Dedicated cleaning staff shown to reduce C. difficile contamination in hospital rooms

With rates and deaths associated with Clostridium difficile (C. difficile) at historically high levels, many hospitals have taken extra steps to reduce these infections. New research finds that a dedicated daily cleaning crew who adequately clean and disinfect rooms contaminated by C. difficile using a standardized process can be more effective than other disinfection interventions. The study is published in the May issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America (SHEA), in a special topic issue focused on the role of the environment in infection prevention.

C. difficile is a highly contagious, antibiotic-resistant intestinal that causes inflammation of the colon, known as colitis. Any surface, (e.g., toilets, bathing tubs, and electronic rectal thermometers) can become contaminated with C. difficile spores. can also be transferred to patients via the hands of who have touched a contaminated surface or item.

During a 21-month period, researchers conducted a prospective at the Cleveland Veterans Affairs Medical Center through three intervention sequences including: 1) the use of fluorescent markers applied to high-touch surfaces in to provide monitoring and feedback on thoroughness of cleaning; 2) utilization of an automated ultraviolet (UV) radiation device as a complementary disinfection strategy used after cleaning; and 3) an enhanced disinfection process composed of a dedicated daily disinfection team and a process requiring supervisory assessment and clearance of terminally-cleaned C. difficile infected rooms. Each strategy built on the previous one.

To determine the effectiveness of the interventions, cultures were obtained from rooms contaminated with C. difficile after cleaning and disinfection. The fluorescent marker intervention modestly improved the disinfection of high-touch surfaces over traditional cleaning practices (57 percent versus 67 percent). The use of the UV device further reduced the percentage of positive cultures, but C. difficile still was present in 35 percent of rooms. Ultimately, disinfection was dramatically improved with the addition of enhanced standard disinfection intervention, reducing positive cultures to 7 percent.

"Healthcare facilities are increasingly turning to automated room disinfection devices as a strategy to optimize environmental disinfection. With effective monitoring and feedback, motivated environmental services personnel can achieve results that rival or surpass many of the automated devices," said Curtis Donskey, MD, staff physician at Louis Stokes Cleveland Veterans Affair Medical Center and an author of the study.

The enhanced standard disinfection intervention included formation of a dedicated C. difficile disinfection team that used bleach wipes to disinfect high-touch surfaces. Establishing a dedicated team of highly-motivated housekeepers eliminated the problem of variability in housekeeper performance. Supervisory housekeeping staff and/or infection control personnel cleared C. difficile rooms granting an opportunity to directly observe individual housekeeper performance and provide immediate feedback. Notably, although use of the UV device was continued in the third intervention, it did not contribute to the effectiveness of the intervention (i.e., all negative cultures were negative both before and after operation of the UV device).

While the study highlights the potential for environmental services personnel to achieve excellent of C. difficile rooms, it does have several limitations. Researchers have not yet demonstrated if this intervention could be maintained long-term or if it would be effective in reducing C. difficile transmission and infections. Additionally, environmental cultures for C. difficile were crucial to the success of the intervention, but are currently not feasible for most healthcare facilities.

More information: Brett Sitzlar, Abhishek Deshpande, Dennis Fertelli, Sirisha Kundrapu, Ajay K. Sethi, Curtis J. Donskey. "An Environmental Disinfection Odyssey: Evaluation of Sequential Interventions to Improve Disinfection of Clostridium difficile Isolation Rooms." Infection Control and Hospital Epidemiology 34:5 (May 2013).

add to favorites email to friend print save as pdf

Related Stories

Intervention drops hospital infection rate by 1/3

Mar 19, 2010

Clostridium difficile (C. difficile) is the one of the leading pathogens causing hospital-acquired infection in the United States. It may cause diarrhea, colitis, sepsis and lead to prolonged hospitalization and death. Ma ...

UV lotion lights the way to cleaner facilities

May 11, 2008

A team of Canadian scientists using a lotion which glows under ultraviolet light have shown that up to a third of patient toilets are not properly cleaned. Their findings, published in BioMed Central’s journal, BMC Infectious Di ...

Disinfection caps cut CLABSI cases in half

Jan 03, 2013

Central line-associated bloodstream infections (CLABSI) dropped by 52 percent when an alcohol-impregnated disinfection cap was used instead of standard scrubbing protocol, according to a new study published in the January ...

APIC launches first national C. difficile prevalence study

Mar 20, 2008

The Association for Professionals in Infection Control and Epidemiology (APIC) today announced a detailed strategy to combat Clostridium difficile-associated disease (CDAD). The initiative begins with the first national prevalence ...

Recommended for you

Liberia holds Senate vote amid Ebola fears

2 hours ago

Health workers manned polling stations across Liberia on Saturday as voters cast their ballots in a twice-delayed Senate vote that has been criticized for its potential to spread the deadly Ebola disease.

Evidence-based recs issued for systemic care in psoriasis

22 hours ago

(HealthDay)—For appropriately selected patients with psoriasis, combining biologics with other systemic treatments, including phototherapy, oral medications, or other biologic, may result in greater efficacy ...

Bacteria in caramel apples kills at least four in US

22 hours ago

A listeria outbreak believed to originate from commercially packaged caramel apples has killed at least four people in the United States and sickened 28 people since November, officials said Friday.

Steroid-based treatment may answer needs of pediatric EoE patients

23 hours ago

A new formulation of oral budesonide suspension, a steroid-based treatment, is safe and effective in treating pediatric patients with eosinophilic esophagitis (EoE), according to a new study in Clinical Gastroenterology and Hepatology, the official clinical practice journal ...

Discovery of genes that predispose a severe form of COPD

Dec 19, 2014

A study by Ramcés Falfán-Valencia, researcher at the National Institute of Respiratory Diseases (INER), found that the mestizo Mexican population has a number of variations in certain genes that predispose ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.