CDI rooms with positive cultures after disinfection were reduced to 57%, 35%, and 7%, respectively. CONCLUSIONS. An intervention that included formation of a dedicated daily disinfection team and implementation of a standardized process for clearing CDI rooms achieved consistent CDI room disinfection. Culturing of CDI rooms provides a valuable tool to drive improvements in environmental disinfection.

Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination

“…The number of screened sites positive for C. difficile decreased by 14% (P ϭ 0.024), 48% (P Ͻ 0.001), and 89% (P ϭ 0.006) for interventions 1, 2, and 3, respectively, compared with prestudy levels. Positive cultures after disinfection were recovered from two-thirds of CDI rooms before the study began, whereas during periods 1, 2, and 3, the percentages of CDI rooms with positive cultures after disinfection fell by 57%, 35%, and 7%, respectively (68).…”

“…A systematic cleaning and disinfection program was assessed by screening frequently touched surfaces for the presence of C. difficile in CDI rooms after cleaning (68). Three sequential interventions were introduced over a 21-month period: (i) fluorescent markers placed at key sites for the purposes of monitoring and feedback to cleaners, (ii) use of automated UV equipment for enhanced disinfection, and (iii) support from a designated team responsible for daily assessment of terminally cleaned CDI rooms.…”

Dos and don’ts for hospital cleaning

“…Hospital pathogens survive in the hospital environment until removed through some cleaning process but the best way to achieve this remains elusive [1,3,4]. Many studies have demonstrated persistent contamination following domestic attention, including high-risk hand-touch sites beside the patient [5][6][7][8][9]10 & ]. If a patient is admitted into a room previously occupied by a patient colonized or infected with a specific pathogen, then the new admission has an increased risk of acquiring the same organism [11][12][13][14][15].…”

Improved control of nosocomial C. difficile transmission by daily use of an oxygen-releasing sporicidal disinfectant

“…36,37,38 High compliance with the new disinfection protocol is likely to be sustained by the lack of procedural change needed in the case of CDI occurrence, the short disinfectant exposure time and the lack of unpleasant odour of the sporocide Oxygenon ® Liquid (Antiseptica). Our findings warrant the conclusion that using an oxygen-releasing sporicide for daily surface decontamination might be superior to targeted sporicidal disinfection in preventing nosocomial CDI.…”