P186
Influence of formulation and wipe materials on efficacy of quaternary ammonium compounds (QAC) - containing wet wipe products
Reiko Matsumura1, Junko Ochi1, Masashi Yamamoto1, Yoshihiko Hirata1
1Biochemical Laboratory, SARAYA CO., LTD., Osaka, Japan
Correspondence:Reiko Matsumura
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P186
Introduction:Quaternary ammonium compounds (QAC) are common disinfecting agents used for environmental disinfection of health- care facilities in Japan. Recently, some commercially wet wipe avail- able products contain both QAC and cleaning agent, possessing dis- infecting and detergent properties. However, it has been reported that the efficacy of QAC was interfered by incompatibility of formula- tion and wipe materials, failing to perform the required efficacy.
Objectives:This study evaluated formulations and their compatibility with wet wipe materials to obtain the optimum combination that will not interfere with the efficacy of QAC.
Methods:QAC - impregnated sample wipes for environmental disinfec- tion were wrung and evaluated for the efficacy of QAC. Furthermore, EN 16615 was also performed to evaluate the wet wipe products.
Results:It was confirmed that the efficacy of QAC was influenced by formulation and wipe materials. The wet wipe product which QAC ef- ficacy was not affected and was compatible with the wipe materials, satisfied the requirements of EN 16615.
Conclusion:It is desirable to use wet wipe products which QAC effi- cacy will not be affected by formulation or wipe materials, for envir- onmental disinfection in health-care facilities.
Disclosure of Interest
None Declared
P187
Disinfectant efficacy testing: how updates to current methodology and new method developments impact use concentrations
James Clarke, Aaron Nightingale, Lauren Oakes
Microbiology - Disinfection and Preservation, Lonza, Manchester, United Kingdom
Correspondence:James Clarke
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P187
Introduction:It is the responsibility of disinfectant suppliers to sub- stantiate the efficacy claims of their products through adequate effi- cacy tests in order for healthcare institutions to choose the appropriate disinfectants for any prescribed hygiene regime
Objectives:This investigation assesses how recent updates in testing methodology will affect the use levels required for disinfectants to meet the required efficacy criteria.
Methods: A selection of widely-used healthcare hard surface disin- fectant chemistries were tested according to recently introduced and newly updated European efficacy standard to assess the impact of new methodologies on pass levels and hence use recommendations for users’hygiene plans.
1. Non-mechanical surface test (EN13697:2015) with increased bacter- ial load and harmonised Aspergillus brasiliensis spore preparation (High and low ratios of mature: immature spores)
2. Mechanical surface test (EN16615:2015), a new test method to sub- stantiate wiping use patterns, using both viscose and synthetic wipes (PP/PE).
Results: 1) The increase in bacterial load in the EN13697:2015 test norm showed a positive correlation with small increases in use con- centration required to meet the pass criteria for all disinfectant chemistries. 2) All disinfectant chemistries showed varying magni- tudes of increased concentrations required to meet EN13697 pass criteria against mature A. brasiliensisspores when compared to im- mature spores. 3) The difference in pass concentrations identified for the same product in EN13697 and EN16616 varied between 0 and 50%. 4) The most significant impact on pass concentrations was demonstrated by the substrate composition in the EN 16615 method. QAC-based disinfectants synthetic (PP/PE) wipe substrate gave much lower pass concentrations compared to viscose substrates.
Conclusion:It is clear that updates to efficacy methodology and new method developments can impact the concentrations required for products to achieve certain pass criteria. Healthcare institutions should make certain their suppliers routinely assess their products opposite the most recent methods and method versions to verify that use levels are still effective. This will assist hospitals in using effi- cacious levels of disinfectants in their hygiene regimes for the benefit of their patients and staff.
Disclosure of Interest
None Declared
P188
Biofilms in healthcare settings and the mro transmission risk
Greg S. Whiteley1, Iain Gosbell2, Karen Vickery3, Slade Jensen2, Jessica
Knight2on behalf of Surgical Infection Research Group, Australian School of Advanced Medicine, Macquarie University
1
School of Science and Health, Western Sydney University, Richmond;
2School of Medicine, Western Sydney University, Liverpool;3ASAM,
Macquarie University, Sydney, Australia
Correspondence:Greg S. Whiteley
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P188
Introduction: The presence of multi resistant organisms (MRO) lo- cated within biofilms on dry surfaces within hospital settings has been demonstrated. MRO and other microbial species demonstrate enhanced survival characteristics consistent with hydrated biofilms. Traditional methods of treatment including cleaning, disinfecting and sterilisation have been shown to have limited capacity against the defensive features of these biofilms and new treatments and ap- proaches will be required.
Objectives:1. To understand the role of dry surface and other bio- films in survival of pathogenic bacteria within hospital settings; 2. To investigate the frequency of presence and distribution of these biofilms within hospital settings.
Methods:Destructive sampling from a range of hospital surfaces and objects, medical devices and in addition a revised sampling method was used to identify biofilm and presence of MRO. Samples were col- lected in situ from a number of different hospitals and various
locations within each hospital. Bacterial recovery methods included selective media, extended recovery times and stored samples were subjected to extended recovery times. Bacteria were regrown using a dry surface biofilm method (Almatroudi 2015) and subjected to disin- fectants and sterilisation processes including autoclaving and dry heat. Bacterial survivors were identified using traditional enumeration and live/dead stains.
Results: Samples obtained from hospital surfaces and devices fre- quently showed biofilm visible under SEM. Sustained storage of sam- ples revealed that MRO located within biofilms from dry surfaces have unexpectedly long survival and recovery characteristics. Expos- ure to a variety of disinfectants and Sterilant processes including chlorine and autoclaving were unable to guarantee inactivation of sessile bacteria located within the dry surface biofilms.
Conclusion:MRO located with biofilms on dry surfaces exhibit en- hanced survival and transmission characteristics. Standard ap- proaches to disinfection and sterilisation may be compromised where biofilms are present on hospital surfaces and reusable medical devices. A more aggressive approach to cleaning and hygienic treat- ments such as terminal room cleaning may be required.
References
Almatroudi et al., J Microbiol Methods:2015:117:171-176
Disclosure of Interest
None Declared
P189
Analysis of coagulase-negative staphylococcus (CONS) strains isolated from the touch surfaces in polish hospital wards for drug resistance and potential biofilm formation
Agnieszka Chmielarczyk, Anna Różańska, Dorota Romaniszyn, Małgorzata Bulanda
Chair of Microbiology, Jagiellonian University Medical College, Krakow, Poland
Correspondence:Agnieszka Chmielarczyk
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P189
Introduction:Transfer of etiological factors of nosocomial infections through contact route is still very frequent. The problem becomes particularly important in the case of multiresistant bacteria in a hos- pital environment such as methicillin resistant CoNS (MRCoNS).
Objectives: The aim of the study was to characterize the CoNS strains isolated from the touch surfaces in hospital wards for their drug resistance and the ability of biofilm formation.
Methods: The research material consisted of 92 strains from 13 wards in 3 hospitals. Identification of the species was carried out using an API-Staph and MALDI-TOF MS. Antibiotics used in this study included erythromycin, clindamycin, gentamycin, ciprofloxacin, tri- methoprim/sulphametoxazole, mupirocin. MRSA phenotype was con- firmed by detection of the mecA gene in PCR. Erythromycin resistance genes (ermA,ermB,ermC, andmsrA/B) and themupgene was performed by PCR. Biofilm formation was screened using the method with Congo red agar. For an accurate assessment an six- colour scale was used.
Results: There were 8 different species of CoNS found, most fre- quently S.epidermidis (34.8%) S.haemolyticus (30.4%) and S.hominis
(15.2%) were isolated.Above 68% of the strains were MRCoNS. The
mecA gene was confirmed in 69.5%. Among other antibiotics highest resistance was observed to erythromycin (71.7%) and to clindamycin (53.2%). The mechanism MLSB was detected in 51.6% isolates (in- cluding cMLSB 35.9% and iMLSB 16.3%) and MSB was confirmed in 17 isolates (18.5%). The geneermB was detected in only one strain and themsrA gene in 27 isolates. Resistance to mupirocin was dem- onstrated in 14 strains and gene mup was found in 18 strains. Biofilm-producing strains (very-black, black and almost-black) were 31 (33.7%), and the strains that do not produce biofilm (bordeaux, very red and red) were 61 (66.3%).
Conclusion: MRCoNS are not dangerous for people with properly functioning immune systems but they are a risk for patients seriously
ill, the elderly, immunocompromised, hospitalized in the ICU. Clean- ing and disinfecting of touch surfaces is an obvious action relevant for the MRCoNS control. The project was financially supported by The Polish National Center for Research and Development - decision PBS3/A9/32/2015
Disclosure of Interest
None Declared
P190
Chemical free cleaning is safer for health
Elizabeth E. Gillespie
Infection control and epidemiology, Monash Health, Clayton, Australia Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P190
Introduction: Monash Health began cleaning without chemicals in 2011. All patient environments are now cleaned using this method, including intensive care units, operating rooms and neonatal and special care nurseries.
Objectives:To demonstrate the benefits of this cleaning method To provide the cleaning assessment demonstrating cleaning compliance
Methods:Across 2150 inpatient beds at Monash Health, microfibre cloths of < 0.3 decitex and microfibre mops are dampened with water only. Steam is used intermittently to assist with the cleaning of stubborn stains, for difficult to reach areas such as bed rails, joints of equipment, cavities in equipment and areas where visible soil can accumulate.
Six monthly point prevalence screening for carbapenemase- producing Enterobacteriaceae (CPE) occurs in intensive care units (adult and neonatal), haematology unit and renal transplant unit. Ultraviolet markers (UVM) are used to demonstrate cleaning compliance.
Results:This cleaning method is used consistently regardless of a pa- tients perceived or known carriage of disease or multidrug resistant organism, including CPE.
When UVM demonstrates cleaning compliance, sporadic gastro- enteritis outbreaks are eliminated and clostridium difficile trans- mission does not occur. Where CPE carriage has been identified, transmission has been limited to 1 person, prior to the introduc- tion of transmission based precautions. This cleaning system saves time and water, reduces risk of falls and back injury, elimi- nates chemical exposure, limits cost and protects equipment from chemical damage.
Conclusion:Cleaning without chemicals using the cleaning system described, is as effective as using a 2-step cleaning method of deter- gent followed by disinfectant. However, it is safer, as significant risks are eliminated or reduced. Used for all patient environmental clean- ing, this system provides a level of protection not able to be demon- strated using chemical methods.
Disclosure of Interest
None Declared
P191
How effective is standard cleaning to remove dirt and microorganisms?
Marc Dangel1, Hansruedi Brunner2, Mladen Matulin3, Andreas Widmer1
1Division of Infectious Diseases & Hospital Epidemiology, UNIVERSITY
HOSPITAL BASEL;2Bardusch AG;3UNIVERSITY HOSPITAL BASEL, Basel, Switzerland
Correspondence:Marc Dangel
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P191
Introduction: Environmental cleaning is a fundamental principle of infection prevention in hospitals, but its role in reducing transmission of healthcare-acquired pathogens has been difficult to prove experimentally.
Objectives: The aim of the present short study was to evaluate whether adenosine triphosphate (ATP) presence, measured by
bioluminescence methods (surrogate marker for dirt), can predict microbiological contamination of hospital surfaces, measured by col- ony forming units (CFU)/100 cm2.
Methods:In four patient rooms we took Rodac plates from different places before and after cleaning. Simultaneously, we determined ATP testing (expressed as relative light units or RLU) from the same surfaces. The different places which we analysed were: floor under the patient’s table, patient’s table, armrest chair, bedside table, paper roll dispenser, flush tank button, toilet seat, floor at the entrance, door handle.
Results:A total 142 samples were taken, 72 Rodac plates and 70 ATP (2 missing data). All samples were positive for coagulase-negative
Staphylococcus, Micococcus ssp, Bacillus andCorynebacterium species. Before cleaning,Staphylococcus aureus(MSSA) was found in 27.8% of the samples (10/36). After cleaning, MSSA was found in 22.2% (8/36) and in 2.7% (1/36) methicillin-resistantStaphylococcus aureus (MRSA) was found. Analysis of the MRSA strain by PFGE provides strong evi- dence that the strain originated from a patient of a room at the same ward, but 36.5 meters apart, who had been put on contact isolation. Before and after cleaning, both dirt measured by ATP (p < 0.04) as well as microbiological contamination measured by (CFU)/100 cm2 (p < 0.02), resulted in a significant reduction. To our surprise, dirt re- moval and microbiological reduction were highly correlated (p < 0.001).
Conclusion:ATP reliably detects residual dirt and can be used for a surveillance of the quality of cleaning. However, detection ofS. aur- eusand even MRSA requires microbiological analyses, as these micro- organisms are not detectable by ATP. In conclusion, ATP and microbiological sampling provide supplementary information, al- though ATP predicts to some degree the level of microbiological contamination.
Disclosure of Interest
None Declared
P192
Monitoring the effectiveness of terminal cleaning in six Taiwan hospitals
I-Chen Hung1, Hao-Yuan Chang2, An-Chi Chen1, Yeur-Hur Lai3, Wang- Huei Sheng4
1
Center for Infection Control, National Taiwan University Hospital;
2School of Nursing, National Taiwan University,3Department of Nursing; 4
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Province of China
Correspondence:I-Chen Hung
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P192
Introduction: Improvement of environmental cleaning in hospitals has been shown to decrease cross-transmission of pathogens. Sev- eral objective methods, including aerobic colony counts (ACCs), ad- enosine triphosphate (ATP) bioluminescence assay and fluorescent marker were developed for cleanliness evaluation. However, few in- formation regarding the correlation of each test and the interpret- ation of fluorescent marker are locking.
Objectives:Our study aim was to monitor the cleaning efficacy in hospi- tals, and compare the results of targeting surfaces with fluorescent markers with those obtained by quantitative ATP method and ACC method.
Methods:This study was conducted a prospective survey of a strati- fied sampling of 47 wards in 6 hospitals. The same 10 to 12 high- touch surfaces at each room were tested after terminal cleaning (TC), using fluorescent markers, ATP method and ACC method. The aggre- gate outcome of tested surfaces at each room was calculated TC score. In fluorescence marker, 10 scores meant less than 1/4 residual gel, 5 meant 1/4 to 3/4 residual gel, 0 meant more than 3/4 residual gel. The ACC benchmark was <2.5 colony forming units (CFU)/cm2. An ATP benchmark was <500 relative light units (RLU) in general wards, and 250 RLU in ICU.
Results: In total, 830 ACC tests, 1390 ATP tests, and 1668 fluores- cence markers from 139 beds were performed. The mean± SD TC score of fluorescence marker, ATP method and ACC method were 46.0 ± 25.1, 64.2 ± 20.8 and 96.3 ± 6.2. The TC score of 3 methods had significant correlation each other (fluorescence marker v. ATP method, r = 0.33,p< 0.001; fluorescence marker v. ACC method, r = 0.42,p< 0.001; ATP method v. ACC method, r = 0.25,p= 0.025).
Conclusion: Fluorescent marker, as well as ATP bioluminescence assay, could offer objective standards for hospital cleanliness. Sim- plify the cleaning procedures and strengthen the cleaning of high- touch surfaces can improve the cleaning quality. Further studies are necessary to establish the association of cleanliness and microbial transmission and healthcare-associated infections.
Disclosure of Interest
None Declared
P193
A new approach for validation of cleanliness monitoring
Greg S. Whiteley1,2, Trevor O. Glasbey1, Paul Fahey3, Jessica Knight4, Iain Gosbell4, Slade Jensen5
1
Whiteley Corporation, North Sydney;2School of Science and Health, Western Sydney University, Richmond;3School of Science and Health,
Western Sydney University, Campbelltown;4School of Medicine, Western Sydney University, Liverpool;5School of Medicine, Western Sydney
University, Lliverpool, Australia
Correspondence:Greg S. Whiteley
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P193
Introduction:The monitoring of cleanliness levels on reusable med- ical devices (RMD) and environmental surfaces (ES) within healthcare settings is a potential cornerstone of infection prevention strategies. Recontamination of RMD and ES is a constant and heightens trans- mission risks of Multi Resistance Organisms (MRO). This study exam- ined a combination of monitoring methods including ATP testing and environmental swabbing to establish the cleanliness of RMD and ES within healthcare settings.
Objectives: 1. To improve the validation of surface cleanliness monitoring
2. To improve the reliability of ATP testing data
3. To improve the efficiency of environmental surface microbiology
Methods:RMD and ES were subjected to ATP testing using commer- cially available devices and consumables. A new sampling algorithm was used to reduce the risks of inherent variability arising from the ATP testing. The algorithm uses a duplicate sampling approach com- bined with an intervention step. Microbiological methods used an aggressive swabbing technique intended to reveal both transient and resident microbes of interest. Bacterial elucidation applied ex- tended recovery periods in selective media and identification using MALDITOF.
Results: Use of the ATP testing algorithm improved the reliability of ATP testing data (P = 0.001)and suggests new lower ATP levels for cleanliness acceptance. Aggressive swabbing technique demonstrated a surface contamination rate for MRO/biofilms as high as 17.65% of high touch objects located within the Intensive Care Unit.
Conclusion:The use of ATP testing has been contentious due to is- sues including variability and lack of correlation with relevant micro- bial contamination. The new sampling algorithm improves reliability to better than 99.9% through the mitigation of inherent variability, and suggests more severe standards for cleanliness standard setting (<25RLU–brand specific). The use of aggressive swabbing more reli- ably indicates MRO presence, even when located within dry surface biofilms. These new methods offer improved cleanliness monitoring for use within healthcare settings.
Disclosure of Interest
P194
Withdrawn
P195
Using fluorescent marker to evaluate the effectiveness of surface cleaning work in patient room, procedure room and icu room at HCMC University Medical Center
Tuan M. Huynh, Nguyen Thi Hong Van, Nguyen Vu Hoang Yen, Trinh Thi Thoa, Pham Thi Lan, Ha Thi Nha Ca, Tran Tri Kien
Infection Control, Ho Chi Minh City University Medical Center, Ho Chi Minh City, Viet Nam
Correspondence:Tuan M. Huynh
Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P195
Introduction: Hospitals must implement control for environmental surface cleaning and disinfection, especially“high touch”area, to en- sure that surfaces are appropriately clean and disinfected, so that there is no cross transmission to patient as well as healthcare worker. However, the usual control method, by using visual checklist, is not precise enough. Therefore, we carried out this study, using fluores- cent marker, to evaluate the effectiveness of routine cleaning processes.
Objectives:Determine the rate of unsatisfactory cleaning by using fluorescent marker, at “high touch” areas in patient/procedure/ICU room at HCMC UMC.
Methods:"High touch" areas related to injection vehicle, ventilator, toilet, patient room/procedure room/ICU rooms were marked for surveillance.
We evaluated cleaning result using "visual checklist" as usual; using "fluorescent marker" and calculating TDC Score following CDC guide- line in a manner of single-blind design.
Results: From 1/2016 to 6/2016, we collected a total of 883 "high touch" areas, evaluated 100% well using visual checklist; followed were their TDC Scores: