Biomedical Engineering Reference
In-Depth Information
List of Abbreviations
CDC Centers for Disease Control and Prevention
CRE Carbapenem-resistant enterobacteriaceae
EPA Environmental Protection Agency
HAIs Healthcare-associated infections
HPV Hydrogen peroxide vapor
MRSA Methicillin-resistant
Staphylococcus areus
OSHA
Occupational Safety and Health Administration
PEL
Permissible exposure limit
RH
Relative humidity
TLV
™
Threshold Limit Value
UV
Ultraviolet
UVA
Ultraviolet A
UVB
Ultraviolet B
UVC
Ultraviolet C
VRE
Vancomycin-resistant
Enterococcus
9.1
Introduction
There has been increased interest in the use of chemical fumigation and ultraviolet
germicidal irradiation in healthcare facilities because of concerns about the role of
the environment as a cause of healthcare-associated infections (HAIs) and a
perception that current surface cleaning and disinfection methods are ineffective.
Methicillin-resistant
Staphylococcus areus
(MRSA) and other gram-positive
bacteria have become an increasingly common problem in healthcare environments
[
1
-
3
]. One major concern has been the upswing in incidence of infections caused
by
Clostridium difficile
(
C. difficile
) colitis [
4
]. This organism is now considered
to be the most important cause of diarrheal HAI [
5
].
Acinetobacter baumanni
is yet
another microorganism involved in HAIs that has been linked to environmental
contamination [
6
-
8
]. While norovirus has been primarily a food or waterborne
disease, it is becoming a serious HAI problem in healthcare settings because it
survives on surfaces and is highly infectious [
9
]. The latest microbes of concern
are the carbapenem-resistant Enterobacteriaceae (CRE), especially involving
Klebsiella pneumoniae
[
10
,
11
]. CRE is becoming more prevalent in
U.S. hospitals because it is difficult to treat, and it also has a case fatality rate that
may exceed 40 % [
12
]. On the positive side, CRE organisms will be less resistant to
environmental disinfection than other organisms such as spore formers.
HAIs are a significant contributor to morbidity, mortality and cost in healthcare
facilities [
13
-
16
]. Klevens et al. estimated there were 1.7 million HAIs in 2002 and
98,987 deaths. Scott estimated the cost of HAIs to range from $28.4 to $33.8 billion
after adjusting to 2007 dollars. Research has demonstrated that the cost associated
with drug resistant strains is $27,000-$127,000 higher
than the costs of
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