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Environmental Cleaning is Imperative to Infection PreventionThe good news is that an increasing number of hospitals are becoming aware of the role that contaminated environmental surfaces play in the transmission of pathogenic organisms. The bad news is that many hospitals still are not doing everything they can to ensure rigorous environmental cleaning protocols and practices, hence the continued proliferation of multidrug-resistant organisms (MDROs) and infections that can trigger increased healthcare costs, lengths of stay and mortality. It’s certainly not for a lack of data on the subject; Goodman (2008) observes, “Environmental contamination with pathogens commonly occurs during routine medical care. Many studies have described transmission of pathogenic organisms through contact with contaminated room surfaces.” And Eckstein (2007) notes, “Patients colonized or infected with healthcare-associated pathogens often shed these organisms onto their skin and into the environment. Although direct contact with patients is generally considered the major source for acquisition of pathogens on healthcare workers’ hands and subsequent transmission to other patients, several recent studies suggest that contaminated environmental surfaces may also play an important role in pathogen transmission.”
Goodman (2008) found that vancomycin-resistant Enterococci (VRE) and Staphylococcus aureus were frequently acquired on hands after contact with contaminated objects such as bed rails and bedside tables in colonized patients’ rooms. However, they also found that daily disinfection of environmental surfaces in VRE-colonized patients’ rooms was associated with reduced acquisition of this pathogen on hands. Studies have demonstrated that routine environmental cleaning can decrease VRE contamination on surfaces and healthcare workers’ hands, and also control VRE cross-transmission. Other studies indicate that a reduction in Clostridium difficile infection can be achieved through environmental decontamination.
It’s a message that hasn’t been lost on Phillip C. Carling, MD, director of infectious diseases and epidemiology at Caritas Carney Hospital in Boston and a professor at Boston University School of Medicine. Carling has long been an advocate of pairing the basics of infection prevention such as handwashing, with environmental cleaning and better education of environmental services (ES) personnel to cultivate greater awareness of sanitation technique.
“The critical importance of environmental cleaning has been coming to the forefront, particularly with the emergence of C. diff, VRE, MRSA and other MDROs that are showing their strength, virulence and persistence despite improvements in hand hygiene clarification of isolation and the revised isolation guidelines developed by the Centers for Disease Control and Prevention (CDC) several years ago,” Carling says. And while infection preventionists (IPs) and epidemiologists have been among the earliest adopters of evidence-based practices to prevent infections – and specifically acknowledging the effectiveness of surface and terminal cleaning – ES personnel have embraced these concepts to a lesser degree.
“Environmental services personnel have not yet had the opportunity to embrace these concepts and that’s what’s needed to change,” Carling confirms. “Despite recommendations by the CDC since 2003 that hospitals ensure that appropriate environmental hygiene practices are utilized and as well as specific mandated standards related to ensuring appropriate environmental hygiene practice requirements implemented by Medicare in 2007, adoption of these practices has been slow and inconsistent among institutions.”
环境清洁对防止感染是必须的
好消息是，越来越多的医院已经认识到，污染的环境表面在传播病原微生物上所发挥的作用。坏消息是，很多医院仍然不能尽其所能，以确保严格的环境清洁规程的和实践，因而多重耐药菌（MDROs）和感染继续扩散，引发医疗成本增长，住院时间延长和死亡率增高。这当然不是因为就这一问题的资料不足;Goodman
（2008）指出，“病原体污染环境，通常发生在日常的医疗过程中。许多研究已经描述了通过接触污染的房间表面传播病原体。” Eckstein（2007）指出，“感染或定植医疗相关病原体的病人，往往这些生物从他们的皮肤上脱落，并播散在环境中。尽管与病人直接接触一般被认为是医护人员的手获得病菌并随后传播给其他病人的主要来源，然而最近有几项研究表明，受污染的环境表面也发挥着传播病原体的重要作用。”
Goodman（2008）发现耐万古霉素肠球菌（VRE）和金黄色葡萄球菌往往在手接触污染的物品后获得，如定植病人房间的床栏杆和床边桌。然而，他们还发现，对VRE定植病人房间的表面环境进行日
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常消毒，与这种病原体手部污染的减少有关。研究表明，日常环境清洁消毒可减少表面和医护人员的手的VRE污染，并控制VRE的交叉污染。其他一些研究表明，艰难梭状芽胞杆菌感染的减少可以通过环境净化来实现。
这是一个尚未被Caritas Carney Hospital in Boston传染病和流行病学主任，Boston University School of Medicine 教授，Phillip C. Carling, MD,丢弃的信条。他一直主张将预防感染的基本措施如洗手，同环境清洁和更有效地环境服务（ES）人员教育配合，以培养更好的卫生技术意识。
“环境清洁的极端重要性已经来了前列，特别是随着C. diff，VRE，MRSA和其他MDROs的凸显，尽管CDC数年前制定和修改的手卫生和隔离指南有所改善，它们一直在表现出耐力、毒力和持久性”，卡林说。虽然感控专家（IPS）和流行病学家是以徇证医学为基础采取感染预防措施的最早接收者－特别是承认终末消毒和表面清洁的效果－而环境服务（ES）人员只是在较小的程度上已经接受了这些概念。
“环境服务人员尚未有机会接受这些概念，这也正是需要改变的”，Carling肯定。“尽管自2003年CDC就建议，医院要确保有适当的环境卫生措施，以及确保适当的环境卫生措施的要求于2007年被医疗保险制度实施，采纳这些做法的进展一直缓慢，机构间也存在不一致。”
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发表于 2011-4-2 10:25:00
发表于 2011-4-2 10:25:01
