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Rigorous cleaning blocks MRSA from prior patient
Improvements with VRE not as dramatic
A rigorous environmental cleaning intervention can reduce the transmission of methicillin- resistant Staphylococcus aureus(MRSA) and other multidrug-resistant organisms in hospital intensive care units (ICUs), according to research presented recently in San Diego at the annual meeting of the Society for Healthcare Epidemiology of America (SHEA).
Researchers found that following an enhanced cleaning protocol reduced the spread of MRSA to patients exposed to rooms in which the prior occupant had been colonized or infected. The multimodal cleaning intervention consists of three parts: a change from use of a pour bottle to bucket immersion for applying disinfectant to cleaning cloths; an educational campaign involving the environmental services staff at the hospital; and feedback method using removal of intentionally applied marks visible only under UV light.
"Studies have shown that multidrug-resistant organisms such as MRSA and vancomycin-resistant enterococci (VRE) can be cultured off a variety of surfaces such as doorknobs, countertops, keyboards, and sink handles," Rupak Datta, MPH, an MD/PhD candidate at the University of California at Irvine, said at a SHEA press conference. "We previously found that patients admitted to intensive care unit rooms where the prior occupant was MRSA- or VRE-positive had a 40% higher risk of acquiring MRSA or VRE. This finding was notable not only because it occurred in a hospital where cleaning standards exceeded national guidelines, but it also suggested that environmental contamination persists despite discharge room cleaning."
This study found that using additional measures over and above national guidelines, such as cleaning cloths saturated with disinfectant, can improve environmental cleaning. "This is just a way to ensure that the cleaning cloths are actually saturated with disinfectant," he noted. "The second aspect of the intervention was actually an educational campaign for staff — for environmental services staff. [It involved] making sure that they repeatedly immerse the cloth in disinfectant before cleaning, as well as making sure that they discard the disinfection solution after room cleaning. One of the more interesting aspects of the intervention was a method of targeted feedback. We used a fluorescent marker that was visible only under ultraviolet light. "
MRSA falls sharply
The retrospective study of more than 13,000 hospital stays in 10 ICUs at a large, tertiary care academic medical center in Boston measured the risk of MRSA and VRE acquisition before (September 2003-April 2005) and during the cleaning intervention (September 2006-April 2008).1 Routine admission and weekly screenings for MRSA and VRE were conducted during both periods providing a systematic method to identify new cases of MRSA and VRE. During the pre-intervention period, 3.9% of the 1,454 patients exposed to a prior occupant with MRSA acquired the pathogen compared to just 1.5% of the 1,443 patients exposed during the intervention. Of the 1,291 patients exposed to VRE prior to the intervention, 4.5% acquired VRE, compared to 3.5% of 1,446 patients during intervention.
"The results suggest that a multimodal cleaning intervention can reduce MRSA and, to a lesser extent, VRE transmission in high-risk patient areas, including the ICU," said Datta. Datta and his co-authors point out that a relatively small percentage of health care-associated infections (HAIs) are transmitted due to inadequate room cleaning (constituting about 5% of all new cases of either pathogen.) Still, there are measures hospitals can take to put patients' minds at ease. "Even though we know the risk is relatively low, it is unsettling for patients admitted to hospitals to know that the health condition of the prior room occupant could impact their risk for acquiring MRSA or another antibiotic-resistant infection." he added.