Monday, June 30, 2008

MRSA deep clean a waste? Not really.

The headline blared, PATIENTS STILL AT RISK FROM MRSA DESPITE 57 MILLION POUND DEEP CLEAN'. The entire premise, I thought, was so bizarre. The idea that a one-time cleaning of something would prevent the return of contamination. If this was true, my 5 year old son would be overjoyed. He could take a bath in June and be set for the entire summer.
MRSA infection is a complex problem that is not to be eradicated with a one shot effort. Simple solutions, those sometimes promoted by press and politicians, are part of the answer, but not the entire answer. Maybe that's because staph bugs don't read the newspaper or listen to political speeches. Otherwise they would know to completely leave the hospital and never return following the 'deep clean'.
The headline in question appeared in the UK's Independent, written by Brian Brady and Jane Merrick:
Thousands of patients will remain at risk from superbugs, despite a £57m "deep clean" of hundreds of hospitals, because a vital screening programme will not be put in place for at least a year.
One of the world's leading experts on hospital-acquired infections (HAIs) warned yesterday that every one of the hospitals cleaned under Gordon Brown's flagship health policy will be back to square one as soon as the cleaners finish, because no one is stopping bacteria such as MRSA and Clostridium difficile from coming into the buildings.
Professor Hugh Pennington of Aberdeen University said the deep-clean programme would be "an expensive waste of resources".
The thought that a one time deep cleaning would end Hospital acquired Infections is naive at best, dangerous at worst. Professor Pennington' s assertion that MRSA infections are not "...environmental..." depends on what your definition of environmental is.
"Professor Pennington said: "Politicians get hung up on cleaning, but the major issue isn't environmental; it is people bringing the bugs into hospitals. Once the bacteria hit the floor they die off. The natural home of MRSA is either in infected patients or up the noses of the rest of us, so that is what they should be attacking."
At VIGILAIR we stress that all infections are environmental. A good example of MRSA as an environmental pathogen
is found in an article published in the journal of the Hospital infection Society-- 'Ventilation grilles as a potential source of methicillin-resistant Staphylococcus aureus causing an outbreak in an orthopaedic ward at a district general hospital', (1998) 39: I 27-I 33).
This article showed how MRSA was being distributed in a hospital via the ventilation system. While it is true that most MRSA is introduced into the hospital by visitors, patients and staff, environmental controls are key in removing these pathogens from the environment. Pennington's statement that MRSA bacteria die when they hit the floor is contradicted by a large body of research. The November 2006 issue of Infection Control and Hospital Epidemiology contains a report on MRSA survival that is typical of this research:
"We examined the duration of survival of 2 strains of methicillin-resistant Staphylococcus aureus (MRSA) on 3 types of hospital fomites. MRSA survived for 11 days on a plastic patient chart, more than 12 days on a laminated tabletop, and 9 days on a cloth curtain."
Ignoring the care environment in the fight against MRSA is short sighted. The strategy that we recommend acknowledges that the environment plays a significant role in hospital acquired infection and that several tactics must be employed together to be successful.
We've been able to culture Staph from the cooling coils of hospital HVAC units. Psuedomonas, Staph and many other bacteria are taken from patient care areas, and then find an excellent breeding ground in the dark, cool and food rich home in hospital ventilation systems.
VIGILAIR technology removes the HVAC as a reservoir for pathogens by disinfecting the HVAC system. VIGILAIR UVGI deactivates bacteria, fungi and viruses on surfaces as well as in the air. Importantly, this protection is constant.
Unlike one time cleanings the germicidal irradiation of cooling coils continues 24 hours a day, VIGILAIR technology is no silver bullet, either. It must be used in tandem with hand washing and 'deep cleaning'. The combination of these efforts is the best way to remove these pathogens. Any one of these tactics used in isolation will provide only a temporary relief, because hospital acquired infections are environmental by nature.

Thursday, June 05, 2008

MRSA Action UK-They Get it!

Over on our other site we highlighted a new report on anti-bacterial wipes yesterday. This morning we see that MRSA Action UK agrees with our sentiments:

MRSA Action UK: Antibacterial wipes are not the panacea for healthcare infections

Wednesday, 04 Jun 2008 08:46
MRSA Action UK’s contention has always been that to eliminate bacteria from the healthcare environment a systematic, comprehensive policy of eradication must be employed. In today’s medical arena the battle against infections is not just against MRSA and Clostridium difficile, but also against the others waiting in the wings. As a Charity that has been campaigning for safer hospitals in this country all the initiatives that have been introduced to reduce infections in our hospitals will fail, if this systematic and comprehensive approach is not taken.

Hospital cleanliness is paramount for the safety of patients in the NHS, and using antibacterial wipes as a policy to keep our hospitals clean is doomed to failure.

Antibacterial wipes can be effective against pathogens such as MRSA but only if used in the right way. They should only be used once for one surface, however there is no substitute for proper cleaning and decontamination performed by staff that are properly educated and trained in this process, using the appropriate equipment and techniques. The cleaning process should be comprehensive, and we believe monitored on its efficacy, and compliant in all ways. To be successful in this decontamination process it must be supported by regular environmental testing.

Controlling the infections in our hospitals cannot be solved by any single method, there are many ways for these pathogens to be transmitted on hands, uniforms, contaminated equipment and by the airborne route. The abject failure of this government to introduce a comprehensive system of infection prevention and control has ensured that as a nation we will stay bottom of the league with the numbers of healthcare infections in our hospitals, and until they tackle this problem head-on we will not have the safe, clean care of our neighbours in Northern Europe, where eradication of the bacteria remains a top priority.

As a Charity we have always maintained that whilst antibacterial wipes may help to prevent a patient contracting a healthcare infection, they are no guarantee, only thorough regular decontamination, and strict adherence to comprehensive infection prevention and control policies will do this.

Derek Butler
MRSA Action UK
Registered Charity No. 1115672
Telephone: 07762 741114

Eureka! They really get it.