In this era of increasing patient choice, imagine a patient is offered the choice between two identical-looking hospital rooms. The chances of picking up a multidrug-resistant organism (MDRO) are approximately doubled if the patient chooses the wrong room.
But there is no way to know which room is safest. The key information the patient has not been given is the MDRO status of the room’s previous occupants. One room had been occupied by a patient with C. difficile (C. diff). By choosing this room, the patient’s risk of developing C. diff infection doubles.
But it’s not just C. diff. This same association has been demonstrated for MRSA, VRE, Acinetobacter baumannii and Pseudomonas aeruginosa. Underpinning this association is the uncomfortable fact that cleaning and disinfection applied at the time of patient discharge is simply not good enough to protect the incoming patient.
C. diff is short for Clostridium difficile. A CDI is a Clostridium difficile infection in a patient. Difficile is Latin for “difficult.” C. diff used to be difficult to grow in a lab, and now it is difficult to stop it from growing in the hospital and community. CDI forms a spore and requires a sporicidal disinfectant to eliminate it from surfaces.
Three steps to success
CDI prevention begins with the right products and processes and an educated environmental services (EVS) staff:
Right products. CDI elimination requires a disinfectant from the EPA List K. My advice is to select a product from List K that requires a contact time of less than five minutes, is non-corrosive and does not cause asthmatic responses among those employees applying it to surfaces.
Right processes. First consider fitness for purpose. If hygiene procedures are to be effective, a determination needs to be made regarding not only product efficacy but more importantly, whether the process results in what we want to achieve — namely, environmental surfaces that are hygienically clean (fit for purpose) sufficient to break the chain of infection transmission.
When it comes to professionally cleaning surfaces, we need to get rid of the term “clean when visibly soiled.” Increasingly, the data show that potentially unsafe levels of pathogens can remain on visibly clean surfaces. Fecal matter the size of a pinhead contains sufficient infective material to transmit C diff. When staff are given the instruction to clean visibly soiled touchpoint surfaces, are they looking for soil the size of a pinhead? No. That is why managers should eliminate that term from education, training, policies and procedures.
It needs to be made clear that in hygiene practice, a surface can only be judged safe if it has been subjected to a validated hygiene process carried out in the prescribed manner. Visible cleanliness alone is not sufficient to judge whether a surface is safe.
Educated EVS staff. The prevention and control of CDI demands an educated and well-trained EVS staff. Moreover, CDI prevention will only become a reality when EVS workers are properly regarded, educated and equipped. EVS workers must be:
- well trained
- equipped with the necessary tools to clean and disinfect
- allotted time to do the necessary tasks
- educated about the prevention and transmission of CDI.
We have known about this association with the prior room occupant for some time – around 10 years, in fact. But I don’t think this alarming fact is in the consciousness of many hospital staff, much less the public. I feel strongly that this is not an acceptable situation that a patient’s risk of acquisition is influenced by the MRDO status of the room’s previous occupant. I forecast a storm when the public gets hold of this.
J. Darrel Hicks, BA, MESRE, CHESP, Certificate of Mastery in Infection Prevention, is the past president of the Healthcare Surfaces Institute. Hicks is nationally recognized as a subject matter expert in infection prevention and control as it relates to cleaning. He is the owner and principal of Safe, Clean and Disinfected. His enterprise specializes in B2B consulting, webinar presentations, seminars and facility consulting services related to cleaning and disinfection. He can be reached at firstname.lastname@example.org, or learn more at www.darrelhicks.com.