J.M. Boyce Consulting, LLC, 214 Hudson View Terrace, Hyde Park, NY, USA.
Antimicrob Resist Infect Control. 2024 Sep 27;13(1):110. doi: 10.1186/s13756-024-01461-x.
Healthcare-associated infections (HAIs) caused by multidrug-resistant organisms (MDROs) represent a global threat to human health and well-being. Because transmission of MDROs to patients often occurs via transiently contaminated hands of healthcare personnel (HCP), hand hygiene is considered the most important measure for preventing HAIs. Environmental surfaces contaminated with MDROs from colonized or infected patients represent an important source of HCP hand contamination and contribute to transmission of pathogens. Accordingly, facilities are encouraged to adopt and implement recommendations included in the World Health Organization hand hygiene guidelines and those from the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America/Association for Professionals in Infection Control and Epidemiology. Alcohol-based hand rubs are efficacious against MDROs with the exception of Clostridiodes difficile, for which soap and water handwashing is indicated. Monitoring hand hygiene adherence and providing HCP with feedback are of paramount importance. Environmental hygiene measures to curtail MDROs include disinfecting high-touch surfaces in rooms of patients with C. difficile infection daily with a sporicidal agent such as sodium hypochlorite. Some experts recommend also using a sporicidal agent in rooms of patients colonized with C. difficile, and for patients with multidrug-resistant Gram-negative bacteria. Sodium hypochlorite, hydrogen peroxide, or peracetic acid solutions are often used for daily and/or terminal disinfection of rooms housing patients with Candida auris or other MDROs. Products containing only a quaternary ammonium agent are not as effective as other agents against C. auris. Portable medical equipment should be cleaned and disinfected between use on different patients. Detergents are not recommended for cleaning high-touch surfaces in MDRO patient rooms, unless their use is followed by using a disinfectant. Facilities should consider using a disinfectant instead of detergents for terminal cleaning of floors in MDRO patient rooms. Education and training of environmental services employees is essential in assuring effective disinfection practices. Monitoring disinfection practices and providing personnel with performance feedback using fluorescent markers, adenosine triphosphate assays, or less commonly cultures of surfaces, can help reduce MDRO transmission. No-touch disinfection methods such as electrostatic spraying, hydrogen peroxide vapor, or ultraviolet light devices should be considered for terminal disinfection of MDRO patient rooms. Bundles with additional measures are usually necessary to reduce MDRO transmission.
医疗保健相关感染(HAI)由耐多药生物体(MDROs)引起,对人类健康和福祉构成全球威胁。由于 MDROs 经常通过医疗保健人员(HCP)短暂污染的手传播给患者,因此手卫生被认为是预防 HAI 的最重要措施。被定植或感染患者的 MDRO 污染的环境表面是 HCP 手部污染的重要来源,并有助于病原体传播。因此,鼓励设施采用并实施世界卫生组织手卫生指南以及美国医疗保健流行病学协会/美国传染病学会/感染控制和流行病学专业人员协会的建议。酒精类洗手液对 MDROs 有效,除艰难梭菌外,艰难梭菌感染患者应使用肥皂和水洗手。监测手卫生依从性并为 HCP 提供反馈至关重要。控制 MDROs 的环境卫生措施包括每天用季铵盐类杀孢子剂(如次氯酸钠)对艰难梭菌感染患者房间的高接触表面进行消毒。一些专家建议在艰难梭菌定植的患者房间以及耐多药革兰氏阴性菌患者的房间中也使用杀孢子剂。次氯酸钠、过氧化氢或过氧乙酸溶液常用于日常和/或终末消毒收治耳念珠菌或其他 MDROs 患者的房间。仅含有季铵盐类的产品对耳念珠菌的效果不如其他产品。在不同患者之间使用时,应清洁和消毒便携式医疗设备。除非在使用消毒剂之前先使用清洁剂,否则不建议在 MDRO 患者房间的高接触表面使用清洁剂。设施应考虑在 MDRO 患者房间的终末清洁中使用消毒剂而不是清洁剂来清洁地板。对环境服务员工进行教育和培训对于确保有效的消毒措施至关重要。使用荧光标记物、三磷酸腺苷检测或不太常见的表面培养物监测消毒措施并为人员提供绩效反馈,有助于减少 MDRO 传播。应考虑使用非接触式消毒方法,如静电喷雾、过氧化氢蒸气或紫外线设备,对 MDRO 患者房间进行终末消毒。通常需要包含其他措施的捆绑包来减少 MDRO 传播。