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An effective and automated approach for reducing infection risk from contaminated privacy curtains

Open AccessPublished:June 11, 2021DOI:https://doi.org/10.1016/j.ajic.2021.06.004

      Abstract

      Privacy curtain contamination, including with multidrug-resistant organisms, and the associated infection transmission risks have been well described; however, current approaches for addressing these risks and available guidance are limited. The present study describes the successful reduction of curtain contamination in five different units within a tertiary care hospital utilizing continuous dry hydrogen peroxide (DHP). Microbial load was reduced by 99.47 percent on Day 1 and statistically significant reductions were maintained throughout the 28-day study.

      Key words

      Background

      Privacy curtains are widely used in hospitals, skilled nursing facilities and clinics. These curtains are frequently touched by healthcare providers and easily become contaminated.
      • Ohl M
      • Schweizer M
      • Graham M
      • Heilmann K
      • Boyken L
      • Diekema D.
      Hospital privacy curtains are frequently and rapidly contaminated with potentially pathogenic bacteria.
      The frequency of curtain changes for cleaning and disinfection is only addressed in the standards as it relates to visible soiling and a “routine” but undefined schedule for patients not on isolation precautions.

      Chou T. (2014) Environmental Services. In Boston K.M., et al, eds. APIC Text. Available from: https://text.apic.org/toc/infection-prevention-for-support-services-and-the-care-environment/environmental-services#book_section_1319. Accessed April 1, 2021.

      Studies have shown that privacy curtains harbor dangerous bacteria including multidrug- resistant organisms like MRSA, C. difficile, and VRE.
      • Shek K
      • Patidar R
      • Kohja Z
      • et al.
      Rate of contamination of hospital privacy curtains in a burns/plastic ward: a longitudinal study.
      • 3rd Trillis F
      • EC Eckstein
      • Budavich R
      • Pultz MJ
      • Donskey CJ
      Contamination of hospital curtains with healthcare-associated pathogens.
      Further, lack of hand hygiene and direct contact with the curtain can lead to microbial transmission.
      • Larocque M
      • Carver S
      • Bertrand A
      • McGeer A
      • McLeod S
      • Borgundvaag B
      Acquisition of bacteria on health care workers' hands after contact with patient privacy curtains.
      Attention to cleaning and disinfection of non-porous and soft surfaces such as curtains and textiles appears to be lacking. This may be, in part, because there is a limited number of surface disinfectants that can be effective on these types of surfaces. Most privacy curtains are not changed following patient discharge. The frequency of routine curtain cleaning and changes are defined by hospital policy for example following an isolation room discharge or at defined, routine intervals: monthly, quarterly or yearly.
      There is limited information on how to reduce levels of curtain contamination while they are in use and between changings. Here we describe the outcome of using dry hydrogen peroxide (DHP™) to reduce levels of contamination on privacy curtains used in different areas of the hospital.

      Methods

      Setting and equipment

      The study was conducted in five in-patient locations at a tertiary care multispecialty hospital, which included the pediatric ED, pediatric ICU, adult oncology service, adult Cardiovascular Trauma Intensive Care Services (CVTU), and adult Trauma Surgical Intensive Care (TSICU). The DHP units (Synexis, Lenexa, KS) were installed in the respective intervention location's HVAC system at the diffuser level by the manufacturer. The equipment operated continuously (24/7) throughout the study period in four of the intervention units. The units generate hydrogen peroxide in a non-aqueous, dry gas form at a range of 5 to 25 parts per billion (ppb) with transient concentrations as high as 40 ppb when measured with an InterScan 4000 Series Hydrogen Peroxide Sensor. More recent measurements using a Picarro PI2114 indicate that the DHP units generate 0.5 to 5 ppb.

      Sampling and data analysis

      Surface samples were collected from pre-determined grab locations approximately four feet from the ground, starting at the edge of the curtain and with a swab-defined area of 25 cm2 in a horizontal and then a vertical direction. Baseline surface and air microbial sampling pre-DHP implementation (Study Days -3, -2, -1) were compared to post-implementation sampling (Study Days 1, 7, and 28). Total surface colony forming unit (CFU) data was analyzed using an independent t-test. For all data, a mean of the baseline air and surface samples (Study Days -3, -2, -1) was used as the comparative point for analysis. Statistical analysis was performed using IBM SPSS statistics version 25. A P-value of less than or equal to 0.05 was considered significant.

      Results

      Over the course of the three days of baseline data, it was discovered that the privacy curtains frequently yielded CFU counts greater than 1 million. As seen in Table 1, the mean of the 45 privacy curtain samples collected during the 3 days before initiation of DHP was calculated to be slightly lower than 3.6 million CFU. This mean value was treated as the baseline level of microbial load during the subsequent analysis. There was a statistically significant difference in mean microbial surface counts (t28 = 8.250, P < .001) between day 0 and day 1 post-installation with a 99.47% decrease in the average CFU count by the end of day 1. Days 7 and 28 yielded samples with slightly higher average microbial counts, yet both remained significantly lower compared with day 0 (t28 = 8.132, P < .001, respectively). No curtain changes occurred during the study period.
      Table 1Aggregate privacy curtain microbial counts and percent reductions
      BaselineDay 1Day 7Day 28
      Average Sample Count (CFU)3,595,09319,01651,997122,469
      Percent decrease99.47%98.55%96.59%

      Discussion

      Privacy curtain contamination with potentially dangerous pathogens and its risk of transmission has been well described.
      • Shek K
      • Patidar R
      • Kohja Z
      • et al.
      Rate of contamination of hospital privacy curtains in a burns/plastic ward: a longitudinal study.
      ,
      • Ghani U
      • Assad S
      • Sulehria T
      • Arif I
      Hospital curtains: an undermined source of nosocomial infections.
      However, approaches to manage and reduce microbial contamination have been limited, particularly when these curtains are not being changed after each patient discharge. Potential solutions for addressing this issue include using antimicrobial impregnated curtains. Studies have shown that curtains containing silver and other antimicrobial metal alloys were effective in reducing contamination, but their long-term efficacy may be an issue and they would then be subject to the same laundering requirements/needs as standard curtains.
      • Schweizer M
      • Graham M
      • Ohl M
      • Heilmann K
      • Boyken L
      • Diekema D.
      Novel hospital curtains with antimicrobial properties: a randomized, controlled trial.
      Existing literature identified that most facilities do not change curtains more often than once every 3-6 months, when visibly soiled, or after the discharge of a patient on isolation precautions because there is no clear guideline for the proper interval of privacy curtain changes; making the benefit of these curtains very limited.
      • Ohl M
      • Schweizer M
      • Graham M
      • Heilmann K
      • Boyken L
      • Diekema D.
      Hospital privacy curtains are frequently and rapidly contaminated with potentially pathogenic bacteria.
      ,
      • 3rd Trillis F
      • EC Eckstein
      • Budavich R
      • Pultz MJ
      • Donskey CJ
      Contamination of hospital curtains with healthcare-associated pathogens.
      ,
      • Schweizer M
      • Graham M
      • Ohl M
      • Heilmann K
      • Boyken L
      • Diekema D.
      Novel hospital curtains with antimicrobial properties: a randomized, controlled trial.
      ,
      • Price A
      • Knoke MT
      • Andrews J
      • Streed S.
      Hydrogen peroxide privacy curtain cleaning study.
      • Rutala WA
      • Gergen MF
      • Sickbert-Bennett EE
      • Williams DA
      • Weber DJ.
      Effectiveness of improved hydrogen peroxide in decontaminating privacy curtains contaminated with multidrug-resistant pathogens.
      Additionally, long-term use of antimicrobial-impregnated curtains while cost effective, may contribute to the development of microbial resistance.
      • Luk S
      • Chow VCY
      • Yu KCH
      • et al.
      Effectiveness of antimicrobial hospital curtains on reducing bacterial contamination-A multicenter study.
      Another approach is to directly apply an EPA-approved disinfectant such as hydrogen peroxide with concentrations between 1.4%- 3 %. This direct, spray-on approach was found to be effective, but its persistence may vary and has an undefined frequency of application.
      • Price A
      • Knoke MT
      • Andrews J
      • Streed S.
      Hydrogen peroxide privacy curtain cleaning study.
      • Rutala WA
      • Gergen MF
      • Sickbert-Bennett EE
      • Williams DA
      • Weber DJ.
      Effectiveness of improved hydrogen peroxide in decontaminating privacy curtains contaminated with multidrug-resistant pathogens.
      This approach requires additional manual labor/time, is an episodic intervention and therefore inherently limited. Additionally, spraying between patients does not eliminate contamination risk during a single patient's stay.
      As noted, hydrogen peroxide is an effective disinfectant agent but as a chemical applied via spraying or wiping, its effect is episodic, and it may not be safe to use in an occupied patient room. In our study, we found that using DHP led to significant microbial reduction which persisted from baseline to day 28. The continuous exposure of the curtains to DHP prevented microbial growth, thereby reducing risk of pathogen transmission.

      Conclusion

      DHP is an effective bridge solution to reduce levels of contamination on privacy curtains in between changes for standard laundering, cleaning and disinfection.

      Disclaimer

      This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.

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        Hospital privacy curtains are frequently and rapidly contaminated with potentially pathogenic bacteria.
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        Rate of contamination of hospital privacy curtains in a burns/plastic ward: a longitudinal study.
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        • EC Eckstein
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        Contamination of hospital curtains with healthcare-associated pathogens.
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        Acquisition of bacteria on health care workers' hands after contact with patient privacy curtains.
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        • Assad S
        • Sulehria T
        • Arif I
        Hospital curtains: an undermined source of nosocomial infections.
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        • Graham M
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        Novel hospital curtains with antimicrobial properties: a randomized, controlled trial.
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        Effectiveness of antimicrobial hospital curtains on reducing bacterial contamination-A multicenter study.
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