Alternative Room Disinfection Modalities –Pros and Cons - Use of Biocidal Surfaces for Reduction of Healthcare Acquired Infections - page 188

observational study attempted to identify the kinds of contacts between patients,
healthcare personnel, and visitors that present a risk of nosocomial infection [ 45 ].
The researchers found that in 21.6 % of interactions between patient and
healthcare provider or a visitor, there was no contact with either the patient or the
environment. The most frequent interaction was contact with the patient's environ-
ment (33.5 %), followed by contact with intact patient skin (27.1 %). The interac-
tion with the highest potential for infection transfer was contact with the patient's
blood or body fluids (17.8 %). A particular concern was the proper use of gloves
while touching blood or body fluids. The study revealed that healthcare providers
complied over 94 % of the time, whereas only 33 % of visitors did. This is an
important consideration because failure to comply with hand hygiene and
gloving policy by visitors may significantly increase the potential for infection
transmission.
While hand hygiene is the cornerstone of modern infection prevention, there
are inherent weaknesses in standard infection control practices in U.S. hospitals.
The CDC has promoted the use of alcohol-based hand scrubs as the standard of
practice for hand hygiene for many years [ 46 ]. Unfortunately, alcohol is ineffective
in destroying C. difficile , and in the case of A. baumannii , Edwards et al., found that
it enhances the growth and pathogenicity of the organism [ 47 ]. These authors
believe that for C. difficile and A. baumannii , there should be a return to basic
hand washing as the primary approach to hand hygiene.
The design and maintenance of healthcare building construction or mechanical
systems is important in preventing HAIs. For example, poor construction or main-
tenance can contribute to water infiltration and mold growth or leaking isolation
rooms. Even if the isolation rooms were initially constructed properly, renovations
and other modifications such as cable installations can result in barrier penetrations.
A serious problem with mechanical systems occurs when isolation rooms have
substandard air exchange rates. Researchers have found isolation rooms that
were not air tight due to penetrations and inadequate exchange rates [ 48 - 52 ].
In one study, the authors found 9 % of negative pressure isolation rooms were
actually under positive pressure relative to the corridor [ 52 ]. The problem with
insufficient pressurization was most pronounced in isolation rooms with suspended
ceilings.
Chemical fumigation was used in the 1960s to supplement standard environ-
mental surface disinfection in hospital isolation rooms and other critical areas [ 53 ].
There was an assumption that surface disinfection was inadequate and that a
chemical fog would destroy microorganisms in hard to reach locations. The CDC,
in their Guidelines for Environmental Infection Control in Health-Care Facilities ,
recommended against the practice of using chemical fogging for general infection
control in routine patient care areas because there was a lack of evidence of efficacy
[ 22 ]. In 2001, a fumigation technique using chlorine dioxide effectively destroyed
bacteria and their spores in the heavily contaminated Hart Senate Office Building
and some U.S. Post Office facilities [ 54 ]. Because of the success in destroying
anthrax using fumigation, healthcare officials have begun adopting fumigation
techniques in hospitals and similar institutional environments as an adjunct to
routine cleaning methods.