Automatic environmental disinfection with hydrogen peroxide and silver ions versus manual environmental disinfection with sodium hypochlorite: a multicentre randomized before-and-after trial.

BACKGROUND: New technologies for automated disinfection have been developed, including the use of hydrogen peroxide atomized by specific equipment, with associated silver compounds. AIMS: To compare the effectiveness of an automated disinfection system with hydrogen peroxide <8% and silver ion versus a manual method with 0.5% sodium hypochlorite solution when evaluating the reduction of microbial mesophilic contamination and Clostridium difficile presence; and to evaluate the time required for both of these processes. METHODS: This was a randomized multicentre trial performed in different hospital wards that had been occupied previously by patients with Clostridium difficile infection. When patients were discharged their rooms were randomized to one of two decontamination arms. The surfaces where sampled using swabs, before and after disinfection. Swab samples were cultured for quantitative detection of microbial mesophilic contamination and qualitative detection of C. difficile. FINDINGS: Before disinfection, 13% of surfaces decontaminated with hydrogen peroxide and silver ions and 20% of surfaces decontaminated with sodium hypochlorite showed presence of C. difficile spores. After disinfection, the samples containing C. difficile were 0% (P < 0.001) in the group decontaminated with hydrogen peroxide and silver ions, and were 3% (P < 0.001) in the group decontaminated with sodium hypochlorite. This difference was not statistically significant; nor was the difference in the reduction of the microbial mesophilic contamination. CONCLUSION: The differences between the groups were not statistically significant; however, the disinfection with hydrogen peroxide and silver ions is preferable due to less dependence on operators.

Prevalence of infections in long-term care facilities: how to read it?

PURPOSE: Prevalence surveys are mostly used in European countries for infection surveillance in long-term care facilities (LTCFs). The purpose of this paper is to document the prevalence of infections in LTCFs and to identify and discuss the potential sources of variation in the overall prevalence of infections. METHODS: Six repeated prevalence surveys were carried out over a period of 3 years in 11 LTCFs in the Emilia-Romagna region, involving a mean of 812 residents in each survey. In one facility, continuous surveillance was also conducted. McGeer's infection criteria were used. Observers undertook a 1-day training course and on-field training. RESULTS: The average prevalence of infected residents was 11.5/100 residents: respiratory tract infections were the most common (5.7/100 residents), followed by urinary tract infections (2.6%), skin infections (1.9%), and ocular infections (1.4%). In a multivariate model, the prevalence significantly varied by season (p < 0.001) and residents' case-mix index (CMI, p < 0.001). In individual homes, the case mix varied from 0.91 to 1.1 and the observed prevalence varied from 6.6 to 40.4%. One facility set up and maintained continuous surveillance: three clusters of lower respiratory tract infection were identified in 1.5 years by a temporal scan test. Cases belonging to one outbreak only were captured by the prevalence surveys conducted in the same periods. CONCLUSIONS: The prevalence of infections in LTCFs needs to be interpreted cautiously, given the effects of seasonality and case-mix variation. Repeated prevalence surveys may be a good start in individual facilities, but the identification of outbreaks requires a continuous surveillance system.

Prevalence of long-term care acquired infections in nursing and residential homes in the Emilia-Romagna Region.

BACKGROUND: Hardly any data on the occurrence of infection in Italian nursing homes have been published; yet Italy has the second oldest population in the world. The objective of the study was to assess the frequency of infections in a sample of Italian nursing homes. MATERIALS AND METHODS: A 1-day prevalence survey was conducted in three local health authorities (LHAs) of the Emilia-Romagna region in Italy, aimed at describing the prevalence of patients with long-term care facilityassociated infections and their associated factors among residents of nursing and residential facilities. All nursing homes (NHs) and a stratified random sample of residential homes (RHs) in the three LHAs were included in the study, for a total of 1,926 elderly people in 49 facilities. The following data were recorded: infections, medical condition, activities of daily living (ADL), use of antibiotics. The main outcome of the study was infection prevalence. RESULTS: The prevalence of patients with long-term care facility-associated infection was 8.4/100 residents overall (CI 95% 7.9-9.0), 14.6/100 in NHs and 7.5/100 in RHs (CI 95% 6.8-8.1). The prevalence of infection significantly varied with LHA and facility. It was associated with level of dependency and exposure to invasive procedures, such as urinary catheterization and parenteral procedures. Six percent of residents received a systemic antimicrobial on the day of the study, and in 22% of cases there was no evidence of suspected or diagnosed infections. CONCLUSION: The prevalence study identified a high prevalence of infected patients in nursing homes in Italy, consistent with observation in other geographic areas.