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. 2007 Jun 21;7:61.
doi: 10.1186/1471-2334-7-61.

Reduction of Clostridium Difficile and Vancomycin-Resistant Enterococcus Contamination of Environmental Surfaces After an Intervention to Improve Cleaning Methods

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Free PMC article

Reduction of Clostridium Difficile and Vancomycin-Resistant Enterococcus Contamination of Environmental Surfaces After an Intervention to Improve Cleaning Methods

Brittany C Eckstein et al. BMC Infect Dis. .
Free PMC article

Abstract

Background: Contaminated environmental surfaces may play an important role in transmission of some healthcare-associated pathogens. In this study, we assessed the adequacy of cleaning practices in rooms of patients with Clostridium difficile-associated diarrhea (CDAD) and vancomycin-resistant Enterococcus (VRE) colonization or infection and examined whether an intervention would result in improved decontamination of surfaces.

Methods: During a 6-week period, we cultured commonly touched surfaces (i.e. bedrails, telephones, call buttons, door knobs, toilet seats, and bedside tables) in rooms of patients with CDAD and VRE colonization or infection before and after housekeeping cleaning, and again after disinfection with 10% bleach performed by the research staff. After the housekeeping staff received education and feedback, additional cultures were collected before and after housekeeping cleaning during a 10-week follow-up period.

Results: Of the 17 rooms of patients with VRE colonization or infection, 16 (94%) had one or more positive environmental cultures before cleaning versus 12 (71%) after housekeeping cleaning (p = 0.125), whereas none had positive cultures after bleach disinfection by the research staff (p < 0.001). Of the 9 rooms of patients with CDAD, 100% had positive cultures prior to cleaning versus 7 (78%) after housekeeping cleaning (p = 0.50), whereas only 1 (11%) had positive cultures after bleach disinfection by research staff (p = 0.031). After an educational intervention, rates of environmental contamination after housekeeping cleaning were significantly reduced.

Conclusion: Our findings provide additional evidence that simple educational interventions directed at housekeeping staff can result in improved decontamination of environmental surfaces. Such interventions should include efforts to monitor cleaning and disinfection practices and provide feedback to the housekeeping staff.

Figures

Figure 1
Figure 1
Percentage of positive environmental cultures for vancomycin-resistant Enterococcus (VRE) before and after housekeeping cleaning and after disinfection with 10% bleach by the research team. Seventeen rooms of patients with VRE colonization or infection were cultured.
Figure 2
Figure 2
Percentage of positive environmental cultures for Clostridium difficile before and after housekeeping cleaning and after disinfection with 10% bleach by the research team. Nine rooms of patients with Clostridium difficile-associated disease were cultured.
Figure 3
Figure 3
Culture plate showing gross contamination of a call button with vancomycin-resistant Enterococcus (VRE) after completion of cleaning by housekeeping staff. The patient was a 68 year-old man with Clostridium difficile-associated disease and VRE intestinal colonization. A sterile, pre-moistened cotton-tipped swab was applied to the surface of the call button and directly plated onto Enterococcosel agar containing 20 μg per mL of vancomycin. The same call button yielded C. difficile by broth enrichment culture.

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