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Surface sanitation

September 1, 2008
by Chris Kosobud
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Choose disinfection tools carefully for optimum infection control


According to the Centers for Disease Control and Prevention (CDC), approximately 15% of nursing home residents have infections, including wound infections, respiratory infections, urinary tract infections, or pneumonia. Another sobering statistic: Acute infections account for 27% of transfers of nursing home residents to hospitals, according to the Agency for Healthcare Research and Quality.

There are many types of infections in long-term care (LTC) facilities, but one type of infection has received increased attention over the past year or so: methicillin-resistant Staphylococcus aureus (MRSA). For example, one recent study showed that S. aureus, the second most common cause of bacteremia, soft tissue infections, and pneumonia in elderly patients in acute care settings, can be traced to LTC facilities, which, the study authors called, a “major reservoir” of MRSA. In these types of cases, even if there is a low incidence of MRSA infection in an LTC facility, its residents may be colonized with MRSA and act as carriers.

Prevalence increasing

MRSA, like C. difficile (which has doubled in nursing homes and other LTC facilities in the past several years and is now the most common cause of nosocomial infectious diarrhea in nursing homes), Vancomycin-resistant enterococci (VRE), and Norovirus are examples of infections that have become more prevalent outside of acute care settings, including places such as schools, exercise facilities, and LTC facilities. In LTC facilities, MRSA is often associated with urinary catheters and gastrostomy tube sites. Close living proximity, multiple medications, and pressure sores also make nursing homes ideal for breeding and spreading MRSA. In general, elderly, critically ill patients and those who have endured a prolonged hospital stay are particularly susceptible to MRSA infections, especially since MRSA infections tend to increase with advancing age.

While MRSA is typically spread by skin-to-skin contact, germs such as MRSA also have been found on environmental surfaces such as computer keyboards and sinks, suggesting that sources of environmental contamination are not limited to a patient's belongings or patient rooms. Staph/MRSA can survive for weeks to several months on almost all surfaces. C. difficile bacteria can live for years on environmental surfaces. VRE bacteria are very hardy and can live for several days on surfaces. And noroviruses can survive on virtually any hard surface for up to 12 hours.

Several strategies may be employed to help reduce the spread of MRSA and other germs, including frequent and proper handwashing, along with proper environmental cleaning. LTC facilities may want to pay particular attention to their cleaning regimen, because research has shown that something as simple as the choice of wiping materials can dramatically affect the amount of disinfecting agent that actually reaches the surface being cleaned.

Cleaning to reduce infection rates

The CDC notes that cleaning and disinfecting environmental surfaces in healthcare facilities is critical to reducing the contribution of those surfaces to the incidence of healthcare-associated infections. In addition to proper hand hygiene, cleaning and disinfecting can help to minimize the transfer of microorganisms that can occur via hand contact between contaminated surfaces and LTC facility residents.

Surface sanitation may be a particularly effective method for stopping the spread of germs because, unlike in acute care settings, it is not practical to isolate infected individuals in LTC facilities. Moreover, effective surface sanitation is a practice that can be applied at all points on the LTC spectrum—from retirement homes and assisted living facilities to skilled nursing homes.

The CDC, along with the Healthcare Infection Control Practices Advisory Committee (HICPAC), offers guidance on environmental surface cleaning and disinfecting in the Guidelines for Environmental Infection Control in Health Care Facilities. The guidelines note that continued compliance with environmental infection control measures (including environmental surface cleaning and disinfecting) will decrease the risk of healthcare-associated infections among LTC facility residents. The Guidelines can be downloaded at http://www.cdc.gov.

Environmental surfaces

The CDC Guidelines divide environmental surfaces into two parts: medical equipment surfaces, such as knobs or handles on machines, carts, and similar equipment; and housekeeping surfaces, such as floors, walls, and tabletops. Housekeeping surfaces can be further divided into those with minimal hand contact (referred to as “low-touch” surfaces) and those with frequent hand contact (“high-touch” surfaces).

The number and types of microorganisms present on environmental surfaces are influenced by:

  • Number of people in the environment

  • Amount of activity

  • Amount of moisture (microorganisms are present in great numbers in moist organic environments, but some can also persist under dry conditions)

  • Presence of material capable of supporting microbial growth

  • Rate at which organisms suspended in air are removed

  • Type of surface and orientation (i.e., horizontal or vertical)

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