Alternative Room Disinfection Modalities –Pros and Cons - Use of Biocidal Surfaces for Reduction of Healthcare Acquired Infections - page 187

non-resistant strains [ 17 ]. Cost has been particular concern for the healthcare
industry because in 2008, the Centers for Medicare and Medicaid Services began
denying payments for HAIs [ 18 ]. The issue of HAI cost is complex and is
influenced by many factors including the type of patient procedure and the type
of infectious agent. In a 2011 study by Umscheild et al., they found that the
percentage of HAI that were preventable ranged from 69 to 45 %. If prevented,
this would correspond to 134,800 fewer infections and 3,100 fewer deaths and
a savings to the nation's healthcare system of $160-$630 million annually.
Our understanding of which microbes are causing the most significant morbidity,
mortality, and cost continues to evolve. C. difficile has been assumed to be one of
the most significant pathogens because of its environmental resistance and its high
prevalence in hospitals. Stewart and Hollenbeak found that C. difficile 's contribu-
tion to costs and mortality have been overestimated due to reporting bias [ 19 ].
They found that previous researchers had not controlled for differences in types of
hospitals, differences in patient populations, and the presence of comorbidities
such as diabetes when estimating the total costs of C. difficile to healthcare systems.
This is an important consideration because concern over limiting the spread of
C. difficile infections has been a major factor in the push to find alternative
disinfection modalities.
Until recently, the common assumption has been that the number one risk factor
for HAI is direct contact spread between a carrier and the patient or autoinfection
of the patient due to colonizing organisms [ 20 , 21 ]. According to the Centers
for Disease Control and Prevention (CDC), there have only been a few reports
documenting “cause and effect” between environmental contamination and infec-
tion [ 22 ]. In the last several years, there have been a number of studies that suggest a
more important role of the environment in HAI [ 3 , 6 , 21 , 23 - 34 ]. There are a
number of factors that contribute to the contamination of healthcare environments.
Patients infected with MRSA and other communicable diseases will shed these
microorganisms and may potential serve as a source of HAIs [ 24 , 27 , 29 , 35 - 38 ].
Since C. difficile is a spore-former, it would be expected to be viable for months
[ 39 ]. More importantly, the patient's environment has long been known as an
important reservoir for C. difficile infections [ 40 ]. Even gowns and gloves worn
to protect the healthcare worker have been found to be contaminated and to serve as
potential vehicles of transmission [ 41 ]. A particular concern is that hospital textiles
such as linens, surgical drapes, uniforms, patient apparel and many more may play
a role in infection transmission [ 42 ]. There is evidence that the type of species
or strain of microorganism affects survival in the environment. For example,
A. baumannii strains survive desiccation better than other Acinetobacter sp .
[ 35 , 43 ]. In the case of C. difficile , there is evidence that the organism has mutated
and now has greater toxin production, pathogenicity, and infectivity [ 4 , 44 ].
Akerlund et al., refer to this mutated organism as “hypervirulent.” While there is
ample evidence that certain microbes can survive in the environment for long
periods of time, the assumption that the environment was the cause of the infection
has been based primarily on correlation studies. The actual mechanism of transfer
of the infectious agent

to the patient is not well understood. A large scale