The role of the healthcare environment in the spread of multidrug-resistant organisms: update on current best practices for containment

Abstract

The role of the environment in harboring and transmitting multidrug-resistant organisms has become clearer due to a series of publications linking environmental contamination with increased risk of hospital-associated infections. The incidence of antimicrobial resistance is also increasing, leading to higher morbidity and mortality associated with hospital-associated infections. The purpose of this review is to evaluate the evidence supporting the existing methods of environmental control of organisms: environmental disinfection, contact precautions, and hand hygiene. These methods have been routinely employed, but transmission of multidrug-resistant organisms continues to occur in healthcare facilities throughout the country and worldwide. Several new technologies have entered the healthcare market that have the potential to close this gap and enhance the containment of multidrugresistant organisms: improved chemical disinfection, environmental monitoring, molecular epidemiology, self-cleaning surfaces, and automated disinfection systems. A review of the existing literature regarding these interventions is provided. Overall, the role of the environment is still underestimated and new techniques may be required to mitigate the role that environmental transmission plays in acquisition of multidrug-resistant organisms.

Are we teaching our hospitalized patients self-management skills? Opportunities lost

“…More specifically, we aimed to evaluate whether (1) hospital providers teach any content of these four basic self management skills ("four skills") as part of regular care to patients and their caregivers, and (2) whether information presented regarding any of the four skills' is understood and retained after the provider leaves the room. Secondarily, the project gathers information about standard or "control" care behaviors, such as hand washing on room entry or exist, [8] and quality of the provider-patient interaction [9] to capture a baseline rate for five "good clinical practice" activities.…”

Healthcare‐acquired infections: prevention strategies

“…23,36 Patients admitted to rooms previously occupied by VRE or MRSA carriers have a two-to three-fold increased risk of acquisition, and similar rates are seen for A. baumannii, Pseudomonas aeruginosa and, as discussed above, C. difficile. 37,38 Molecular typing of MRO outbreaks has linked the environment, hands of HCW, and patient isolates. HCW may have a primary role in spread, but they can acquire MRO from the environment or inadequately cleaned equipment, including monitors, blood pressure cuffs and tourniquets.…”

“…23,37,47 However, the completeness of physical cleaning is variable and dependent on staff performance. When measured, 50-60% of high touch surfaces that should be cleaned and disinfected are not.…”

“…While manual cleaning alone was previously viewed to be a sufficient focus of environment management, it is now clear that educational interventions and staff motivation are key determinants of cleaning efficacy and HAI prevention. 37,47 Other interventions to prevent HAI…”

How are nursing homes cleaned? Results of a survey of 6 nursing homes in Southeast Michigan

“…1–3 NH residents who are colonized or infected with MDROs shed these organisms onto their skin, clothing, bedding, and nearby environmental surfaces for prolonged periods of time. 4–7 Residents may acquire pathogens directly through contact with contaminated environmental surfaces or indirectly from touching the hands of the healthcare personnel. 8,9 The majority of these residents remain silent carriers after acquisition; however, some develop healthcare-associated infections (HAI).…”