The Role of Contaminated Surfaces in the Transmission of Nosocomial Pathogens - Use of Biocidal Surfaces for Reduction of Healthcare Acquired Infections - page 39

t ransmission of nosocomial pathogens
Reference Setting, location Organism Study design Key findings

Mayfield et al. [97] Three units, USA C. difficile 18-month before-after study of a switch from

QAC to bleach disinfection

Significant reduction in CDI incidence on the highest
risk unit from 8.6 to 3.3 cases per 1,000 patient-days

Wilcox et al. [15] Two units, UK C. difficile 2-year ward cross-over study of a switch from

detergent to bleach disinfection

Significant reduction in CDI incidence on one of the
units (from 8.9 to 5.3 cases per 100 admissions), but
not on the other

McMullen et al. [98]

Medical and
surgical intensive
care units (MICU,
SICU), USA

C. difficile 2-month before-after evaluation of bleach

disinfection of CDI rooms on SICU and 4-
month evaluation of bleach disinfection of all
rooms on MICU in a hyper-endemic setting

Significant reduction in CDI incidence on both units
(10.4 to 3.9 cases per 1,000 patient days on SICU;
16.6 to 3.7 cases per 1,000 patient days on MICU)

Valiquette et al. [99] Hospital-wide,

Canada

C. difficile 5-month evaluation of enhanced infection

control and disinfection, including a switch to
bleach,

Neither environment intervention made a significant
impact on the incidence of CDI; a reduction in the use
of high-risk antibiotics significantly reduced the
incidence of CDI

and a subsequent switch to

'accelerated' hydrogen peroxide

Boyce et al. [61] Hospital-wide, USA C. difficile 20-month before-after study on the use of

HPV disinfection for terminal disinfection of
CDI rooms

Significant reduction in CDI incidence on five high
incidence units (from 2.3 to 1.3 cases per 1,000
patient-days). Lesser reduction

in CDI incidence

hospital wide

Hacek et al. [100] Three hospitals, C. difficile 3-year before-after study on switching from

QAC to bleach for terminal disinfection of
CDI rooms

Significant reduction in the incidence of CDI (from
0.85 to 0.45 per 1,000 patient days) USA

Orenstein et al. [101] Two medical units,

USA

C. difficile 2-year before-after study on switching to

bleach wipes for daily and terminal
disinfection of all rooms

Significant reduction in the incidence of CDI (from
24.2 to 3.6 per 1,000 patient days)

Manian et al. [102]

Hospital-wide, USA C. difficile 3-year before-after study on enhanced terminal

disinfection of CDI rooms using HPV and
bleach

Significant reduction in the incidence of CDI (from
0.88 to 0.55 cases per 1,000 patient days)

Hayden et al. [82] ICU, USA VRE 9-month before-after study on educational

improvement of cleaning and hand hygiene

The frequency of environmental contamination and
patient acquisition of VRE were reduced from 33 to
17 acquisitions per 1,000 patient-days during the
improved cleaning phase

Datta et al. [13] ICU, USA VRE 3-year before-after study of an intervention

(fluorescent markers, “bucket method” and
education) to enhance daily and terminal
cleaning

Significant reduction of MRSA (3.0 - 1.5% of
admissions) and VRE (3.0 - 2.2% of admissions)
acquisitions; intervention significantly reduced the
increased risk from the prior occupant for MRSA but
not VRE

MRSA

Perugini et al. [103] Hospital-wide,

Brazil

VRE 4-year before-after study of an educational and

observational intervention for cleaners

Significant reduction in VRE infection (from 7.7 to
1.9 per 1,000 patient days) and environmental
contamination

Grabsch et al. [104]

Hospital-wide,
Australia

VRE 18-month before-after study of a multimodal

intervention (switch to bleach, improved
monitoring of cleaners, modification of VRE
contact

Significant reduction of VRE colonization (from 10.7
to 8.0% of patients) and VRE environmental
contamination

isolation, periodic 'super-clean-

disinfection' of high-risk wards)

Passaretti et al. [12] ICU, USA VRE / all

MDROs

30-month cohort study on the impact of HPV
decontamination

Patient admitted to rooms disinfected using HPV
significantly less likely to acquire an MDRO (15.7 to
6.2 per 1,000 patient days) and VRE (11.6 to 2.4 per
1,000 patient days)

Mahamat et al. [105] Hospital-wide, UK MRSA 8-year interrupted time series analysis of

multiple infection control interventions

Introduction of bleach disinfection, environmental
sampling, alcohol gels and admission screening all
reduced the prevalence of MRSA

Dancer et al. [106]

Two wards, UK MRSA 12-month cross over-study on the impact of

one extra cleaner

Enhanced cleaning was associated with significant
reductions surface contamination, hygiene fails and
MRSA acquisition

Wilson et al. [107]

ICU, UK MRSA 12-month randomized cross-over study on the

impact of additional twice daily cleaning of
hand contact surfaces

Significant reduction in the detection of MRSA on
surfaces and hands, but no significant change in
MRSA acquisition was detected

Dharan et al. [108] 5 medical wards,

Switzerland

- 4-month controlled study where 3-wards

received an intervention (including an active
oxygen based compound) and 2 wards
continued current practice

Intervention associated with reduced contamination
but not reduced nosocomial infection or MRSA
infection / colonization

Rows marked in grey indicate studies that did not find a significant reduction in transmission
associated with the environmental intervention