Modern hygiene management to optimise infection protection

Acinetobacter baumannii plays an ever greater role as nosocomial pathogen and has been associated with increased morbidity and mortality rates and excess healthcare costs. The bacterium’s ability to persist on inanimate surfaces for prolonged time periods is considered a possible cause of nosocomial transmission. However, there had been a lack of knowledge of which patient-near surfaces and areas Acinetobacter baumannii commonly contaminates to derive targeted and effective surface disinfection measures. The prospective cohort study conducted in an intensive care unit with patients colonised or infected with multidrug-resistant Acinetobacter baumannii (MDR-AB) aimed at filling this gap.

For this, 10 surfaces in each patient room were sampled and evaluated for the presence of Acinetobacter baumannii. A total of 479 samples from 50 single rooms were collected and analysed during the study period of 4 months. Almost half of the patient rooms sampled were positive for growth of the bacterium at one or more surfaces. Most commonly contaminated sites were drawer handles of supply carts (20 %), floors (16 %), infusion pumps (14 %), ventilator touch pads (11.4 %), and bed rails (10.2 %). Additionally, it was shown that patients who had acquired the MDR-AB infection within the last 2 months were not more likely to contaminate their environment than patients with MDR-AB infections dating back more than 2 months.

In conclusion, the study found that the environmental surfaces of patients commonly contaminated with Acinetobacter baumannii are the surfaces often touched by healthcare workers and thus may be a source of transmission. According to the authors, the causal direction and nosocomial transmission of Acinetobacter baumannii from contaminated surfaces needs further investigation. In addition, they recommend looking into new techniques such as enhanced cleaning of high-risk areas and routine screening of patient-near surfaces to ensure adequate cleaning.

Source:
American Journal of Infection Control, 2011; 39 (9):711 DOI:10.1016/j.ajic.2010.09.005

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Hand washing is considered the single most important nosocomial infection-control strategy, yet compliance rarely meets levels recommended by infection control authorities. This prospective, observational study conducted in an intensive care unit determines whether placement of hand hygiene foam dispensers in more conspicuous positions and closer

proximity to patients would increase use of infection control agents as measured by volume of product used. Further, to ascertain the influence of dispenser placement vs the number of dispensers available on usage by volume. The study composed of three observation periods.

A control period with standard agent dispenser location (8 dispensers) was followed by two experimental periods: (1) “conspicuous and immediate proximity to patient” placement (16 dispensers) and (2) standard locations with a dramatic increase in the number of dispensers (36 dispensers).

Results: Volume of use for alcohol-based hand hygiene agent during the three observation periods revealed a statistically significant increase in daily consumption after conspicuous and proximate positioning of dispensers (P,.001). However, increasing the number of dispensers did not increase agent use (P=.196).

Conclusion: More conspicuous placement of dispensers containing alcohol-based hand hygiene agent (ie, immediate proximity to patients) resulted in statistically and clinically significant increases in product usage. An increase in the number of dispensers did not increase usage. The impact of dispenser positioning on usage by volume for these highly effective products should be considered when planning and implementing intensive care unit infection-control policies.

Source:
Journal of the American Osteopathic Association , 2009, 109 (5): 263-267.

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