I have absolutely no knowledge of

I have absolutely no knowledge of..

environmental or healthcare..waste management.!

Andreas Voss

Radboud UMC & CWZ

Nijmegen

The Netherlands

http://www.slideshare.net/iPrevent

Robert Weinstein estimated that the source of pathogens causing a healthcare-associatedinfection in the intensive care unit was as follows:

patients’ endogenous flora, 40%–60%;

incl. antibiotic-driven changes in flora;

cross infection via the hands of personnel, 20%–40%;

other (incl. environment): 20%.

modified from Wenzel and Edmond

MR

SA

ESBL

C.d

if&

Co

CR

E

…..

PREVENT everything

Adapted from Otter et al ICHE july 2011, vol. 32, no. 7

Innate surfacesWater

AirHCWs & patients

Coming here

Hematology Operatingroom

Airborneisolation

Brandt et al, Ann Surg 2008; 248:695-700.

63 surgical departments participating in KISS

>99.000 operations

Turbulent + HEPA versus laminar airflow + HEPA

Multivariate analyis to comtrol for other factors influencingoutcome (SSI)

Brandt et al, Ann Surg 2008; 248:695-700.

Follow-up study taking in account the size of the LAF plenum shows no difference in outcome

Mycobacteria & endoscope

reprocessing

Legionella and aerosols

Nonfermenters (especially Pseudo-

monas & Acinetobacter) in sinks &

ventilators

Molds in hematology units

Villegas et al ICHE 2003;24:284-95

Thus, what is allthe fuzz about?

Weber et al. Am J Infect Control 2010;38:S25-33

Kramer et al. BMC Infect Dis 2006;6:130



C. difficile , VRE, MRSA 103 to 109 CFUs/g in stoolNorovirus 1012 particles/g

Environment is generally <10 organisms per cm2

The infectious dose for most environmentally

associated nosocomial pathogens appears to

be low.

Less than 15 S. aureus cells were sufficient to

cause infection in experimental lesions,

Less than 1 CFU/cm2 was sufficient to cause

C. difficile disease in mice

A single norovirus particle is thought to have the

capacity to cause infection

Otter et al ICHE july 2011, vol. 32, no. 7

Contact with hospital room surfaces or medical

equipment by healthcare personnel frequently

leads to contamination of hands and/or gloves.

Weber & ICHE may 2013, vol. 34, no. 5

Stiefel et al ICHE 2011:32:185-87

Bobulsky et al. CID 2008;46:447-50

Skin (orange), gloves (blue)

Bonten et al. Lancet 1996;348:1615-19

Improved environmental cleaning has led to

reduced risk of VRE and C. difficile transmission.

Admission to a room previously occupied by a

patient with MRSA, VRE, Acinetobacter, or C.

difficile increases the risk for the subsequent

patient admitted to the room to acquire the

pathogen

Weber & ICHE may 2013, vol. 34, no. 5

Otter et al. AJIC 2013;41:56

Huslage et al. Infect Control Hosp Epidemiol 2010; 31(8):850-853

Huslage et al. Infect Control Hosp Epidemiol 2010; 31(8):850-853

Obviously all should be clean,but high-touch really needs to be!

Eckstein et al. BMC Infect Dis June 2007


C. difficile


VRE

Boyce et al. ICHE 2008;29:723

Copper a day -Keeps MRSA away

Noyce et al. J Hosp Infect 2006;63:289-297

Thom et al. Infect Control Hosp Epidemiol 2014;35:1060-62


MSDS Poly spray (silicone quaternary amine)

8 surfaces

sink, call button, bedside table, monitor,

telephone, supply cart, door handle, floor

Results:

No significant effect on environmental

contamination


Problem adherence?

Love the concept of changing the surface

Studies with copper, silver silica, Biosafe HM

4100 (polymer) embedded in polyurethane,

light-activated antimicrobials, … have worked

before

Freeman et al. Antimicrob Resistance Infect Control 2014;3:5

Freeman et al. Antimicrobial Resistance and Infection Control 2014, 3:5

Rooms of patients with ESBL-KP have substantially highercontamination rates than those with ESBL-EC. This finding mayhelp explain the apparently higher transmissibility of ESBL-KP in the hospital setting

Kampf et al. BMC Infect Dis 2014;14:37

Kampf et al. BMC Infect Dis 2014;14:37

Reusable tissue dispensers with different surface

disinfectants were randomly collected from

healthcare facilities.

66 dispensers containing disinfectant solutions

with surface-active ingredients were collected in

15 healthcare facilities. 28 dispensers from nine

healthcare facilities were contaminated

In none of the hospitals dispenser processing had

been adequately performed

… it is not about the details of this paper, but the point that even

“helpful parts of the environment” may be a source for infections

Roomservice

Roomservice-plus

Registered nurse

Nurse asistant

Cleaning

Even if you think youknow it, are theyactually doing it?

Weber et al. J Hosp Infect 2012;80:252-4

Highest rate of mannequin contamination was long sleeves + tie (transmission occurred in 4/5 experiments) and lowest withshort sleeves no tie (0/5).

> >

Weber et al. J Hosp Infect 2012;80:252-4

Eli: “flaw in this study was that ties were narrowly defined as neckties and excluded bow ties”

http://haicontroversies.blogspot.nl

Enter a solution to all of our infection control

problems: the Jumbo Squirting Bow Tie!

This often overlooked clothing accessory is a veritable

infection prevention dream.

A bow tie can increase our professionalism and limit

pathogen transmission.

Add in the "Jumbo Squirting" action and you can squirt

alcohol hand rub into the eyes of non-compliant clinicians

(operant conditioning) and also into your own hands to

improve compliance with the WHO 5 Moments.

http://haicontroversies.blogspot.nl

https://www.surveymonkey.com/r/2XG8LV6

iPrevent

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I have absolutely no knowledge of