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Surface disinfection

The Centers for Disease Control and Prevention (CDC) highlighted the importance of utilizing contact precautions for mitigating the transmission of Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococcus (VRE), underscoring the critical importance of a total protocol that includes proper handwashing, gloving, masking (for MRSA), gowning, and appropriate practices for handling devices and laundry, and for daily surface disinfection.

In recognition of healthcare-acquired infections’ profound impact on patient outcomes and healthcare costs, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) released strengthened infection control guidelines. In addition to raising awareness that infections can be acquired in any healthcare setting, including hospitals, ambulatory care, home care, and long-term care organizations, the new guidelines also address emerging antimicrobial resistance.

When portable equipment is carried by health care workers, such as stethoscopes, blood pressure cuffs, otoscopes, pens, and pagers,1 microorganisms can be carried directly to another patient or transferred to furniture or equipment. Thus unwittingly, microorganisms are transferred between patients. Many surfaces in the room can be affected, including bed rails, bed tables, linens, wheelchairs, thermometers, pulse oximeters, patient gowns, privacy curtains, patient charts, and doorknobs. Nurses’ gloves become contaminated 42 percent of the time after touching these contaminated surfaces. 2

Despite the best efforts of healthcare facilities to maintain a clean and safe environment, contact transfer of harmful microorganisms seems to be inevitable. Studies have shown that, in rooms of patients who were colonized or infected, 70 percent of environmental surfaces were contaminated with potentially harmful microorganisms, 3 and 65 percent of healthcare workers’ gowns were contaminated with MRSA after routine morning care for patients with MRSA in a wound or patient’s urine. 4

The impact of healthcare-acquired infections is staggering:

Approximately 90,000 deaths occur annually due to healthcare-acquired infections.5

Treatment costs can range from $2,300 to $80,000 per patient.6

Healthcare-acquired infections represents an annual impact of $6.7 billion to healthcare facilities.7

Annually, more than 2.9 million patients (5 to 10 percent) develop healthcare-acquired infections.8

Patients with healthcare-acquired infections spend an average of 12 additional days in the hospital.9

Approximately 30 percent of patients in ICUs develop healthcare-acquired infections.10

Thirty percent to 40 percent of resistant infections result from contact transfer via the hands of healthcare workers.11

Forty percent of health care workers’ gowns were contaminated with VRE after care of a colonized or infected patient.12

Forty-two percent of nurses’ gloves were contaminated with MRSA after touching environmental surfaces even if they never touched the MRSA infected patient.13

Sixty-four percent of environmental surfaces in burn units were contaminated.14

Sixty-five percent of health care workers’ gowns were contaminated with MRSA after routine morning care for patients with MRSA in a wound or in their urine.15

Methicillin-resistant Staphylococcus aureus (MRSA) can survive on sterile packages for more than 38 weeks.16

Vancomycin-resistant Enterococcus (VRE) can persist on dry environmental surfaces anywhere from seven days to four months.17

Seventy percent of rooms had environmental contamination when the patient was colonized or infected.18

Bed rails, wheelchairs, thermometers, pulse oximeters, doorknobs, bed tables, linen, patient gowns, charts, etc.19

References:
1. Muto C., Jernigan, J., Ostrowsky B., Richet H., Jarvis W., Boyce J., and Farr B. SHEA Guideline for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol. 2003, 367.
2. Boyce J.M. Infect Control Hosp Epidemiol. 1997; 18:622-627.
3. Boyce J.M. Infect Control Hosp Epidemiol. 1997;18:622.
4. Muto C., Jernigan J., Ostrowsky B., Richet H., Jarvis W., Boyce J., and Farr B. SHEA Guideline for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol. 2003, 367.
5. Weinstein R.A. Emerging Infectious Diseases. 1998.
6. Salgado C. and Farr B. Infect Control Hosp Epidemiol. 2003;24:690-698; Managing Infection Control. 2003;3:14-16.
7. CDC Guideline 1999 Surgical Site Infections.
8. CDC. 1992; 41: 783-7.
9. Kopp B., Nix D., and Armstrong E. Ann Pharmacother.2004;9:1377-82; Carbon C.J Antimicrobial Chemotherapy. 1999;44:31-36.
10. CDC. 1992; 41: 783-7.
11. Proceedings of the Fourth Decennial International Conference on Nosocomial Infections And Healthcare-Associated Infections; 2000 March 5-9; Atlanta, Ga.
12. Muto C., Jernigan J., Ostrowsky B., Richet H., Jarvis W., Boyce J., and Farr B. SHEA Guideline for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus and Enterococcus
13. Ibid.
14. Ibid.
15. Ibid.
16. Ibid.
17. Ibid.
18. Boyce J.M. Infect Control Hosp Epidemiol. 1997;18:622.
19. Muto C., Jernigan J., Ostrowsky B., Richet H., Jarvis W., Boyce J., and Farr B. SHEA Guideline for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol. 2003, 367.

 

 

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