A disturbing finding in a recent study will make hospitals rethink some of their laundering/cleaning practices. Shek et al. (Shek 2018) assessed microbial burdens on hospital privacy curtains. They found that such curtains, minimally contaminated when first hung, tested positive for MRSA by day 14, and by day21 had MRSA loads that exceeded dangerous levels. The curtains were not in rooms occupied by patients with MRSA. The findings indicate that regular curtain contact that occurs in proximity to an occupied patient bed results in increasing colonization over time. Given that they sampled areas where people hold curtains, the researchers felt it likely that the increasing contamination was because of direct contact. The results suggest that curtains are a source of cross-contamination in hospitals. Because between days 10 and 14 after being hung curtains showed increased MRSA positivity, the authors suggest this may represent an opportune time to intervene, either by cleaning or replacing the curtains.
One might speculate lesser contact with privacy curtains might explain why studies have shown lower rates of some hospital-acquired infections in patients housed in private rooms. Analyzing over a million discharge records in Texas, O’Neill et al. (O’Neill 2018) found that patients who stayed in bay rooms had 64 percent more central line infections than patients who stayed in private rooms. Even after adjusting for relevant covariates, patients assigned to bay rooms had a 21 percent greater relative risk of a central line infection, compared with patients assigned to private rooms. At the hospital level, a 10% increase in private rooms was associated with an 8.6% decrease in central line infections, regardless of individual patients' room assignment.
And a study done in NICU’s (Washam 2018) showed that infants housed in a single-bed unit were associated with a significantly decreased risk of both MRSA and MSSA acquisition compared with infants housed in multibed pods.
That prestigious medical journal, Reader’s Digest, picked up on the Shek study on hospital privacy curtains and extended it to the “10 Things to Never Touch in Hospitals” (Gold 2018). Actually, that article provides links to the medical journals containing the original studies documenting the risks. The 10 items are:
And, of course, items often used by nurses and other healthcare professionals are mobile handheld devices (MHD’s) - tablets and smartphones- that are used to facilitate care documentation and as resource tools. A study at Mary Washington Health care in Fredericksburg,Virginia, sponsored by the Nursing Research Council (NRC), assessed the infection potential of MHDs and possible cleaning methods (Wentz 2018). They found that the mean MHD bioburden before cleaning was 106.8 relative light units (RLUs), indicating bacterial contamination. The mean post-cleaning bioburden was 49.98 RLUs, within the “clean” range. The results indicate that this regimen (70% isopropyl alcohol and 15 seconds of friction) effectively cleans MHDs and decreases the risk of spreading harmful bacteria to patients in the healthcare setting.
Bottom line: cross-contamination occurs frequently wherever healthcare workers come in contact with surfaces or equipment or other objects. Appropriate environmental cleaning at the right time should play a key role in our efforts to reduce hospital-acquired infections.
Shek K, Patidar R, Kohja Z, et al, Rate of contamination of hospital privacy curtains in a burns/plastic war021d: A longitudinal study, American Journal of Infection Control 2018; 46(9): 1019-1021
O’Neill L, Park S-H, Rosinia F. The role of the built environment and private rooms for reducing central line-associated bloodstream infections. PLOS One 2018; Published: July 27, 2018
Washam MC, Ankrum A, Haberman BE, et al. Risk Factors for Staphylococcus aureus Acquisition in the Neonatal Intensive Care Unit: A Matched Case-Case-Control Study. Infection Control Hospital Epidemiology 2018; 39(1): 46-52
Gold SS. 10 Things to Never Touch in Hospitals. Reader’s Digest 2018;
Wentz B, Bowles MJ. Mobile Devices and Healthcare-Associated Infections. Am Nurs Today 2018; 13(9)