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Current principles and practices; new research; and new technologies in disinfection, sterilization, and antisepsis

  • William A. Rutala
    Correspondence
    Address correspondence to William A. Rutala, PhD, MPH, Division of Infectious Diseases, 130 Mason Farm Road, Bioinformatics, UNC at Chapel Hill, Chapel Hill, NC 27599-7030.
    Affiliations
    Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC

    Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC
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  • David J. Weber
    Affiliations
    Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC

    Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC
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      Health care-associated infections are an important source of morbidity and mortality with an estimated 1.7 million infections and 99,000 deaths annually in the United States. The major source of health care-associated pathogens is thought to be the patient's endogenous flora, but an estimated 20% of pathogens are acquired via other transmission routes such as the environment, and 20% to 40% is attributed to cross-infection via the contaminated hands of health care personnel.
      • Weinstein R.A.
      Epidemiology and control of nosocomial infections in adult intensive care units.
      This Special Edition of the American Journal of Infection Control provides concise reviews of the scientific literature and current guidelines in 3 important areas of infection control. First, the role that the contaminated room environment plays in the transmission of several important health care-associated pathogens (eg, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus spp, Clostridium difficile, and Acinetobacter spp); second, an update of issues regarding skin antisepsis including hand hygiene; finally, reviews of new current issues in sterilization and disinfection of medical devices and instruments including new technologies.
      In the past decade, new evidence has clearly demonstrated that contaminated room surfaces are an important component in the transmission of key health care-associated pathogens. Evidence supporting this view includes that these pathogens persist in the environment for prolonged periods of time, frequent contamination occurs of the hands/gloves of health care personnel, contact with the environment is equally likely to lead to hand/glove contamination, and admission to a room previously occupied by a patient colonized or infected with one of these pathogens increases the risk the subsequent patient will develop an infection with one of these pathogens. Nine papers in this Special Issue focus on the contaminated surface environment including the role of environmental surfaces in disease transmission (Otter et al), the importance of surface contamination in C difficile transmission (Weber et al), methods for assessing the adequacy of room cleaning (Carling), best practices for surface disinfection (Havill/Boyce), new room decontamination technologies (Rutala/Weber), and whether improved room disinfection reduces health care-associated infections (Donskey). As noted in these reviews, interventions focused on how environmental service workers can improve room disinfection and reduce health care-associated infections. “No-touch” methods of room disinfection (eg, ultraviolet light, hydrogen peroxide) demonstrate promise for further improving terminal room disinfection.
      Appropriate hand hygiene remains a cornerstone of preventing patient-to-patient transmission of health care-associated pathogens. In addition, new practices have been incorporated into infection control for skin antisepsis for preparation of surgical sites, skin antisepsis prior to invasive procedures, and routine bathing of patients in intensive care units. Three papers in this Special Issue provide reviews on this topic including monitoring hand hygiene (Larson), update of issues in hand hygiene and skin antisepsis (Boyce), and irrigation of wounds, preoperative shower, and preoperative skin antisepsis with chlorhexidine gluconate (Edmiston et al).
      Although the basic principles of disinfection and sterilization of patient devices, equipment, and surgical instruments have not changed, new procedures and technologies continue to be introduced. Seven papers in this Special Issue focus on sterilization and disinfection to include improving the effectiveness and monitoring of cleaning devices (Alfa), new developments in reprocessing semicritical devices (Rutala/Weber), the role of biofilms (Roberts), issues regarding immediate use steam sterilization (formerly called “flash” sterilization) (Seavey), new technologies (Schneider), and assessing risk of disease transmission to patients when there is a failure to follow current disinfection/sterilization guidelines (Weber/Rutala). It is likely that new procedures and technologies will continue to be introduced as we strive to develop the “ideal” disinfectant and “ideal” sterilization process.
      • Schneider P.M.
      Low-temperature sterilization alternatives in the 1990s.
      • Rutala W.A.
      • Weber D.J.
      Use of chemical germicides in the United States: 1994 and beyond, in chemical germicides in health care.
      This Special Issue was primarily developed from symposia presented at the APIC annual meeting in 2012. We thank all the presenters and authors for turning their presentations into these concise state-of-the-art reviews.

      References

        • Weinstein R.A.
        Epidemiology and control of nosocomial infections in adult intensive care units.
        Am J Med. 1991; 9: S179-S184
        • Schneider P.M.
        Low-temperature sterilization alternatives in the 1990s.
        Tappi J. 1994; 77: 115-119
        • Rutala W.A.
        • Weber D.J.
        Use of chemical germicides in the United States: 1994 and beyond, in chemical germicides in health care.
        in: Rutala W.A. Association for Professional in Infection Control and Epidemiology, Inc, Washington [DC]1995: 1-22