Environmental Surveillance FIDSSA Dr Ben Prinsloo Medical Microbiologist

Transcription

1 Environmental Surveillance FIDSSA 2015 Dr Ben Prinsloo Medical Microbiologist

2 The Scientist A scientist, in a broad sense, is a person engaging in a systematic activity to acquire knowledge We require evidence WE NEED AN ANSWER

3 YES / NO

4 Lunar Distance

5 Laser ranging retro reflector

6 Lunar Distance

7 HCAI

8 Hand Hygiene Actions

9 BMC Infectious Diseases 2006, 6:130 Bacterial & Fungal Persistence

10 Viral Persistence

11 Age of Resistance VRE, MRSA, CRE, ESBL, C difficile, C parapsilosis Antibiotic resistant pathogens continues to escalate Hayden MK. Clin Infect Dis 2006;42:

12 HCAI HCAI is a major problem for patient safety and its surveillance and prevention must be a first priority prolonged hospital stay long-term disability increased resistance of microorganisms to antimicrobials massive additional financial burden

13 HCAI HCAI concerns 5 15% of hospitalized patients 9 37% of those admitted to intensive care units (ICUs) 25 million extra days of hospital stay Economic burden of billion

14 Housing Challenge 20x15 R300 billion x1000 R million/ EUR Euro million houses built by the state since 1994 according to the 20 Year Review. ( /year)

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16 The Patient zone The patient zone is defined as the patient s intact skin and his/her immediate surroundings colonized by the patient flora and the healthcare area as containing all other surfaces

17 My Five Moments for Hand Hygiene

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21 HCAI

22 Environmental contamination Multidrug-resistant (MDR) Acinetobacter baumannii (MDR-AB) is an important nosocomial pathogen Prospective cohort study of ICU patients colonized or infected with MDR-AB For each patient, 10 surfaces in the patient room were sampled AJIC Volume 39, Issue 9, November 2011, Pages

23 Environmental contamination Fifty rooms were sampled 48% (24/50) were positive at 1 or more sites Supply carts (10/50, 20%) Floors (8/50, 16%) Infusion pumps (7/50, 14%) Ventilator touch pads (5/44, 11.4%) Surrounding environment is frequently contaminated AJIC Volume 39, Issue 9, November 2011, Pages

24 The Patient zone Patients occupying rooms previously occupied by patients with VRE MRSA, Clostridium difficile, and Acinetobacter baumannii infection or colonization have on average a 73% increased risk of acquiring the same pathogen Infect Control Hosp Epidemiol 2006;27: Epub February 8, 2006

25 The Patient zone Only 40% of near patient surfaces are being cleaned in accordance with existing hospital policies Studies have shown thoroughness of disinfection cleaning can be improved to 82% (on average more than 100% over baseline)

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27 Direct Practice Observation Covert monitoring of disinfection cleaning can provide an objective assessment of individual ES staff performance and compliance with cleaning protocols Cleaning improved from 48% to 87% Maintaining such a program

28 General Principles: Microbiologic Sampling of the Environment Before 1970, US hospitals conducted regularly scheduled culturing of the air and environmental surfaces (e.g., floors, walls, and table tops) During , 25% of US hospitals reduced the extent of such routine environmental culturing

29 High-touch surfaces The CDC (2003) recommended that hospitals clean and disinfect high-touch surfaces Hospitals monitor (ie, supervise and inspect) cleaning performance Consistent cleaning and disinfection Touched by the patient and health care professionals

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31 Swab Cultures Limited feasibility of monitoring multiple surfaces in multiple patient rooms as part of an ongoing monitoring program

32 Environmental Surface Sampling Routine environmental-surface sampling (e.g., surveillance cultures) in health-care settings is neither cost-effective nor warranted Environmental surface surveillance can not directly protect a patient from HCAI

33 1 Support an investigation of an outbreak of disease or infections when environmental reservoirs or fomites are implicated epidemiologically in disease transmission

34 2 Environmental sampling may be warranted in research

35 3 Monitor a potentially hazardous environmental condition Presence of a hazardous chemical or biological agent Validate the successful abatement of the hazard

36 4 Quality assurance to evaluate the effects of a change in infection-control practice or to ensure that equipment or systems perform according to specifications and expected outcomes

37 Agar Slide Cultures Agar coated glass slides with finger holds were developed to simplify quantitative cultures of liquids Determine pre-cleaning levels of contamination for each object evaluated in order to accurately assess cleaning practice

38 Fluorescent Markers Surfaces that are effectively disinfected but less effectively cleaned may be more likely flagged as failing to meet a quality standard using one of these markers than one of the culture techniques Disinfection cleaning improving from 48% to 77%

39 ATP Bioluminescence A specialized swab is used to sample a standardized surface area Total amount of ATP, both microbial and non-microbial, is quantified and expressed as relative light units

40 Evaluating the Pt Zone

41 Cleanliness versus cleaning practice Observation and fluorescent gel systems directly evaluate the cleaning process The swab or slide culture as well as ATP bioluminescence systems measure cleanliness Intrinsically low concentration of most major HAPs on surfaces limits the use of pathogen-specific monitoring

42 ICE

43 Creepy Crawlies Cockroaches Gram-negative bacteria Acinetobacter spp.; Citrobacter freundii; Enterobacter spp., E. cloacae; Escherichia coli; Flavobacterium spp.; Klebsiella spp.; Proteus spp.; Pseudomonas spp., P. aeruginosa, P. fluorescens, P. putida; Salmonella spp.; Serratia spp., S. marcescens; Shigella boydii Gram-positive bacteria Bacillus spp.; Enterococcus faecalis; Micrococcus spp.; Staphylococcus aureus, S. epidermidis; Streptococcus spp., S. viridans Fungi Aspergillus niger; Mucor spp.; Rhizopus spp. Candida spp. (houseflies)

44 Conclusions Hand Hygiene Bacterial Persistence of MDR organisms Patient zone Monitoring / Evaluation

45 Clutter and confusion are failures of design, not attributes of information. Edward Tuft Don t make the process harder than it is. Jack Welch

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