It has long been known that medical devices and hand washing play a major part in the transmission of hospital acquired infections. There has been more debate, however, on the role of the patient environment and surfaces.
Initiatives in Safe Patient Care published Infection Prevention: Contamination and Cross Contamination on Hospital Surfaces and Medical Equipment — an article and panel discussion with experts in the field addressing this topic. A few of the most compelling arguments are below:
“There is an increasing body of literature that shows the role of the environment in transmission of infection. For example, there is a greater risk of infection with various drug-resistant organisms and C. difficile for patients who are housed in rooms previously occupied by others with these organisms. In addition, surface cleaning is not done as well as protocols suggest. The revelation that cleaning is not done consistently and that drug-resistant organisms can be recovered from hospital surfaces has brought about an awareness of the role of these areas in disease transmission.”
- Janet Haas, DNSc
“The transmission of two common HAI pathogens illustrates the importance of the environment in HAI prevention. C. difficile – or VRE – colonized patients contaminate their environment, leading to subsequent transmission of these pathogens to patients. Recent outbreaks of the C. difficile strain known as the North American Pulsefield Type 1 (or NAP 1 strain) have illustrated the critical importance of environmental cleaning in preventing C. difficile associated disease (CDAD). As noted by my fellow panelists, with the emergence of every more resistant pathogens, enhanced environmental cleaning is a critical for preventing infections
- William Jarvis, MD
“Environmental surfaces act as a reservoir for bacterial and viral gathering and proliferation.
These organisms can be expelled from an infected or colonized patient either through direct contact, aerosol droplets, or feces…The advent of molecular epidemiology is helping with a better understanding of the role of the environment in nosocomial infection by confirming that environmental isolates are the same as patient isolates.”
- John Davies, MS, RRT, FAARC
No studies have adequately assessed the relative role of the environment versus other modes of transmission of HAI pathogens. Furthermore, the relative importance of the environment in HAI pathogen transmission varies by the specific HAI pathogen. It is clear that for C. difficile (where spores rather than vegetative forms can survive for long periods in the environment and can be difficult to eradicate) and VRE, the environment plays a large and important role in transmission. MRSA, the environment was thought to be of relatively little importance, except in burn units where the environment was contaminated by MRSA caring skin squames. However, more recent data suggest that MRSA can contaminate the environment around infected or colonized patients. Thus the environment may play a larger role in MRSA transmission than previously thought, albeit less than healthcare worker hand hygiene. In general, the environment plays a larger role in transmission of Gram-negative than Gram-positive pathogens. Contamination of inanimate objects, particularly those taken from patient to patient increases the risk of colonization of the patient and of subsequent infection.”
- William Jarvis, MD
“Today, with highly antibiotic-resistant microorganisms, this primary means of controlling infection is no longer available. Hence, now there is an increased focus on the remaining tools that are available for preventing infection, i.e. cleaning and disinfection and better compliance with behavioral practices.”
- Alice Neely, PhD, FAAM, FIDSA
“Given the critical importance of environmental cleaning in preventing HAI transmission, it is unfortunate that this component of infection prevention often gets little attention. Often, environmental personnel are the least educated, lowest paid personnel with very high turnover rates. Environmental services personnel should all receive education about HAI prevention at the time of hire and in-service. Didactic lectures are not sufficient. Visual training of how they should clean the environment and medical equipment should be provided. Videos can be helpful. They should then be asked to clean a room after glow-germ has been applied to important environmental surfaces. A black light can show them how well they’ve done. In addition, having personnel do a hand culture, with and without hand hygiene, can illustrate the extent to which invisible pathogens are on their hands.”
- William Jarvis, MD
“The hospital environment is contaminated by a variety of pathogenic and nonpathogenic microorganisms that can persist on surfaces for prolonged periods. Numerous studies have demonstrated that the hands and gloves of healthcare workers readily acquire pathogens after contact with contaminated hospital surfaces and can transfer these organisms to subsequently touched patients and inanimate surfaces.
The acquisition of nosocomial pathogens by a patient and the resultant development of infection depend on a multifaceted interplay between the environment, a pathogen and a susceptible host. However, there is good evidence that infection transmission via hospital surfaces and medical equipment can occur. For these reasons, hospitals must implement evidence-based infection prevention measures that will reduce the risk of transmission of pathogens via contaminated hospital surfaces and medical equipment and hold personnel accountable for adhering to these measures.”
- Contamination and Cross Contamination on Hospital Surfaces and Medical Equipment