Effectiveness and satisfaction in non-critical surface cleaning and disinfection using quaternary ammonium-based spray and wipe formats / Efectividad y satisfacción en la limpieza y desinfección de superficies no críticas utilizando amonio cuaternario en formatos de aerosol y toallitas húmedas

OBJECTIVE: To compare the effectiveness and satisfaction with the use of sprays and wipes formats under healthcare facilities conditions. METHODS: Randomized crossover experimental study in four hospitals in the Region of Madrid. A quaternary ammonium formula in spray and wipe formats in a crossover manner over two weeks in all the units. The effectiveness was evaluated by means of relative light unit (RLU). The variables of effectiveness, method of use and satisfaction were taken into account. RESULTS: Samples were taken from 162 surfaces and no differences were found after disinfection, 60.00 (17.00-148.00) RLU for sprays and 67.00 (36.00-139.00) RLU for wipes (p = 0.271). A wider range of uses and results was found for sprays. 70.96% of the staff (n = 93) preferred wipes over sprays. CONCLUSIONS: Being equally effective, disinfection with wipes generated greater satisfaction with less variety in the results than sprays

OBJETIVO: Comparar la efectividad y satisfacción con el uso de aerosoles y formatos de toallitas húmedas en las condiciones de los centros de salud. MÉTODOS: Estudio experimental aleatorizado, cruzado en cuatro hospitales de la Comunidad de Madrid. Una fórmula de amonio cuaternario en formato aerosol y toallitas de forma cruzada durante dos semanas en todas las unidades. La efectividad se evaluó mediante Unidades Relativas de Luz (RLU). Se tuvieron en cuenta las variables de efectividad, método de uso y satisfacción. RESULTADOS: Se tomaron muestras de 162 superficies y no se encontraron diferencias después de la desinfección, 60,00 (17,00-148,00) RLU para aerosoles y 67,00 (36,00-139,00) RLU para toallitas (p = 0,271). Se encontró una gama más amplia de usos y resultados para los aerosoles. El 70,96% del personal (n = 93) prefirió las toallitas húmedas a los aerosoles. CONCLUSIONES: Siendo igualmente eficaz, la desinfección con toallitas generó mayor satisfacción con menos variedad en los resultados que los aerosoles

Impacto de la retirada de los lavabos en una unidad de cuidados intensivos sobre los aislamientos por bacilos gramnegativos no fermentadores en pacientes con ventilación mecánica invasiva / Impact of removing sinks from an intensive care unit on isolations by gram-negative non-fermenting bacilli in patients with invasive mechanical ventilation

Introducción y objetivo: La contaminación de los lavabos, incluso por su infrautilización, se asocia a la transmisión de bacilos gramnegativos no fermentadores (BGNNF) en unidades que atienden a pacientes con alto riesgo de infección. Tras vigilancia previa con muestras ambientales y de pacientes, se explora ahora el impacto de la retirada de los lavabos de los boxes de una UCI sobre aislamientos incidentes relacionados con la atención sanitaria en muestras de broncoaspirado de pacientes con ventilación mecánica invasiva (VMI). Material y métodos: Estudio cuasiexperimental antes-después, con anualidades preintervención y postintervención correspondientes a los períodos abril 2014-2016 y abril 2016-2017, respectivamente. Se estudiaron las densidades de incidencia por 1.000 días de VMI comparándose por el método exacto basado en la distribución binomial y estimándose la razón de densidades de incidencia. Resultados: Las densidades de incidencia por 1.000 días de VMI de aislamientos por BGNNF en las muestras de broncoaspirado de los períodos pre y postintervención fueron 11,28 y 1,91, respectivamente, lo que supone una densidad de incidencia postintervención 5,90 veces menor que la previa (IC95%: 1,49-51,05; p=0,003). Conclusiones: A pesar de las limitaciones del diseño, la retirada de los lavabos apunta a una reducción de los aislamientos

Introduction and objective: Contamination of sinks, even due to their underuse, is associated with the transmission of non-fermenting gram-negative bacilli (NFGNB) to patients in Augmented Care Units. After previous monitoring with environmental and patient samples, we now explore the impact of removing sinks from ICU cubicles on incidental isolations related to health care in bronchoaspirate samples of patients with invasive mechanical ventilation (IMV). Material and methods: Quasi-experimental study, before-and-after, pre-intervention annuities April 2014-2016 and post-intervention April 2016-2017. Incidence densities per 1,000 days of IMV were studied, comparing by the exact method based on the binomial distribution and estimating the incidence density ratio. Results: The incidence densities per 1,000 days of IMV of isolations by NFGNB in bronchoaspirate samples of the pre and post-intervention periods were 11.28 and 1.9, respectively. This implies a post-intervention incidence density 5.90 times lower than before (95% CI: 1.49-51.05, P=.003). Conclusions: Despite of the limitations of the design, the removal of sinks showed a reduction of the isolations

Impact of removing sinks from an intensive care unit on isolations by gram-negative non-fermenting bacilli in patients with invasive mechanical ventilation. / Impacto de la retirada de los lavabos en una unidad de cuidados intensivos sobre los aislamientos por bacilos gramnegativos no fermentadores en pacientes con ventilación mecánica invasiva.

INTRODUCTION AND OBJECTIVE: Contamination of sinks, even due to their underuse, is associated with the transmission of non-fermenting gram-negative bacilli (NFGNB) to patients in Augmented Care Units. After previous monitoring with environmental and patient samples, we now explore the impact of removing sinks from ICU cubicles on incidental isolations related to health care in bronchoaspirate samples of patients with invasive mechanical ventilation (IMV). MATERIAL AND METHODS: Quasi-experimental study, before-and-after, pre-intervention annuities April 2014-2016 and post-intervention April 2016-2017. Incidence densities per 1,000 days of IMV were studied, comparing by the exact method based on the binomial distribution and estimating the incidence density ratio. RESULTS: The incidence densities per 1,000 days of IMV of isolations by NFGNB in bronchoaspirate samples of the pre and post-intervention periods were 11.28 and 1.9, respectively. This implies a post-intervention incidence density 5.90 times lower than before (95% CI: 1.49-51.05, P=.003). CONCLUSIONS: Despite of the limitations of the design, the removal of sinks showed a reduction of the isolations.

La infrautilización de grifos en una unidad de cuidados intensivos como causa de reservorios de bacilos gramnegativos no fermentadores / Under-utilization of taps in intensive care unit as a cause of reservoirs of nonfermenting gram-negative bacilli

INTRODUCCIÓN: La infrautilización de grifos se relaciona con reservorios de bacilos gramnegativos no fermentadores en su interior con capacidad de diseminación. Se describe la detección del problema y abordaje en una UCI. MÉTODOS: Estudio descriptivo en una UCI con boxes individuales con lavabo propio. Se recogieron muestras clínicas de pacientes y ambientales de los aireadores de los grifos. Se revisaron medidas de higiene. RESULTADOS: Se identificaron 4 casos de Chryseobacterium indologenes, uno de Elizabethkingia meningoseptica y otro por Pseudomonas aeruginosa, tanto en muestras clínicas como ambientales. Los profesionales indicaron utilizar solución hidroalcohólica casi siempre en la higiene de manos. Tras descartar la apertura controlada diaria de grifos por ineficiente, se decidió su retirada. CONCLUSIONES: Las recomendaciones nacionales resultaron insuficientes para la prevención, detección y control de la contaminación de los grifos de una unidad de alto riesgo de infección. Es necesario mejorar el manejo de los grifos en estas unidades

INTRODUCTION: The under-utilisation of taps is associated with the generation of reservoirs of non-fermenting gram-negative bacilli with the ability to disseminate. We describe the detection and approach of the problem in an ICU. METHODS: Observational descriptive study in an ICU with individual cubicles with their own sink. We collected clinical samples from patients and environmental samples from tap aerators and reviewed the unit's hygiene measures. RESULTS: We detected four cases due to Chryseobacterium indologenes, one to Elizabethkingia meningoseptica and another to Pseudomonas aeruginosa; they were identified both in clinical and the environmental samples. The healthcare professionals reported that almost every hand hygiene opportunity was performed with a hydroalcoholic solution. After considered the daily flushing of water outlets as inefficient, it was decided to remove them. CONCLUSIONS: National recommendations were insufficient for preventing, detecting and controlling tap contamination in units with a high risk of infection. The management of taps in these units needs to be improved

Under-utilization of taps in intensive care unit as a cause of reservoirs of nonfermenting gram-negative bacilli. / La infrautilización de grifos en una unidad de cuidados intensivos como causa de reservorios de bacilos gramnegativos no fermentadores.

INTRODUCTION: The under-utilisation of taps is associated with the generation of reservoirs of non-fermenting gram-negative bacilli with the ability to disseminate. We describe the detection and approach of the problem in an ICU. METHODS: Observational descriptive study in an ICU with individual cubicles with their own sink. We collected clinical samples from patients and environmental samples from tap aerators and reviewed the unit's hygiene measures. RESULTS: We detected four cases due to Chryseobacterium indologenes, one to Elizabethkingia meningoseptica and another to Pseudomonas aeruginosa; they were identified both in clinical and the environmental samples. The healthcare professionals reported that almost every hand hygiene opportunity was performed with a hydroalcoholic solution. After considered the daily flushing of water outlets as inefficient, it was decided to remove them. CONCLUSIONS: National recommendations were insufficient for preventing, detecting and controlling tap contamination in units with a high risk of infection. The management of taps in these units needs to be improved.