Enhanced disinfection methods employed daily by cleaning crews specifically educated in attacking Clostridium difficile dramatically reduce the presence of the notoriously resilient organisms in infected rooms, finds a study published in the May issue of Infection Control and Hospital Epidemiology.
Researchers at Case Western Reserve University School of Medicine looked at efforts by the Louis Stokes Cleveland Veterans Affairs Medical Center to eliminate C. difficile from rooms infected during a 2002-2004 outbreak. Environmental cultures were still testing positive in 2009, Medscape Today reported, prompting a 21-month phased intervention by the university.
In the first phase, fluorescent marks were added to high-touch surfaces to assess how thoroughly rooms were being cleaned by regular cleaning crews. Rooms were cleaned more thoroughly, the researchers found, but were not disinfected daily as required. The result was a 14 percent reduction in rooms with positive C. diff cultures.
The second phase added automated portable ultraviolet disinfection devices to the cleaning regimen, but changed no other procedures. The number of rooms with positive cultures fell 48 percent from the baseline. Researchers had expected better results, and found cleaning crews were less scrupulous in cleaning when the UV devices were used.
For the third phase, a dedicated team of three housekeepers was educated about disinfection and provided feedback by an expert observing their work. High-touch surfaces were cleaned daily with germicidal wipes. If swab cultures can back positive, the entire room was recleaned and disinfected. The results: C. diff room infection fell by 89 percent from the baseline.
"Our experience suggests that culturing of [C. difficile infected] rooms after terminal cleaning could provide a valuable means to assess the effectiveness of cleaning interventions," the authors concluded.
A separate study published last month in the American Journal of Infection Control found healthcare workers' technical understanding of C. diff is limited, complicating efforts to control the notoriously stubborn infection. Doctors and nurses were especially ill-informed, the study found.
Another survey released this spring found only incremental improvements in infection control despite increased emphasis on environmental cleaning and equipment decontamination practices.