Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy.
Anesthesia and Intensive Care Unit PS, University Hospital, 56124 Pisa, Italy.
Int J Environ Res Public Health. 2018 Oct 19;15(10):2305. doi: 10.3390/ijerph15102305.
High-touch surfaces cleaning and disinfection require the adoption of effective and proper executed protocols, especially during carbapenem-resistant (CRAB) endemo-epidemic situations. We evaluated the effectiveness and residual disinfectant activity of disposable pre-impregnated wipes (Modified Operative Protocol, MOP) in reducing environmental bioburden versus a two-step Standard Operative Protocol (SOP) in a 12-bed Intensive Care Unit. Five high-touch surfaces were cleaned and disinfected either according to the SOP (alcohol-based cleaning and chlorine-based disinfection) or using quaternary ammonium compounds-based disposable wipes (MOP). Sampling was performed before each procedure and at 0.5, 2.5, 4.5 and 6.5 h after (560 sites). Total viable count (TVC) was evaluated according to Italian hygiene standard (<50 CFU/24 cm²). Clinical and environmental CRAB strains isolated were genotyped. On non-electromedical surfaces the difference between TVC before procedure and at each of the following times was significant only for the MOP ( < 0.05, Wilcoxon test). Using the MOP, only 7.4% (10/135) of sites showed TVC >50 CFU/24 cm² (hygiene failures) versus 18.9% (25/132) after SOP ( < 0.05, Fisher's Exact test). On infusion pumps a higher number of hygiene failures was observed after the SOP (7/44, 15.9%) compared with the MOP (4/45, 8.9%). Genotyping highlighted a common source of infection. On high-touch surfaces, the use of disposable wipes by in-house auxiliary nurses may represent a more effective alternative to standard cleaning and disinfection procedure performed by outsourced cleaning services, showing effectiveness in reducing microbial contamination and residual disinfection activity up to 6.5 h.
高接触表面的清洁和消毒需要采用有效且正确执行的方案，特别是在耐碳青霉烯肠杆菌科（CRAB）地方性流行期间。我们评估了一次性预浸渍擦拭巾（改良手术方案，MOP）在降低环境生物负荷方面的有效性和残留消毒剂活性，与标准手术方案（SOP）相比，在 12 张床的重症监护病房中。对五例高接触表面进行清洁和消毒，分别按照 SOP（基于酒精的清洁和基于氯的消毒）或使用基于季铵化合物的一次性擦拭巾（MOP）进行。在每次操作前、操作后 0.5、2.5、4.5 和 6.5 h 进行采样（560 个部位）。总活菌计数（TVC）根据意大利卫生标准（<50 CFU/24 cm²）进行评估。从临床和环境中分离出的耐碳青霉烯肠杆菌科菌株进行了基因分型。在非电医疗器械表面，只有 MOP 方案前后的 TVC 差异具有统计学意义（<0.05，Wilcoxon 检验）。使用 MOP 方案，只有 7.4%（10/135）的部位 TVC >50 CFU/24 cm²（卫生失败），而 SOP 方案后为 18.9%（25/132）（<0.05，Fisher 精确检验）。在输液泵上，SOP 后观察到更高比例的卫生失败（7/44，15.9%），而 MOP 后为 4/45，8.9%）。基因分型显示了共同的感染源。在高接触表面，内部辅助护士使用一次性擦拭巾可能是替代外包清洁服务执行标准清洁和消毒程序的更有效方法，可有效降低微生物污染和残留消毒剂活性，最长可达 6.5 h。
