An Abstract on Preventing Contamination Of Substrates and Surfaces, from Community Acquired M.R.S.A., (methycillin-resistant staphylococcus aureus) and C. diff (Clostridium difficile).

PURPOSE: This abstract is to provide the general public, information on basic prevention measures, of community acquired M.R.S.A. infections, and is not a means of substituting medical advice from a physician or a healthcare professional.

Methicillin-resistant Staphylococcus aureus (MRSA) are isolates of the Bacterium Staphylococcus aureus that have acquired genes encoding Antibiotic resistance to all Penicillins, including Methicillin and other narrow-spectrum Blactamase-resistant penicillin Antibiotics. [1] The first MRSA was discovered in the United Kingdom UK in 1961, but MRSA are now widespread in the hospital setting. MRSA is commonly termed a Antibiotic resistance superbug. MRSA may also be known as oxacillin-resistant Staphylococcus aureus (ORSA) and multiple-resistant Staphylococcus aureus, while non-methicillin resistant strains of S. aureus are sometimes called methicillin-susceptible Staphylococcus aureus (MSSA) if an explicit distinction must be made. (1) Methicillin-resistant Staphylococcus aureus - Wikipedia, the free encyclopedia.

Common germs, such as Staphylococcus aureus, can live up to three weeks on a dry surface and may cause skin and surgical infections, food poisoning and pneumonia, according to the Association for Professionals in Infection Control and Epidemiology (APIC). Vancomycin resistant enterococci (VRE) can live on dry surfaces from seven days to four months. Clostridium difficile is another hardy pathogen that can survive in the environment as a spore. APIC also notes that contaminated environmental surfaces in healthcare facilities are a mode of transmission for multiple drug-resistant organisms (MDROs). (2) Surface Sanitation in Healthcare: Why Your Disinfection System May Be Letting You Down. Although MRSA has traditionally been seen as a hospital-associated infection, community-acquired MRSA strains have appeared in recent years, notably in the United States U.S. and Australia. [2] The abbreviations CA-MRSA (community-associated MRSA) and HA-MRSA (hospital-associated MRSA) are now commonly seen in medical literature. (1) Methicillin-resistant Staphylococcus aureus - Wikipedia, the free encyclopedia.

Although MRSA has traditionally been seen as a hospital-associated infection, community-acquired MRSA strains have appeared in recent years, notably in the U.S. and Australia. [2] The abbreviations CA-MRSA (community-associated MRSA) and HA-MRSA (hospital-associated MRSA) are now commonly seen in medical literature. (1) Methicillin-resistant Staphylococcus aureus - Wikipedia, the free encyclopedia.

According to the World Health Organization (WHO), one out of every 136 hospital patients in the United States becomes seriously ill as a result of acquiring an infection in a hospital. This is equivalent to 2 million cases and about 80,000 deaths a year. In a recent study of the financial impact of healthcare-acquired infections (HAIs), it was found that the average additional incremental direct cost for patients with an HAI was $8,832 and that each HAI-infected patient reduced overall net inpatient margins by $5,018. (2) Surface Sanitation in Healthcare: Why Your Disinfection System May Be Letting You Down.

Cleaning and disinfecting surfaces in healthcare facilities is critical to reducing HAIs. However, infection control practitioners and other healthcare professionals may be surprised to learn that not all surface sanitation efforts are equal. (2) Surface Sanitation in Healthcare: Why Your Disinfection System May Be Letting You Down.

Community Acquired MRSA, (methycillin-resistant staphylococcus aureus), is a serious issue, not only in Hospitals, Medical Facilities, and Rehabilitation Clinics, but also in Universities, Colleges, Professional Sport teams, School Districts, and Prisons. Restaurants, Shopping Malls, Supermarkets, and Farms, are also potential infectious sites. Skin-to-skin contact involving no abrasion and indirect contact with contaminated objects such as towels, sheets, sports equipment, patient rolling equipment, doorknobs, light switches, keyboards, computer mice, cell phones, keys, pens, animals, livestock, pets, and even coins and money, are the possible modes of transmission. Many people who are symptomatic present with pus-filled boils, and occasionally with rashes. People infected with M.R.S.A. have longer durations in hospitals, increased costs associated with illness, and are five times at more risk of death, compared to inpatients without M.R.S.A. (1) Methicillin-resistant Staphylococcus aureus - Wikipedia, the free encyclopedia.

APIC points to studies which show that 70 percent of environmental surfaces in rooms of patients who were colonized or infected, were contaminated with potentially harmful microorganisms. (2) Surface Sanitation in Healthcare: Why Your Disinfection System May Be Letting You Down.

APIC defines cleaning as the removal of all foreign material (i.e., dirt, body fluids, lubricants) from objects by using water with detergents or soaps and by washing or scrubbing the object. Cleaning is the necessary first step of any sterilization or disinfection process. It is needed to render the environmental surface safe to handle or use by removing organic matter, salts, and visible soils – all of which interfere with microbial inactivation. In fact, the physical action of scrubbing with detergents and surfactants and rinsing with water removes large numbers of microorganisms from surfaces. (2) Surface Sanitation in Healthcare: Why Your Disinfection System May Be Letting You Down.

Patient Satisfaction is a Very Important Concern: Infection rates in healthcare facilities are a major patient safety concern. In fact, cleanliness topped the list of factors considered by consumers in a 2005 national telephone survey about decision factors when choosing a hospital. An overwhelming majority (94 percent) of those polled rated "clean" as very important when deciding on a hospital, while 85 percent considered low infection rates very important in hospital selection. Moreover, nearly nine in ten survey respondents said that a higher-than-average infection rate is a very important reason to avoid a hospital, while four out of five respondents said that lack of cleanliness is a very important reason to avoid a hospital. (2) Surface Sanitation in Healthcare: Why Your Disinfection System May Be Letting You Down.

Methods of Cleaning Surfaces and Substrates:
Proper prevention of spreading M.S.R.A., is the key to lower infectious rates. There are several methods of prevention, and the methods include different characteristics.

Hand Washing- Washing hands repeatedly, several times a day, or using alcohol hand based rubs, and wear disposable gloves as required. Washing hands was demonstrated by a fivefold increase in the amount of alcohol-based handrub used over the period (Table 1). Hospital-acquired infection prevalence fell from 17% in 1994 to 10% in 1998 (Table 1), New cases of MRSA fell by half (Figure 1) (3) http://www.jr2.ox.ac.uk/bandolier/band82/b82-2.html

Chemical Methods To Clean Surfaces and Substrates- Alcohol, Quaternary ammonium, and all purpose cleaner-degreasers, can be used as an initial pre-treatment cleaning. But, the duration of the application and the mechanical means of the application are limited, as not all of the substrates or surfaces, are cleaned. For instance, most undersides, wheels, and crevices of patient rolling equipment and surfaces, are not reached, hence not cleaned. Also, studies have shown, some commonly used hospital cleaning and disinfectant agents not only fail to kill bacteria, they actually promote spore formation. (4) Hospital bug 'spread by cleaning products' | the Daily Mail

Bleach solutions are not recommended, as bleach is corrosive to most surfaces and substrates, and omits toxic fumes. As a result, bleach solutions may degrade or corrode equipment and substrates, and may decrease Indoor Air Quality.

Ultraviolet Light To Clean Surfaces- UVC disinfection significantly reduced the number of bacteria on surfaces directly or indirectly exposed to UVC to a very low number. Completely shadowed areas in the isolation unit (e.g. the bed rail, lockers, and mattresses) still required disinfection by chemicals. (5) http://www.journals.uchicago.edu/ICHE/journal/issues/v27n7/2004146/2004146.web.pdf

Dry Steam Vapor Sanitizing On Surfaces- Dry Steam Vapor is applied by high temperatures (250 degrees F), and low pressure, which produces a very low moisture vapor (about 5% moisture content), and can be applied to almost every substrate and surface. Bacteria and Viruses are killed instantly at 250 degrees F. Dry Steam Vapor is the most inexpensive and effective method for sanitizing. (6) Disinfection & Sterilization of Patient-Care Equipment, 1985 | CDC Infection Control in Healthcare.

The benefits with steam vapor's low moisture and high temperature provides deeper cleaning because it penetrates into the pores and crevices better than topically applied cleaners. This produced superior results and a "Pride of Accomplishment" morale factor. Steam vapor cleaning is multi-purpose, and can be used on a variety of surfaces outside of restrooms, including vinyl, carpets, walls, ceilings, upholstery, glass, and blinds. (7) iGreenBuild.com - Article Detail

Conclusion: A combination of techniques is vital to preventing the spreading of M.R.S.A. Constant and multiple Hand washing is a person's first line of defense.

Chemical cleaning of all substrates and surfaces as a pre-treatment is the first step, to remove sources of bacteria, viruses, dirt, and particulates. Although Ultraviolet Light is effective in controlling bacteria, viruses and particulates, other techniques such as chemical cleaning are required, for areas that Ultraviolet light can't penetrate or be directly exposed to.

The most effective and inexpensive method for sanitizing surfaces, is to use Dry Steam Vapor Sanitizing as a second step to chemical cleaning, to remove any remaining sources of bacteria, viruses, dirt, and particulates.

References:
Methicillin-resistant Staphylococcus aureus - Wikipedia, the free encyclopedia.
Surface Sanitation in Healthcare: Why Your Disinfection System May Be Letting You Down.
http://www.jr2.ox.ac.uk/bandolier/band82/b82-2.html
Hospital bug 'spread by cleaning products' | the Daily Mail
http://www.journals.uchicago.edu/ICHE/journal/issues/v27n7/2004146/2004146.web.pdf
Disinfection & Sterilization of Patient-Care Equipment, 1985 | CDC Infection Control in Healthcare.
iGreenBuild.com - Article Detail

By Jon A. Barrett, August 9, 2007

Business Development Specialist for Interior Maintenance Company, Inc. www.imc.cc B.S. Degree Temple University; Pre-Physical Therapy curriculum, Institute of Inspection, Cleaning and Restoration Certified, (I.I.C.R.C.), American Biorecovery Association Certified, (A.B.R.A.), American Society for Healthcare Engineering Member, Society for Healthcare Epidemiology of America Member.