AMCLA Medical: Environmental cleaning

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There are approximately 200,000 healthcare-associated infections (HAIs) in Australian acute healthcare facilities each year ¹. An estimated 20%-40% of healthcare associated infections are attributed to transmission via the hands of healthcare workers where contamination has occurred as a result of direct contact with patients or indirectly by contact with contaminated environmental surfaces.²

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The recent literature has identified that environmental contamination plays a role in the transmission of healthcare-associated pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), Acinetobacter spp., norovirus, and Clostridium difficile. Hospital surfaces are frequently contaminated with healthcare-associated pathogens and a patient admitted to a room of a previously colonised or infected person has an increased risk of developing colonisation or infection with the same pathogen.³
These pathogens can remain viable on surfaces or items for days to weeks. Pathogens such as Influenza and rhinovirus can persist on surfaces for a few days, vancomycin resistant Enterococci (VRE) for 5 days – 4 months, Staphylococcus aureus including methicillin resistant Staphylococcus aureus (MRSA) for 2-9 weeks, Acinetobacter species for 3 days – 5 months, Serratia marcescens for 3 days – 2 months and Pseudomonas aeruginosa for 6 hours – 16 months and spores such as Clostridium difficile for to 5 months. ⁴
Improved surface cleaning and disinfection can reduce transmission of these pathogens in healthcare settings and daily disinfection of high-touch surfaces in rooms of patients with Clostridium difficile infection and methicillin-resistant Staphylococcus aureus colonisation has been shown to reduced acquisition of these pathogens on hands of healthcare workers caring for the patients.^3,5
Clostridium difficile spores are resistant to common hard surface disinfectants and management of these organisms in healthcare environments requires the use of a sporicidal chemical, such as sodium hypochlorite (more commonly known as bleach). In Australia commonly used low concentrations of regular bleach (i.e. 1000ppm available chlorine) require 15 to 25 minutes contact time to inactivate spores to a high level.⁶ Long contact times are generally not practical nor effective, in most healthcare settings.
On the other hand higher concentrations of regular bleach (i.e. 5,000ppm) which can inactivate spores to a high level in shorter contact times may result in corrosion, damage to rubber, plastic or metal surfaces and discoloration of colored surfaces such as furniture and countertops.
Gama Healthcare limited the manufacturer of Clinell wipes has been working to provide healthcare facilities with an innovative range of cleaning, disinfecting and sporicidal wipes.
The Clinell Sporicidal Wipe contains peracetic acid. When activated with water the powder sandwiched between the 2 layers will instantaneously produce hydrogen peroxide and this will interact with the Tetra Acetyl Ethylene Diamine (TAED) to produce peracetic acid. These wipes are recommended for specific circumstances in which there is an outbreak or suspected transmission of Clostridium difficile occurring in a healthcare setting. The peracetic acid in the wipes breaks down to safe and environmentally friendly residues (acetic acid, carbon dioxide and water) and can therefore be used in non-rinse applications.
The Clinell Universal Sanitising Wipe utilises a patented antimicrobial solution which contains 6 different biocides (agents that kill or inhibit the growth of microorganisms). These biocides are designed to work in synergy with one another, multiplying their effectiveness many times over, ensuring wide antimicrobial activity and a high kill count. The wipe is bactericidal and has activity against common multidrug resistant organisms (MDROs) including; methicillin-resistant Staphylococcus aureus (MRSA), vancomycin -resistant enterococci (VRE). The universal wipe can be used on a daily/routine basis and on discharge of patients to clean and disinfect low risk patient equipment (i.e. beds, chairs, commodes) and environmental patient room surfaces.
References
1. NHMRC (2010) Australian Guidelines for the Prevention and Control of Infection in Healthcare. Commonwealth of Australia.
2. Weinstein RA. Epidemiology and control of nosocomial infections in adult intensive care units. Am J Med 1991;9(suppl 3B): S179-S184.
3. Weber DJ et al. The Role of the Surface Environment in Healthcare- Associated Infections. Curr Opin Infect Dis. 2013;26(4):338-344.
4. Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 2006;6:13
5. Kundrapu S et al. Daily Disinfection of High-Touch Surfaces in Isolation Rooms to Reduce Contamination of Healthcare Workers’ Hands. Infection Control and Hospital Epidemiology, Vol. 33, No. 10 (October 2012), pp. 1039-1042.
6. Perez J et al. Activity of selected oxidizing microbicides against the spores of Clostridium difficile: Relevance to environmental control. Am J Infect Control 2005;33:320-5.
For information visit www.amcla.com.au