1393. Frequent environmental contamination with Clostridium difficile after routine cleaning and disinfection of hospital rooms: a multi-hospital study
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C

Background: Contaminated environmental surfaces are an important source for transmission of Clostridium difficile. To improve cleaning, many healthcare facilities perform monitoring of cleaning practices and provide feedback to environmental services personnel. However, it is not known if current strategies for monitoring are adequate to ensure effectiveness of removal of C. difficile from surfaces. 

Methods: Seven Ohio hospitals were surveyed regarding environmental disinfection policies and practices for patients with suspected or confirmed CDI. Research personnel used fluorescent markers to examine thoroughness of daily and terminal cleaning of high-touch surfaces.  Effectiveness of cleaning was evaluated by performing cultures for C. difficile from surfaces in CDI and non-CDI rooms after terminal cleaning and disinfection by environmental services personnel.    

Results: All of the hospitals reported performance of intermittent or routine monitoring of daily and terminal cleaning, with 4 (57%) using fluorescent markers, 2 (29%) using ATP monitoring, and 1 (14%) using observation only. All facilities used bleach for daily and terminal disinfection of CDI rooms, including 2 (29%) that also used bleach for all non-CDI terminal room disinfection. Based on research fluorescent marker removal assessments, cleaning of high-touch surfaces ranged from 40-80% and 10-35% on average for terminal and daily cleaning, respectively. The figure shows the percentages of rooms with cultures positive for C. difficile after terminal cleaning of CDI and non-CDI rooms. Two hospitals had more frequent contamination in non-CDI versus CDI rooms; both used nonsporicidal disinfectants in non-CDI rooms.

Conclusion: Although all of the hospitals reported some form of monitoring, thoroughness of cleaning was suboptimal and C. difficile was frequently cultured from CDI and non-CDI rooms after cleaning and disinfection by environmental services personnel. These data suggest that current practices for monitoring the effectiveness of environmental cleaning and disinfection are inadequate. 

Figure. Percentage of positive cultures for C. difficile from CDI and non-CDI rooms after terminal cleaning and disinfection by environmental services personnel in 7 hospitals

 

Abhishek Deshpande, M.D., Ph.D.1,2, Brett Sitzlar, B.S.1, Dennis Fertelli3, Jennifer Cadnum, B.S.1, Priyaleela Thota, MD1, Erica Pozwick1, Sirisha Kundrapu, M.D.1, Venkata Sunkesula, M.D, M.S1, Amy Ray, MD4, Robert Salata, MD5 and Curtis Donskey, MD1,6, (1)Infectious Diseases, Case Western Reserve University, Cleveland, OH, (2)Infection Control, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, (3)Infectious Diseases, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, (4)Medicine, University Hospitals Case Medical Center, Cleveland, OH, (5)University Hospitals Case Medical Center, Cleveland, OH, (6)Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH

Disclosures:

A. Deshpande, None

B. Sitzlar, None

D. Fertelli, None

J. Cadnum, None

P. Thota, None

E. Pozwick, None

S. Kundrapu, None

V. Sunkesula, None

A. Ray, None

R. Salata, None

C. Donskey, None

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