The Role of Contaminated Surfaces in the Transmission of Nosocomial Pathogens - Use of Biocidal Surfaces for Reduction of Healthcare Acquired Infections - page 38

A. baumannii (Nseir et al. ) [93]
C. difficile (Shaughnessy et al. ) [95]
VRE a (Drees et al. ) [39]
VRE (2 weeks) b (Drees et al. ) [39]
Improved cleaning VRE (Datta et al. ) [13]
P. aeruginosa (Nseir et al. ) [93]
VRE (Huang et al. ) [94]
MRSA (Huang et al. ) [94]
Improved cleaning MRSA (Datta et al. ) [13]
MDR-GNR HPV [12]
MRSA HPV [12]
C. difficile HPV [12]
VRE HPV [12]

0.0 1.0 2.0

Odds ratio

3.0

Fig. 3.2 Chart showing the increased risk associated with the prior room occupant
The figures of difference in risk are unadjusted based on raw data. Several of the studies included
adjusted measures of risk but these were not included due to differences in study design
(a) The immediate prior room occupant was known to be infected or colonized with VRE
(b) Any patient infected or colonized with VRE in the 2 weeks prior to admission

a 12-month pre-intervention phase. Patients admitted to rooms decontaminated
using HPV were significantly less likely to acquire any MDRO (64 % reduction)
than patients admitted to rooms disinfected using standard methods. There was a
significant reduction in the risk of acquiring VRE from the prior room occupant
(80 % reduction), and non-significant reductions in the risk of acquiring MRSA,
C. difficile and MDR-GNRs. HPV decontamination significantly reduced the pro-
portion of rooms environmentally contaminated with MDROs. In particular, rooms
contaminated with multiple MDROs, MDROs cultured from a room that differed
from the room occupant's known MDRO, and MDROs cultured from empty rooms
were less frequent on HPV units during the intervention phase. These environmen-
tal findings are consistent with improved terminal disinfection by HPV.
The next sections review evidence that contaminated surfaces are important in
the transmission of C. difficile , VRE, MRSA, norovirus and certain Gram-negative
rods (Table 3.4 ).

3.7.1 Clostridium Difficile

Outbreaks of C. difficile were first linked to contaminated surfaces in the 1980s
[ 50 ]. Samore et al. [ 109 ]. conducted a detailed 6-month prospective study of all
C. difficile cases in a US hospital. The frequency of positive hand cultures and