Highlights
- •The persistence of multidrug-resistant organisms (MDROs) within intensive care units poses a significant risk to patient safety.
- •A new approach to locating these MDRO was investigated using environmental microbiology with adenosine triphosphate testing, which demonstrated a significant improvement in identification of MDRO locations.
- •Results suggests that MDRO may be hiding within clinical staff work areas and away from immediate patient zones.
Background
The persistence of multidrug-resistant organisms (MDROs) within an intensive care
unit (ICU) possibly contained within dry surface biofilms, remains a perplexing confounder
and is a threat to patient safety. Identification of residential locations of MDRO
within the ICU is an intervention for which new scientific approaches may assist in
finding potential MDRO reservoirs.
Method
This study investigated a new approach to sampling using a more aggressive environmental
swabbing technique of high-touch objects (HTOs) and surfaces, aided by 2 commercially
available adenosine triphosphate (ATP) bioluminometers.
Results
A total of 13 individual MDRO locations identified in this pilot study. The use of
ATP bioluminometers was significantly associated with the identification of 12 of
the 13 individual MDRO locations. The MDRO recovery and readings from the 2 ATP bioluminometers
were not significantly correlated with distinct cutoffs for each ATP device, and there
was no correlation between the 2 ATP devices.
Conclusion
The specific MDRO locations were not limited to the immediate patient surroundings
or to any specific HTO or type of surface. The use of ATP testing helped rapidly identify
the soiled locations for MDRO sampling. The greatest density of positive MDRO locations
was around and within the clinical staff work station.
Key Words
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References
- Epic 3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England.J Hosp Infect. 2014; 86: S1-S70
- Presence of biofilm containing viable multi-resistant organisms despite terminal cleaning on clinical surfaces in an intensive care unit.J Hosp Infect. 2012; 80: 52-55
- Hospital cleanliness: establishing a new science.J Hosp Infect. 2012; 80: 355
- Pattern of bacterial colonisation in a new neonatal intensive care unit and its association with infections in infants.Am J Infect Control. 2012; 40: 512-515
- Interventional evaluation of environmental contamination by vancomycin-resistant enterococci: failure of personnel, product or procedure?.J Hosp Infect. 2009; 71: 123-131
- Dissemination of antibiotic-resistant enterococci within the ward environment: the role of airborne bacteria and the risk posed by unrecognized carriers.Am J Infect Control. 2013; 41: 57-60
- Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients.Infect Control Hosp Epidemiol. 2004; 25: 164-167
- The type, level and distribution of microorganisms within the ward environment: a zonal analysis of an intensive care unit and a gastrointestinal surgical ward.Infect Control Hosp Epidemiol. 2013; 34: 500-506
- Sickbert-Bennett EE, Weber DJ. Microbial assessment of high-, medium-, and low-touch hospital room surfaces.Infect Control Hosp Epidemiol. 2013; 34: 211-212
- Cleanliness audit of clinical surfaces and equipment: who cleans what?.J Hosp Infect. 2011; 78: 178-181
- What may be lurking in the hospital undergrowth? Inapparent cross-transmission of extended-spectrum beta-lactamase–producing Klebsiella pneumoniae.J Hosp Infect. 2014; 88: 156-161
- Search and you will find: detecting extended-spectrum ß-lactamase–producing Klebsiella pneumoniae from a patient's immediate environment.Infect Control Hosp Epidemiol. 2013; 34: 534-536
- An evaluation of hospital cleaning regimes and standards.J Hosp Infect. 2000; 45: 19-28
- Evaluation of ATP bioluminescence assays for potential use in a hospital setting.Infect Control Hosp Epidemiol. 2011; 32: 507-509
- The comparative performance of three brands of portable ATP-bioluminometer intended for use in hospital infection control.Healthcare Infect. 2012; 17: 91-97
- Validation and comparison of three adenosine triphosphate luminometers for monitoring hospital surface sanitization: a Rosetta stone for adenosine triphosphate testing.Am J Infect Control. 2012; 40: e233-e239
- Evaluation of the relationship between ATP bioluminescence assay and the presence of organisms associated with healthcare-associated infections.Healthcare Infect. 2014; 19: 101-107
- The use of adenosine triphosphate bioluminescence to assess the efficacy of a modified cleaning program implemented within an intensive care setting.Am J Infect Control. 2010; 38: 617-622
- Comparison of fluorescent marker systems with 2 quantitative methods of assessing terminal cleaning practices.Infect Control Hosp Epidemiol. 2011; 32: 1187-1193
- Sampling plans for use of rapid adenosine triphosphate (ATP) monitoring must overcome variability or suffer statistical invalidity.Infect Control Hosp Epidemiol. 2015; 36: 236-237
- Floor cleaning: effect on bacteria and organic materials in hospital rooms.J Hosp Infect. 2009; 71: 57-65
- A modified ATP benchmark for evaluating the cleaning of some hospital environmental surfaces.J Hosp Infect. 2008; 69: 156-163
- Evaluation of adenosine triphosphate (ATP) bioluminescence assay to confirm surface disinfection of biological indicators with vaporized hydrogen peroxide (VHP).Healthcare Infect. 2015; 20: 16-22
- Failure analysis in the identification of synergies between cleaning monitoring methods.Am J Infect Control. 2015; 43: 147-153
- Improving cleaning of the environment surrounding patients in 36 acute care hospitals.Infect Control Hosp Epidemiol. 2008; 29: 1035-1041
- Environmental sampling of Acinetobacter baumannii: moistened swabs versus moistened sterile gauze pads.Infect Control Hosp Epidemiol. 1999; 20: 458-460
- Statistical methods in medical research.3rd ed. Blackwell Science, Oxford, UK1996
- The perennial problem of variability in adenosine triphosphate (ATP) tests for hygiene monitoring within healthcare settings.Infect Control Hosp Epidemiol. 2015; 36: 658-663
- What can we learn from each other in infection control? Experience in Europe compared with the USA.J Hosp Infect. 2013; 83: 173-184
- Methods to evaluate environmental cleanliness in healthcare facilities.Healthcare Infect. 2013; 18: 22-30
International Sanitary Suppliers Association. ISSA Clean Standard 0714–2014: measuring the cleanliness of K-12 schools. Lincolnwood, [IL]: International Sanitary Suppliers Association.
- Finding a benchmark for monitoring hospital cleanliness.J Hosp Infect. 2011; 77: 25-30
Hand Hygiene Australia. National data period one, 2015. Available from: http://www.hha.org.au/LatestNationalData.aspx. Accessed May 1, 2015.
Article Info
Footnotes
Conflicts of interest: None to report.
Identification
Copyright
© 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
