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Environmental and body contamination from cleaning vomitus in a health care setting: A simulation study

Published:November 21, 2017DOI:https://doi.org/10.1016/j.ajic.2017.10.003

      Highlights

      • Contamination remained on the floor after cleaning in most experiments, but was lower when participants used towels to remove bulk fluid.
      • Fluorescein was rarely quantified in the air during cleaning.
      • The soles of participants' shoe covers were contaminated in most experiments.
      • Glove contamination was ubiquitous, and was not associated with the number or frequency of environmental surface contacts.
      • Contamination on the body, when it occurred, most commonly occurred on the legs.

      Background

      Environmental service workers may be exposed to pathogens during the cleaning of pathogen-containing bodily fluids.

      Methods

      Participants with experience cleaning hospital environments were asked to clean simulated, fluorescein-containing vomitus using normal practices in a simulated patient room. Fluorescein was visualized in the environment and on participants under black lights. Fluorescein was quantitatively measured on the floor, in the air, and on gloves and shoe covers.

      Results

      In all 21 trials involving 7 participants, fluorescein was found on the floor after cleaning and on participants' gloves. Lower levels of floor contamination were associated with the use of towels to remove bulk fluid (ρ = −0.56, P = .01). Glove contamination was not associated with the number or frequency of contacts with environmental surfaces, suggesting contamination occurs with specific events, such as picking up contaminated towels. Fluorescein contamination on shoe covers was measured in 19 trials. Fluorescein was not observed on participants' facial personal protective equipment, if worn, or faces. Contamination on other body parts, primarily the legs, was observed in 8 trials. Fluorescein was infrequently quantified in the air.

      Conclusions

      Using towels to remove bulk fluid prior to mopping is part of the recommended cleaning protocol and should be used to minimize residual contamination. Contamination on shoes and the floor may serve as reservoirs for pathogens.

      Key Words

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      References

        • Cheng V.C.
        • Chau P.H.
        • Lee W.M.
        • Ho S.K.
        • Lee D.W.
        • So S.Y.
        • et al.
        Hand-touch contact assessment of high-touch and mutual-touch surfaces among healthcare workers, patients, and visitors.
        J Hosp Infect. 2015; 90: 220-225
        • Shek K.
        • Patidar R.
        • Kohja Z.
        • Liu S.
        • Gawaziuk J.P.
        • Gawthrop M.
        • et al.
        Rate of contamination of hospital privacy curtains on a burns and plastic surgery ward: a cross-sectional study.
        J Hosp Infect. 2017; 96: 54-58
        • Weber D.J.
        • Anderson D.
        • Rutala W.A.
        The role of the surface environment in healthcare-associated infections.
        Curr Opin Infect Dis. 2013; 26: 338-344
        • Dancer S.
        The role of environmental cleaning in the control of hospital-acquired infection.
        J Hosp Infect. 2009; 73: 378-385
        • Ramphal L.
        • Suzuki S.
        • McCracken I.M.
        • Addai A.
        Improving hospital staff compliance with environmental cleaning behavior.
        Proc (Bayl Univ Med Cent). 2014; 27: 88-91
        • Su Y.M.
        • Phan L.
        • Edomwandew O.
        • Weber R.
        • Bleasdale S.C.
        • Brosseau L.M.
        • et al.
        Contact patterns during cleaning of vomitus: a simulation study.
        Am J Infect Control. 2017;
      1. Su Y.M., Jones R.M.. Recipes for simulated vomitus. 2017. In press.

        • Sehulster L.M.
        • Chinn R.Y.W.
        Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC).
        MMWR Recomm Rep. 2003; 52: 1-42
        • Makison Booth C.
        Vomiting Larry: a simulated vomiting system for assessing environmental contamination from projectile vomiting related to norovirus infection.
        J Infect Prev. 2014; 15: 176-180
        • Carling P.C.
        • Parry M.F.
        • Bruno-Murtha L.A.
        • Dick B.
        Improving environmental hygiene in 27 intensive care units to decrease multidrug-resistant bacterial transmission.
        Crit Care Med. 2010; 38: 1054-1059
        • Goodman E.R.
        • Goodman E.R.
        • Platt R.
        • Bass R.
        • Onderdonk A.B.
        • Yokoe D.S.
        • et al.
        Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intensive care unit rooms.
        Infect Cont Hosp Epidemiol. 2008; 29: 593-599
        • Griffith C.J.
        • Obee P.
        • Cooper R.A.
        • Burton N.F.
        • Lewis M.
        The effectiveness of existing and modified cleaning regimens in a Welsh hospital.
        J Hosp Infect. 2007; 66: 351-359
        • Deshpande A.
        • Cadnum J.L.
        • Fertelli D.
        • Sitzlar B.
        • Thota P.
        • Mana T.
        • et al.
        Are hospital floors an underappreciated reservoir for transmission of health care-associated pathogens?.
        Am J Infect Control. 2017; 45: 336-338
        • Kogatni S.
        • Alhmidi H.
        • Tomas M.E.
        • Cadnum J.L.
        • Jencson A.
        • Donskey C.J.
        Evaluation of hospital floors as a potential source of pathogen dissemination using a nonpathogenic virus as a surrogate marker.
        Infect Cont Hosp Epidemiol. 2016; 37: 1374-1377
        • Han J.
        • Sullivan N.
        • Leas B.F.
        • Peques D.A.
        • Kaczmarek J.L.
        • Umscheid C.A.
        Cleaning hospital room surfaces to prevent health care-associated infections.
        Ann Intern Med. 2015; 163: 598-607
        • Dimmick R.L.
        • Vogl W.F.
        • Chatigny M.A.
        Potential for accidental microbial aerosol transmission in the biological laboratory.
        in: Hellman A. Oxman M.N. Pollack R. Biohazards in biological research. Cold Spring Harbor Laboratory, Cold Spring Harbor (NY)1973: 246-266
        • Bennett A.
        • Parks S.
        Microbial aerosol generation during laboratory accidents and subsequent risk assessment.
        J Appl Microbiol. 2006; 100: 658-663
        • Atmar R.L.
        • Opekun A.R.
        • Gilger M.A.
        • Estes M.K.
        • Crawford S.E.
        • Neill F.H.
        • et al.
        Determination of the 50% human infectious dose for Norwalk virus.
        J Infect Dis. 2014; 209: 1016-1022