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Challenges to Disinfecting Hospital Rooms to Prevent C. difficile—Part 2

NOV 23, 2017 | KRISTI ROSA
Clostridium difficile (C. diff) is one of the biggest causes of health care-acquired infectious diarrhea, which, in turn, can lead to lengthier hospital stays, increased financial burden, and higher morbidity and mortality rates among those infected. Therefore, the use of appropriate, thorough disinfection practices is critical in health care facilities. However, in the haste to turn over rooms quickly after patient discharge, effective disinfection can fall through the cracks, allowing C. diff spores to remain in the room for the next patient.

Maureen Spencer, RN, BSN, MEd, CiC, FAPIC, director of clinical implementation at Accelerate Diagnostics, sat down with Contagion® for an exclusive interview at this year’s international C. diff Awareness Conference & Health Expo in Las Vegas, Nevada, to discuss surface contamination in hospitals. There are many challenges in the disinfection of hospital rooms and health care workers need to know how to prevent the spread of C. diff.

Contagion®: Can you share some statistics regarding surface contamination?

Spencer: Years ago, Phil Carling, MD, did a study that included 23 acute care hospitals where he used a fluorescent gel that he had developed. He solicited the infection preventionists (IPs) in these hospitals to stamp high-touch surfaces in patient’s rooms, such as bed rails, bedside tables, commodes, [and] bathrooms. The IPs returned the next day and used a black light to see whether the fluorescent gel was still there, or if it had been removed by environmental services (EVS). What they found was that, overall, only approximately 49% of the surfaces in the hospitals were cleaned.

There are a couple of reasons for that. We don’t have enough EVS workers in hospitals; it’s not uncommon for that position to get downsized when hospitals are having financial issues. We also don’t have well-trained EVS workers. Many of the hospitals don’t even have training programs or manuals available on how to clean and disinfect unless they’re outsourced to a company that is a cleaning company. And so, we have rooms that are not being cleaned and disinfected; in fact, if you are admitted to a room where a prior occupant had any of the following multidrug-resistant organisms (MDROs)—methicillin-resistant Staphylococcus aureus (MRSA), Acinetobacter, Pseudomonas, C. diff—your risk of picking up the infection from just being in the room increase 2- to 4-fold. That’s our challenge.

For prevention interventions, we use a lot of innovative EVS equipment—some of it’s really cutting edge and new, while others, like ultraviolet robots, have been around for a while. Hospitals are looking at that technology to treat the room after C. diff patients are discharged.

There’s also technology that is purifying the air—that’s really new over the last 2 years—we never really had that before. This is especially important because we know that C. diff spores can be aerosolized. We have new light fixture technology that disinfects the air using filters and UV that purify the air 24/7. That’s a future goal for a lot of vendors, to create technology for self-disinfecting rooms to help in our battle against environmental issues and the fact that we don’t have enough workers to clean the rooms.

Influenza A (H3N2) has caused most of the illnesses in this severe flu season, but influenza B is becoming increasingly responsible for more infections as the flu season continues to hit the United States.