Journal of Korean Biological Nursing Science

Korean society of Biological Nursing Science (한국기초간호학회)
권호 표지
DOI QR코드

DOI QR Code

Evaluation of Environmental Contamination and Disinfection Effects in Patient Rooms with Carbapenem-Resistant Enterobacteriaceae Using ATP Measurements and Microbial Cultures

ATP 측정과 미생물 배양검사를 이용한 카바페넴내성장내세균 보유환자 병실 환경 오염 및 환경 소독 효과 평가

  • Kim, Ji Eun (Department of Clinical Nursing, Graduate School of Industry, University of Ulsan) ;
  • Jeong, Jae Sim (Department of Clinical Nursing, Graduate School of Industry, University of Ulsan) ;
  • Kim, Mi Na (Department of Diagnostic Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Park, Eun Suk (Department of Infection Control, Severance Hospital Yonsei University College of Medicine)
  • 김지은 (울산대학교 산업대학원 임상전문간호학) ;
  • 정재심 (울산대학교 산업대학원 임상전문간호학) ;
  • 김미나 (울산대학교 의과대학 서울아산병원 진단검사의학과) ;
  • 박은숙 (세브란스병원 감염관리실)
  • Received : 2021.10.14
  • Accepted : 2021.11.26
  • Published : 2021.11.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: To determine the extent of environmental contamination and the effect of disinfection around patients with carbapenem-resistant Enterobacteriaceae (CRE) using adenosine triphosphate (ATP) measurements and microbial culture tests. Methods: The subjects of this study were 10 patients hospitalized in a single room due to CRE from April 13 to 21, 2021. One hundred and sixty samples were collected using cotton swabs from the patients' environment including the surface and drain of sinks and toilet seats before and after disinfection of the room after discharge. Twenty-one samples were collected from the nurses' personal digital assistants (PDAs), keyboards, and computer mice before disinfection. The relative light units (RLUs) and CRE colony-forming units (CFU) of 181 samples were measured using ATP test equipment and chrome agar plates, respectively. Results: The highest RLUs were measured at the sink drains before and after disinfection. Four CRE samples from the sink drains (2), sink surface (1), and toilet bowl (1) before disinfection were cultured. Based on the failure criteria (≥ 250 RLU/cm2 and ≥ 1 CFU/100 cm2), 90 % and 50 % of the samples from the drain exceeded the failure criteria before and after disinfection, respectively. In the culture tests, CRE was not detected after disinfection. Conclusion: According to the RLU and CFU measurements of drain samples, disinfection was not effective. Thus, improvements in the disinfection methods of drains, as well as more efficient and systematic environmental decontamination and disinfection evaluation tools, are needed to accurately evaluate the effectiveness of disinfection in various places.

Keywords

References

  1. Falagas ME, Tansarli GS, Karageorgopoulos DE, Vardakas KZ. Deaths attributable to carbapenem-resistant Enterobacteriaceae infections. Emerging Infectious Diseases. 2014;20(7):1170. https://doi.org/10.3201/eid2007.121004
  2. Go EB, Ju SJ, Hwang KJ, Park SD. Distributions of carbapenem-resistant Enterobacteriaceae (CRE) in Korea, 2019. Public Health Weekely Report. 2020;13(47):3348-3355.
  3. Go EB, Ju SJ, Hwang KJ, Park SD. Distributions of carbapenem-resistant Enterobacteriaceae (CRE) in Korea, 2018. Public Health Weekely Report. 2019;12 (45):1977-1983.
  4. Havill NL, Boyce JM, Otter JA. Extended survival of carbapenem-resistant Enterobacteriaceae on dry surfaces. Infection Control & Hospital Epidemiology. 2014;35(4):445-447. https://doi.org/10.1086/675606
  5. Kizny Gordon AE, Mathers AJ, Cheong EY, Gottlieb T, Kotay S, Walker AS, et al. The hospital water environment as a reservoir for carbapenem-resistant organisms causing hospital-acquired infections-a systematic review of the literature. Clinical Infectious Diseases. 2017;64(10):1435-1444. https://doi.org/10.1093/cid/cix132
  6. Lerner A, Adler A, Abu-Hanna J, Meitus I, Navon-Venezia S, Carmeli Y. Environmental contamination by carbapenem-resistant Enterobacteriaceae. Journal of Clinical Microbiology. 2013;51(1):177-181. https://doi.org/10.1128/jcm.01992-12
  7. Carling PC, Bartley JM. Evaluating hygienic cleaning in health care settings: what you do not know can harm your patients. American Journal of Infection Control. 2010;38(5):41-50. https://doi.org/10.1016/j.ajic.2010.03.004
  8. Huang SS, Datta R, Platt R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Archives of Internal Medicine. 2006;166(18):1945-1951. https://doi.org/10.1001/archinte.166.18.1945
  9. Centers for Disease Control and Prevention. Surface sampling procedures for Bacillus anthracis spores from smooth, non-porous surfaces [Internet]. Atlanta: NIOSH Workplace Safety and Health Topic; 2012, January 30 [cited 2021 November 24]. Available from: https://www.cdc.gov/niosh/topics/emres/surfacesampling-bacillus-anthracis.html
  10. Ellis O, Godwin H, David M, Morse DJ, Humphries R, Uslan DZ. How to better monitor and clean irregular surfaces in operating rooms: insights gained by using both ATP luminescence and RODAC assays. American Journal of Infection Control. 2018;46(8):906-912. https://doi.org/10.1016/j.ajic.2018.03.024
  11. Messina G, Ceriale E, Nante N, Manzi P. Effectiveness of ATP bioluminescence to assess hospital cleaning: a review. Journal of Preventive Medicine and Hygiene. 2017;58(2):177. https://doi.org/10.1093/eurpub/cku163.030
  12. Sanna T, Dallolio L, Raggi A, Mazzetti M, Lorusso G, Zanni A, et al. ATP bioluminescence assay for evaluating cleaning practices in operating theatres: applicability and limitations. BMC infectious diseases. 2018;18(1):538. https://doi.org/10.1186/s12879-018-3505-y
  13. Otter JA, Vickery K, Walker JT, Pulcini ED, Stoodley P, Goldenberg SD, et al. Surface-attached cells, biofilms and biocide susceptibility: implications for hospital cleaning and disinfection. Journal of Hospital Infection. 2015;89(1):16-27. https://doi.org/10.1016/j.jhin.2014.09.008
  14. Tang L, Tadros M, Matukas L, Taggart L, Muller M. Sink and drain monitoring and decontamination protocol for carbapenemase-producing Enterobacteriaceae (CPE). American Journal of Infection Control. 2020;48(8):17. https://doi.org/10.1016/j.ajic.2020.06.132
  15. Aranega-Bou P, George RP, Verlander NQ, Paton S, Bennett A, Moore G, et al. Carbapenem-resistant Enterobacteriaceae dispersal from sinks is linked to drain position and drainage rates in a laboratory model system. Journal of Hospital Infection. 2019;102(1):63-69. https://doi.org/10.1016/j.jhin.2018.12.007
  16. Pantel A, Richaud-Morel B, Cazaban M, Bouziges N, Sotto A, Lavigne JP. Environmental persistence of OXA-48-producing Klebsiella pneumoniae in a French intensive care unit. American Journal of Infection Control. 2016;44(3):366-368. https://doi.org/10.1016/j.ajic.2015.09.021
  17. Smith P, Beam E, Sayles H, Rupp M, Cavalieri R, Gibbs S, et al. Impact of adenosine triphosphate detection and feedback on hospital room cleaning. Infection Control & Hospital Epidemiology. 2014;35(5):564-569. https://doi.org/10.1086/675839
  18. Ho YH, Wang LS, Jiang HL, Chang CH, Hsieh CJ, Chang DC, et al. Use of a sampling area-adjusted adenosine triphosphate bioluminescence assay based on digital image quantification to assess the cleanliness of hospital surfaces. International Journal of Environmental Research and Public Health. 2016;13(6):576. https://doi.org/10.3390/ijerph13060576
  19. Salsgiver E, Bernstein D, Simon MS, Greendyke W, Jia H, Robertson A, et al. Comparing the bioburden measured by adenosine triphosphate (ATP) luminescence technology to contact plate-based microbiologic sampling to assess the cleanliness of the patient care environment. Infection Control & Hospital Epidemiology. 2018;39(5):622-624. https://doi.org/10.1017/ice.2018.39