sodium-hypochlorite and Clostridium-Infections

A 1% potassium peroxymonosulphate-based environmental disinfectant (PPED) produces sodium hypochlorite when combined with sodium chloride, which functions as a disinfectant. However, little is known about the impact of hospital cleaning with PPED on hospital-onset Clostridioides difficile infection (HO-CDI).. To reduce HO-CDI, we promoted antimicrobial stewardship and hospital ward cleaning with PPED: this study was conducted to evaluate their impact.. We began a promotion of post-prescription review with feedback for broad-spectrum antimicrobials and hospital ward cleaning with PPED. We reviewed the ratio of HO-CDI, PPED consumption, and days of therapy (DOT) of broad-spectrum antimicrobials between July 2014 and March 2018, dividing this time into the pre-promotion (July 2014 to June 2015) and post-promotion periods (July 2015 to March 2018).. Using interrupted time series analysis, an immediate significant change in HO-CDI was observed after intervention (P=0.03), although a downward trend was not observed over this period (P=0.19). Trends in PPED consumption significantly changed over this period (P=0.02). DOT of carbapenems decreased immediately after the intervention began (P<0.01). A Poisson regression analysis showed that PPED consumption and DOT of carbapenems were independent factors affecting HO-CDI (P=0.039 and 0.016, respectively).. We revealed that DOT of carbapenems and use of PPED were associated with the HO-CDI ratio and that both interventions reduced the rate of HO-CDI. This is the first report on the impact of hospital ward cleaning with PPED on the reduction of HO-CDI.

Topics: Anti-Infective Agents; Antimicrobial Stewardship; Carbapenems; Clostridioides difficile; Clostridium Infections; Cross Infection; Disinfectants; Hospitals; Humans; Potassium; Sodium Chloride; Sodium Hypochlorite

New technologies for automated disinfection have been developed, including the use of hydrogen peroxide atomized by specific equipment, with associated silver compounds.. To compare the effectiveness of an automated disinfection system with hydrogen peroxide <8% and silver ion versus a manual method with 0.5% sodium hypochlorite solution when evaluating the reduction of microbial mesophilic contamination and Clostridium difficile presence; and to evaluate the time required for both of these processes.. This was a randomized multicentre trial performed in different hospital wards that had been occupied previously by patients with Clostridium difficile infection. When patients were discharged their rooms were randomized to one of two decontamination arms. The surfaces where sampled using swabs, before and after disinfection. Swab samples were cultured for quantitative detection of microbial mesophilic contamination and qualitative detection of C. difficile.. Before disinfection, 13% of surfaces decontaminated with hydrogen peroxide and silver ions and 20% of surfaces decontaminated with sodium hypochlorite showed presence of C. difficile spores. After disinfection, the samples containing C. difficile were 0% (P < 0.001) in the group decontaminated with hydrogen peroxide and silver ions, and were 3% (P < 0.001) in the group decontaminated with sodium hypochlorite. This difference was not statistically significant; nor was the difference in the reduction of the microbial mesophilic contamination.. The differences between the groups were not statistically significant; however, the disinfection with hydrogen peroxide and silver ions is preferable due to less dependence on operators.

Topics: Aged; Aged, 80 and over; Automation; Clostridioides difficile; Clostridium Infections; Cross Infection; Disinfection; Equipment Contamination; Female; Hospitals; Humans; Hydrogen Peroxide; Infection Control; Italy; Male; Middle Aged; Patients' Rooms; Silver; Sodium Hypochlorite

Patients admitted to hospital can acquire multidrug-resistant organisms and Clostridium difficile from inadequately disinfected environmental surfaces. We determined the effect of three enhanced strategies for terminal room disinfection (disinfection of a room between occupying patients) on acquisition and infection due to meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, C difficile, and multidrug-resistant Acinetobacter.. We did a pragmatic, cluster-randomised, crossover trial at nine hospitals in the southeastern USA. Rooms from which a patient with infection or colonisation with a target organism was discharged were terminally disinfected with one of four strategies: reference (quaternary ammonium disinfectant except for C difficile, for which bleach was used); UV (quaternary ammonium disinfectant and disinfecting ultraviolet [UV-C] light except for C difficile, for which bleach and UV-C were used); bleach; and bleach and UV-C. The next patient admitted to the targeted room was considered exposed. Every strategy was used at each hospital in four consecutive 7-month periods. We randomly assigned the sequence of strategies for each hospital (1:1:1:1). The primary outcomes were the incidence of infection or colonisation with all target organisms among exposed patients and the incidence of C difficile infection among exposed patients in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT01579370.. 31 226 patients were exposed; 21 395 (69%) met all inclusion criteria, including 4916 in the reference group, 5178 in the UV group, 5438 in the bleach group, and 5863 in the bleach and UV group. 115 patients had the primary outcome during 22 426 exposure days in the reference group (51·3 per 10 000 exposure days). The incidence of target organisms among exposed patients was significantly lower after adding UV to standard cleaning strategies (n=76; 33·9 cases per 10 000 exposure days; relative risk [RR] 0·70, 95% CI 0·50-0·98; p=0·036). The primary outcome was not statistically lower with bleach (n=101; 41·6 cases per 10 000 exposure days; RR 0·85, 95% CI 0·69-1·04; p=0·116), or bleach and UV (n=131; 45·6 cases per 10 000 exposure days; RR 0·91, 95% CI 0·76-1·09; p=0·303) among exposed patients. Similarly, the incidence of C difficile infection among exposed patients was not changed after adding UV to cleaning with bleach (n=38 vs 36; 30·4 cases vs 31·6 cases per 10 000 exposure days; RR 1·0, 95% CI 0·57-1·75; p=0·997).. A contaminated health-care environment is an important source for acquisition of pathogens; enhanced terminal room disinfection decreases this risk.. US Centers for Disease Control and Prevention.

Topics: Clostridioides difficile; Clostridium Infections; Cross Infection; Cross-Over Studies; Disinfectants; Disinfection; Drug Resistance, Multiple, Bacterial; Female; Humans; Male; Middle Aged; Patients' Rooms; Quaternary Ammonium Compounds; Sodium Hypochlorite; Ultraviolet Rays; United States

The frequency of recovery of Clostridium difficile spores from surfaces after postdischarge cleaning of non-C difficile infection rooms was significantly reduced from 24%-5% after a commercial spray formulation of bleach was substituted for a quaternary ammonium disinfectant. These results suggest that routine use of a sporicidal disinfectant in all postdischarge rooms could potentially be beneficial in reducing the risk for C difficile transmission from contaminated surfaces.

Topics: Clostridioides difficile; Clostridium Infections; Disinfectants; Disinfection; Hospitals; Humans; Methicillin-Resistant Staphylococcus aureus; Quaternary Ammonium Compounds; Sodium Hypochlorite; Spores, Bacterial; Staphylococcal Infections

The hospital environment is a source of pathogen transmission. The effect of enhanced disinfection strategies on the hospital-wide incidence of infection has not been investigated in a multicentre, randomised controlled trial. We aimed to assess the effectiveness of four disinfection strategies on hospital-wide incidence of multidrug-resistant organisms and Clostridium difficile in the Benefits of Enhanced Terminal Room (BETR) Disinfection study.. We did a prespecified secondary analysis of the results from the BETR Disinfection study, a pragmatic, multicentre, crossover cluster-randomised trial that assessed four different strategies for terminal room disinfection in nine hospitals in the southeastern USA. Rooms from which a patient with a specific infection or colonisation (due to the target organisms C difficile, meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci (VRE), or multidrug-resistant Acinetobacter spp) was discharged were terminally disinfected with one of four strategies: standard disinfection (quaternary ammonium disinfectant, except for C difficile, for which 10% hypochlorite [bleach] was used; reference); standard disinfection and disinfecting ultraviolet light (UV-C), except for C difficile, for which bleach and UV-C was used (UV strategy); 10% hypochlorite (bleach strategy); and bleach and UV-C (bleach and UV strategy). We randomly assigned the sequence of strategies for each hospital (1:1:1:1), and each strategy was used for 7 months, including a 1-month wash-in period and 6 months of data collection. The prespecified secondary outcomes were hospital-wide, hospital-acquired incidence of all target organisms (calculated as number of patients with hospital-acquired infection with a target organism per 10 000 patient days), and hospital-wide, hospital-acquired incidence of each target organism separately. BETR Disinfection is registered with ClinicalTrials.gov, number NCT01579370.. Between April, 2012, and July, 2014, there were 271 740 unique patients with 375 918 admissions. 314 610 admissions met all inclusion criteria (n=73 071 in the reference study period, n=81 621 in the UV study period, n=78 760 in the bleach study period, and n=81 158 in the bleach and UV study period). 2681 incidenct cases of hospital-acquired infection or colonisation occurred during the study. There was no significant difference in the hospital-wide risk of target organism acquisition between standard disinfection and the three enhanced terminal disinfection strategies for all target multidrug-resistant organisms (UV study period relative risk [RR] 0·89, 95% CI 0·79-1·00; p=0·052; bleach study period 0·92, 0·79-1·08; p=0·32; bleach and UV study period 0·99, 0·89-1·11; p=0·89). The decrease in risk in the UV study period was driven by decreases in risk of acquisition of C difficile (RR 0·89, 95% CI 0·80-0·99; p=0·031) and VRE (0·56, 0·31-0·996; p=0·048).. Enhanced terminal room disinfection with UV in a targeted subset of high-risk rooms led to a decrease in hospital-wide incidence of C difficile and VRE. Enhanced disinfection overcomes limitations of standard disinfection strategies and is a potential strategy to reduce the risk of acquisition of multidrug-resistant organisms and C difficile.. US Centers for Disease Control and Prevention.

Topics: Clostridioides difficile; Clostridium Infections; Cross Infection; Cross-Over Studies; Disinfectants; Disinfection; Drug Resistance, Multiple, Bacterial; Hospitals; Humans; Quaternary Ammonium Compounds; Randomized Controlled Trials as Topic; Sodium Hypochlorite; Southeastern United States; Ultraviolet Rays

Topics: Clostridioides difficile; Clostridium Infections; Colony Count, Microbial; Disinfectants; Disinfection; Humans; Patients' Rooms; Sodium Hypochlorite; Spores, Bacterial; Toilet Facilities; Ultraviolet Rays

The standard for Clostridium difficile surface decontamination is bleach solution at a concentration of 10 % of sodium hypochlorite. Pulsed xenon UV light (PX-UV) is a means of quickly producing germicidal UV that has been shown to be effective in reducing environmental contamination by C. difficile spores. The purpose of this study was to investigate whether PX-UV was equivalent to bleach for decontamination of surfaces in C. difficile infection isolation rooms. High-touch surfaces in rooms previously occupied by C. difficile infected patients were sampled after discharge but before and after cleaning using either bleach or non-bleach cleaning followed by 15 min of PX-UV treatment. A total of 298 samples were collected by using a moistened wipe specifically designed for the removal of spores. Prior to disinfection, the mean contamination level was 2.39 c.f.u. for bleach rooms and 22.97 for UV rooms. After disinfection, the mean level of contamination for bleach was 0.71 c.f.u. (P = 0.1380), and 1.19 c.f.u. (P = 0.0017) for PX-UV disinfected rooms. The difference in final contamination levels between the two cleaning protocols was not significantly different (P = 0.9838). PX-UV disinfection appears to be at least equivalent to bleach in the ability to decrease environmental contamination with C. difficile spores. Larger studies are needed to validate this conclusion.

Topics: Clostridioides difficile; Clostridium Infections; Colony Count, Microbial; Disinfection; Environmental Microbiology; Humans; Microbial Viability; Sodium Hypochlorite; Ultraviolet Rays

Implementation of a hospital-wide program of terminal cleaning of patient rooms revolving around hydrogen peroxide vapor (HPV) technology and evaluation of its impact on endemic nosocomial Clostridium difficile-associated diarrhea (CDAD) have not been previously reported.. This was a retrospective quasiexperimental study involving a 900-bed community hospital. During the preintervention period (January 2007-November 2008), rooms vacated by patients with CDAD or on contact precautions for other targeted pathogens underwent 1 or more rounds of cleaning with bleach. During the intervention period (January-December 2009), targeted newly evacuated rooms underwent "enhanced cleaning" consisting of use of bleach followed by HPV decontamination utilizing a priority scale based on the pathogen and room location. Rooms vacated by patients with CDAD but for which HPV decontamination was not possible the same day underwent 4 rounds of cleaning with bleach instead.. During the intervention period, 1,123 HPV decontamination rounds were performed involving 96.7% of hospital rooms. Of 334 rooms vacated by patients with CDAD (May-December 2009), 180 (54%) underwent HPV decontamination. The rate of nosocomial CDAD rate dropped significantly from 0.88 cases/1,000 patient-days to 0.55 cases/1,000 patient-days (rate ratio, 0.63; 95% confidence interval: 0.50-0.79, P < .0001).. A hospital-wide program of enhanced terminal cleaning of targeted patient rooms revolving around HPV technology was practical and was associated with a significant reduction in CDAD rates.

Topics: Adult; Clostridium Infections; Cross Infection; Diarrhea; Disinfectants; Disinfection; Endemic Diseases; Hospitals, Community; Housekeeping, Hospital; Humans; Hydrogen Peroxide; Infection Control; Patients' Rooms; Retrospective Studies; Sodium Hypochlorite; Volatilization

This study evaluated daily cleaning with germicidal bleach wipes on wards with a high incidence of hospital-acquired Clostridium difficile infection (CDI). The intervention reduced hospital-acquired CDI incidence by 85%, from 24.2 to 3.6 cases per 10,000 patient-days, and prolonged the median time between hospital-acquired CDI cases from 8 to 80 days.

Topics: Clostridioides difficile; Clostridium Infections; Cross Infection; Disinfectants; Disinfection; Hospitals, Urban; Humans; Incidence; Minnesota; Sodium Hypochlorite

We were alerted to increased rates of Clostridium difficile-positive tests at all 3 hospitals in our health care system by MedMined Data Mining Surveillance Service, CareFusion (San Diego, CA). In response, an intervention of terminal room cleaning with dilute bleach was instituted to decrease the amount of C difficile environmental spore contamination from patients with C difficile infection (CDI).. The intervention consisted of replacing quaternary ammonium compound as a room cleaning agent with dilute bleach to disinfect rooms of patients with CDI upon discharge. All surfaces, floor to ceiling were wiped with dilute bleach applied with towels to thoroughly wet the surfaces. Daily room cleaning remained unchanged. Patients remained on C difficile contact isolation precautions until discharge. To determine the effectiveness of this program, rates of nosocomial CDI for all 3 hospitals were determined using the MedMined Virtual Surveillance Interface for 10 months prior to and 2 years after the cleaning intervention. Statistical significance was determined using Poisson regression analysis.. There was a 48% reduction in the prevalence density of C difficile after the bleaching intervention (95% confidence interval: 36%-58%, P < .0001).. The implementation of a thorough, all-surface terminal bleach cleaning program in the rooms of patients with CDI has made a sustained, significant impact on reducing the rate of nosocomial CDI in our health care system.

Topics: Clostridioides difficile; Clostridium Infections; Cross Infection; Disinfectants; Disinfection; Housekeeping, Hospital; Humans; Sodium Hypochlorite

Clostridium difficile is a health care-associated pathogen that is difficult to eradicate in the health care environment through the use of common hospital disinfectants. Many of these disinfectants fail to inactivate C difficile spores, which can result in patient-to-patient transmission. This study demonstrates that the use of 10% hypochlorite solution, along with interventions, reduced the incidence of health care-associated C. difficile infection.. A case-only study was conducted over a 24-month period. Interventions used to reduce the incidence of health care-associated C difficile included 10% hypochlorite disinfection, soap and water hand hygiene, contact isolation for suspected and confirmed cases, educational tool for patients and visitors, daily isolation rounds, automated report functions, and standardized nursing unit isolation processes. The microbiology method that was used to isolate the C difficile organism for DNA typing included a minimum of 1 mL of stool placed in a conical screw top tube, and then an equal volume of 95% ethyl alcohol was added to the tube. Prereduced blood agar plates were inoculated with the treated and untreated specimen. Plates were incubated anaerobically for 48 hours at 37 degrees C. Plates were examined for gray, flat colonies and gram stains performed; further testing was performed only on gram-positive rods.. A 66% reduction in the number of health care-associated C difficile cases was achieved during the study. A total of 25 isolates was DNA typed per pulse-field gel electrophoresis. Two distinct genetic patterns were identified. Results yielded that the Florida isolates also had the epidemic strain of the organisms that was noted in Quebec, Canada and other parts of the United States.. A combination of automated daily isolation reports, use of a standardized methodology for isolation rounds, as well as development of a 10% hypochlorite disinfection protocol resulted in a dramatic decrease in health care-associated C difficile cases. Weekly nursing director reports and daily rounds by nursing leadership keep the direct line supervisors abreast of infection control issues on their respective nursing units. The addition of the dual-chamber bleach container ensured that the proper dilution was achieved when disinfecting reusable equipment.

Topics: Clostridioides difficile; Clostridium Infections; Cohort Studies; Cross Infection; Data Collection; Disinfectants; Dysentery; Florida; Humans; Infection Control; Nursing Care; Patient Isolation; Sodium Hypochlorite; Universal Precautions

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.. 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.. 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.. 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.

Topics: Clostridioides difficile; Clostridium Infections; Cross Infection; Disinfection; Education; Enterococcus; Equipment Contamination; Fomites; Gram-Positive Bacterial Infections; Hospitals, Veterans; Housekeeping, Hospital; Humans; Infection Control; Patients' Rooms; Sodium Hypochlorite; Vancomycin Resistance