Wipeout: C. diff clean team cuts rates 40%
‘We had difficulty finding C. diff in the rooms.’
The use of a dedicated cleaning team to literally wipe out Clostridium difficile in occupied patient rooms lowered infection rates and left 93% of high touch surfaces negative on C. diff cultures, says Curtis Donskey, MD, staff physician at Louis Stokes Cleveland Veterans Affairs Medical Center and an author of the study.
The superior efficacy of the cleaning teams compared to other approaches like UV light disinfection was determined by environmental cultures, and only 7% of the total samples found in cleaned rooms were positive for C. diff.
“We focused almost entirely on high touch surfaces so we were culturing things that people touch very frequently — bed rails, bedside tables, telephones, call buttons,” he says. “It’s pretty effective. We had difficulty finding C. diff in the rooms.”
Additionally, environmental cultures for C. diff were crucial to the success of the intervention, but are currently not feasible for most healthcare facilities, he says.
“That really is a limitation that hospitals face. Even when they bring in things like these UV devices, they don’t have a good way to monitor how effective they really are.”
Though wary of reading too much into initial results, Donskey says the C. diff infection (CDI) rates fell 40% after six months. The incidence of nosocomial CDI fell from 10 cases per 10,000 days of care to six cases per 10,000 days.
A dedicated team of three housekeepers used bleach wipes to disinfect the rooms of C. diff patients daily, taking about 20 minutes to complete the process, he says.
“We only had one patient who complained that they didn’t like the bleach odor,” he tells Hospital Infection Control & Prevention.
The cleaning team was comprised of top workers who were highly motivated, eliminating the problem of variability in housekeeper performance. “We pre-selected people who were some of the best workers, and provided them with resource funds and education,” he says. “So they were motivated.” The time and cost involved were not prohibitive, particularly since a single C. diff infection can set off a spiral of additional costs due to implementing isolation measures, treatment and extending length of stay.
“For our facility we had five rooms a day — seven or eight rooms at most — [cleaned daily], so it only takes a couple of hours a day to do this,” Donskey explains. “It’s really not that time consuming.”
In addition, the intervention included clearing the rooms of discharged C. diff patients for terminal cleaning prior to admission of the next patient. During this process, infection preventionists and supervisory housekeeping staff were on hand for direct observation of individual housekeeper performance and to provide immediate feedback.
Fluorescent markers, UV device
In addition to the enhanced cleaning effort, Donskey and colleagues tested two other C. diff interventions: The use of fluorescent markers applied to high-touch surfaces in patient rooms to provide monitoring and feedback on thoroughness of cleaning; and the use of an automated ultraviolet (UV) radiation device as a complementary disinfection strategy after cleaning.
The fluorescent marker intervention included education of housekeeping as part of the feedback on their cleaning rigor. A fluorescent marker was applied to 14 high-touch surfaces in patient rooms, and thoroughness of cleaning was assessed on the basis of marker removal.
To determine the effectiveness of the interventions, cultures were obtained from rooms contaminated with C. diff after cleaning and disinfection. The fluorescent marker intervention modestly improved the disinfection of high-touch surfaces over traditional cleaning practices (67% versus 57%). The use of the UV device further reduced the percentage of positive cultures, but C. diff was still present in 35% of rooms. Notably, although use of the UV device was continued in the third dedicated cleaning intervention, it did not contribute to the effectiveness of the intervention (i.e., all negative cultures were negative both before and after operation of the UV device).
“The gold standard for these disinfection devices is the hydrogen peroxide vapor which is very effective,” Donskey says. “It’s more feasible to use the UV device but the tradeoff is that they are not quite as effective. I think people often overestimate how effective they are and this was nicely demonstrated. They are an extra step that will add something, but it’s not the complete answer.”
Though the focus of the project was on C. diff, a similar intervention could provide some benefits for patients under isolation measures for methicillin-resistant Staphylococcus aureus and other infections, he says.
“It really reflects the fact that bleach is very effective if applied [appropriately],” he says. “I think sometimes hospitals may underappreciate how effective bleach is and kind of overestimate the effect of things like the UV devices. If the bleach is applied directly this is really an illustration of how well it works.”
Reference
1. Sitzlar B, Deshpande A, Fertelli D, et al. An Environmental Disinfection Odyssey: Evaluation of Sequential Interventions to Improve Disinfection of Clostridium difficile Isolation Rooms. Infect Control Hosp Epi 2013;34(5):459-465.
The use of a dedicated cleaning team to literally wipe out Clostridium difficile in occupied patient rooms lowered infection rates and left 93% of high touch surfaces negative on C. diff cultures, says Curtis Donskey, MD, staff physician at Louis Stokes Cleveland Veterans Affairs Medical Center and an author of the study.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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