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Int J Environ Res Public Health. 2018 Oct 19;15(10). pii: E2305. doi: 10.3390/ijerph15102305.

Improving Cleaning and Disinfection of High-Touch Surfaces in Intensive Care during Carbapenem-Resistant Acinetobacter baumannii Endemo-Epidemic Situations.

Author information

1
Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy. beatrice.casini@med.unipi.it.
2
Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy. righianna@gmail.com.
3
Anesthesia and Intensive Care Unit PS, University Hospital, 56124 Pisa, Italy. n.defeo@med.unipi.it.
4
Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy. micheleto@hotmail.it.
5
Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy. giorgiserena@yahoo.it.
6
Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy. laviniazezza@alice.it.
7
Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy. paola.valentini@dps.unipi.it.
8
Infectious Disease Unit, University Hospital, 56124 Pisa, Italy. tagliaferrienrico@alice.it.
9
Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy. alauracosta@alice.it.
10
Unit of Microbiology, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy. s.barnini@ao-pisa.toscana.it.
11
Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy. angelo.baggiani@med.unipi.it.
12
Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy. pierluigi.lopalco@unipi.it.
13
Anesthesia and Intensive Care Unit PS, University Hospital, 56124 Pisa, Italy. pmalacarne@hotmail.com.
14
Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy. gaetano.privitera@med.unipi.it.

Abstract

Aims: High-touch surfaces cleaning and disinfection require the adoption of effective and proper executed protocols, especially during carbapenem-resistant Acinetobacter baumannii (CRAB) endemo-epidemic situations. We evaluated the effectiveness and residual disinfectant activity of disposable pre-impregnated wipes (Modified Operative Protocol, MOP) in reducing environmental bioburden versus a two-step Standard Operative Protocol (SOP) in a 12-bed Intensive Care Unit. Methods: Five high-touch surfaces were cleaned and disinfected either according to the SOP (alcohol-based cleaning and chlorine-based disinfection) or using quaternary ammonium compounds-based disposable wipes (MOP). Sampling was performed before each procedure and at 0.5, 2.5, 4.5 and 6.5 h after (560 sites). Total viable count (TVC) was evaluated according to Italian hygiene standard (<50 CFU/24 cm²). Clinical and environmental CRAB strains isolated were genotyped. Results: On non-electromedical surfaces the difference between TVC before procedure and at each of the following times was significant only for the MOP (p < 0.05, Wilcoxon test). Using the MOP, only 7.4% (10/135) of sites showed TVC >50 CFU/24 cm² (hygiene failures) versus 18.9% (25/132) after SOP (p < 0.05, Fisher's Exact test). On infusion pumps a higher number of hygiene failures was observed after the SOP (7/44, 15.9%) compared with the MOP (4/45, 8.9%). Genotyping highlighted a common source of infection. Conclusion: On high-touch surfaces, the use of disposable wipes by in-house auxiliary nurses may represent a more effective alternative to standard cleaning and disinfection procedure performed by outsourced cleaning services, showing effectiveness in reducing microbial contamination and residual disinfection activity up to 6.5 h.

KEYWORDS:

carbapenem-resistant A. baumannii; high-touch surfaces; outsourced cleaning services; pre-impregnated wipes

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