The Role of the Environment and Colonization in Healthcare-Associated Infections

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Abstract

Healthcare-associated infections (HAIs) can be caused by endogenous host microbial flora or by exogenous microbes, including those found in the hospital environment. Efforts to decrease endogenous pathogens via decolonization and skin antisepsis may decrease the risk of infection in some settings. Controlling the spread of potential pathogens from the environment requires meticulous attention to cleaning and disinfection practices. In addition to selection of the appropriate cleaning agent, use of tools that assess the adequacy of cleaning and addition of no-touch cleaning technology may decrease environmental contamination. Hand hygiene is also a critical component of preventing transmission of pathogens from the environment to patients via healthcare worker hands.

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Most cited references 127

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Preventing surgical-site infections in nasal carriers of Staphylococcus aureus.

Lonneke G M Bode, Jan Kluytmans, Heiman Wertheim … (2010)

Nasal carriers of Staphylococcus aureus are at increased risk for health care-associated infections with this organism. Decolonization of nasal and extranasal sites on hospital admission may reduce this risk. In a randomized, double-blind, placebo-controlled, multicenter trial, we assessed whether rapid identification of S. aureus nasal carriers by means of a real-time polymerase-chain-reaction (PCR) assay, followed by treatment with mupirocin nasal ointment and chlorhexidine soap, reduces the risk of hospital-associated S. aureus infection. From October 2005 through June 2007, a total of 6771 patients were screened on admission. A total of 1270 nasal swabs from 1251 patients were positive for S. aureus. We enrolled 917 of these patients in the intention-to-treat analysis, of whom 808 (88.1%) underwent a surgical procedure. All the S. aureus strains identified on PCR assay were susceptible to methicillin and mupirocin. The rate of S. aureus infection was 3.4% (17 of 504 patients) in the mupirocin-chlorhexidine group, as compared with 7.7% (32 of 413 patients) in the placebo group (relative risk of infection, 0.42; 95% confidence interval [CI], 0.23 to 0.75). The effect of mupirocin-chlorhexidine treatment was most pronounced for deep surgical-site infections (relative risk, 0.21; 95% CI, 0.07 to 0.62). There was no significant difference in all-cause in-hospital mortality between the two groups. The time to the onset of nosocomial infection was shorter in the placebo group than in the mupirocin-chlorhexidine group (P=0.005). The number of surgical-site S. aureus infections acquired in the hospital can be reduced by rapid screening and decolonizing of nasal carriers of S. aureus on admission. (Current Controlled Trials number, ISRCTN56186788.) 2010 Massachusetts Medical Society

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Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination.

Stephanie Dancer (2014)

There is increasing interest in the role of cleaning for managing hospital-acquired infections (HAI). Pathogens such as vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), multiresistant Gram-negative bacilli, norovirus, and Clostridium difficile persist in the health care environment for days. Both detergent- and disinfectant-based cleaning can help control these pathogens, although difficulties with measuring cleanliness have compromised the quality of published evidence. Traditional cleaning methods are notoriously inefficient for decontamination, and new approaches have been proposed, including disinfectants, steam, automated dispersal systems, and antimicrobial surfaces. These methods are difficult to evaluate for cost-effectiveness because environmental data are not usually modeled against patient outcome. Recent studies have reported the value of physically removing soil using detergent, compared with more expensive (and toxic) disinfectants. Simple cleaning methods should be evaluated against nonmanual disinfection using standardized sampling and surveillance. Given worldwide concern over escalating antimicrobial resistance, it is clear that more studies on health care decontamination are required. Cleaning schedules should be adapted to reflect clinical risk, location, type of site, and hand touch frequency and should be evaluated for cost versus benefit for both routine and outbreak situations. Forthcoming evidence on the role of antimicrobial surfaces could supplement infection prevention strategies for health care environments, including those targeting multidrug-resistant pathogens.

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The role played by contaminated surfaces in the transmission of nosocomial pathogens.

Jonathan A. Otter, Saber Yezli, Gary French (2011)

Studies in the 1970s and 1980s suggested that environmental surface contamination played a negligible role in the endemic transmission of healthcare-associated infections. However, recent studies have demonstrated that several major nosocomial pathogens are shed by patients and contaminate hospital surfaces at concentrations sufficient for transmission, survive for extended periods, persist despite attempts to disinfect or remove them, and can be transferred to the hands of healthcare workers. Evidence is accumulating that contaminated surfaces make an important contribution to the epidemic and endemic transmission of Clostridium difficile, vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, Acinetobacter baumannii, Pseudomonas aeruginosa, and norovirus and that improved environmental decontamination contributes to the control of outbreaks. Efforts to improve environmental hygiene should include enhancing the efficacy of cleaning and disinfection and reducing the shedding of pathogens. Further high-quality studies are needed to clarify the role played by surfaces in nosocomial transmission and to determine the effectiveness of different interventions in reducing associated infection rates.

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Author and article information

Contributors

J. Chase McNeil: jm140109@bcm.edu

Judith R. Campbell: +118328241780 , judithc@bcm.edu

Jonathan D. Crews: +11210-704-3048 , +11210-704-4520 , crews@bcm.edu

Allison H. Bartlett: abartlett@peds.bsd.uchicago.edu

Journal

Journal ID (publisher-id): 978-3-319-98122-2

Journal ID (doi): 10.1007/978-3-319-98122-2

Journal ID (nlm-ta): Healthcare-Associated Infections in Children

Title: Healthcare-Associated Infections in Children

Subtitle: A Guide to Prevention and Management

ISBN (Print): 978-3-319-98121-5

ISBN (Electronic): 978-3-319-98122-2

Publication date (Electronic): 16 July 2018

Pages: 17-36

Affiliations

[1 ]GRID grid.416975.8, ISNI 0000 0001 2200 2638, Department of Pediatrics, Section of Infectious Diseases, , Baylor College of Medicine and Texas Children’s Hospital, ; Houston, TX USA

[2 ]GRID grid.416975.8, ISNI 0000 0001 2200 2638, Department of Pediatrics, Section of Infectious Diseases, , Baylor College of Medicine and Texas Children’s Hospital, ; Houston, TX USA

[3 ]GRID grid.459440.8, Department of Pediatrics, , Baylor College of Medicine and The Children’s Hospital of San Antonio, ; San Antonio, TX USA

GRID grid.170205.1, ISNI 0000 0004 1936 7822, Department of Pediatrics, Section of Infectious Diseases, , The University of Chicago Medicine, ; Chicago, IL USA

Article

Publisher ID: 2

DOI: 10.1007/978-3-319-98122-2_2

PMC ID: 7120697

SO-VID: 47617c95-6ca6-4900-aeb4-3c7dfe3880d0

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This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

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Keywords: hospital-acquired infections,mrsa,decolonization,environmental cleaning,preoperative antisepsis,mdro colonization,surveillance

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Keywords: hospital-acquired infections, mrsa, decolonization, environmental cleaning, preoperative antisepsis, mdro colonization, surveillance

The Role of the Environment and Colonization in Healthcare-Associated Infections

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Most cited references 127

Preventing surgical-site infections in nasal carriers of Staphylococcus aureus.

Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination.

The role played by contaminated surfaces in the transmission of nosocomial pathogens.

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