The contribution of beds to healthcare-associated infection: the importance of adequate decontamination Link to CIAP Journal
Summary
The hospital bed is comprised of different components, which pose a potential risk of infection for the patient if not adequately decontaminated. In the literature there are a number of descriptions of outbreaks or experimental investigations involving meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Acinetobacter spp., and other pathogens. Often only the bedrail has been sampled during investigation of outbreaks, rather than more important potential reservoirs of infection, such as mattresses and pillows, which are in direct contact with patients. It is essential that these items and other bed components are adequately decontaminated to minimise the risk of cross-infection, but detailed advice on this aspect is often lacking in reports and official documents. Clear guidelines should be formulated, specifying the decontamination procedure for each component of the bed. In outbreaks, investigation should include an assessment of mattresses and pillow contamination as a critical aspect in outbreak management.
A modified ATP benchmark for evaluating the cleaning of some hospital environmental surfaces Link to CIAP Journal
Summary
Hospital cleaning continues to attract patient, media and political attention. In the UK it is still primarily assessed via visual inspection, which can be misleading. Calls have therefore been made for a more objective approach to assessing surface cleanliness. To improve the management of hospital cleaning the use of adenosine triphosphate (ATP) in combination with microbiological analysis has been proposed, with a general ATP benchmark value of 500 relative light units (RLU) for one combination of test and equipment. In this study, the same test combination was used to assess cleaning effectiveness in a 1300-bed teaching hospital after routine and modified cleaning protocols. Based upon the ATP results a revised stricter pass/fail benchmark of 250 RLU is proposed for the range of surfaces used in this study. This was routinely achieved using modified best practice cleaning procedures which also gave reduced surface counts with, for example, aerobic colony counts reduced from >100 to <2.5 cfu/cm2, and counts of
Staphylococcus aureus reduced from up to 2.5 to <1 cfu/cm2 (95% of the time). Benchmarking is linked to incremental quality improvements and both the original suggestion of 500 RLU and the revised figure of 250 RLU can be used by hospitals as part of this process. They can also be used in the assessment of novel cleaning methods, such as steam cleaning and microfibre cloths, which have potential use in the National Health Service.
