PREAMBLE
Active8 is a detergent with activity against bacteria, virus
and fungi. Specifically, it has killing effect against MRSA, Clostridium
difficile, and Norovirus, which makes it well suited
for decontamination of hospital environment. The HPA have assessed
the range of Active8 and have concluded that
• “[Active8] is an unusual product in that it is
a product containing a cocktail of cleaning and disinfecting
agents in a combination that has not been previously described”.
• “The combination of active agents includes alcohols,
surfactant/wetting agents, halogens [iodofor] and quaternary
ammonium compounds in an effective combination that provides
a multilayered attack on bacteria, fungi and viruses within
a low toxicological profile that is rare in an effective cleaning
product.”
A recent Department of Health guideline regarding Clostridium
difficile recommends the use of a chlorinated detergent in order
to be efficient. Iodine belongs to the same group of halogens.
It is less toxic and is less likely to damage the surfaces through
corrosion.
The objective of this study was to assess whether Active8 can
decontaminate clinical environment for multiresistant bacteria
and specifically MRSA without causing physical damages of the
inanimate surfaces.
METHODS
The study has a quasi-experimental design with microbiological
screening of patients and environment for multi-resistant bacteria
before the introduction of Active8 and again one month after.
The introduction of Active8 was a straight replacement of the
currently used cleaning detergent without any other changes in
the cleaning programme.
The multiresistant bacteria recorded were MRSA, VRE, ESBL, Carbapenem
resistant Acinetobacter and Clostridium difficile.
In total, 130 and 120 samples respectively were collected and
processed for the five bacteria mentioned.
The ward has 15 beds and the "PRE" – screening
included 14 patients whilst the "POST"-screening included
11 patients. Patients were screened from Nose, throat and groins,
and the inanimate sites are given in the table 1 (page 6).
RESULTS
Methicillin Resistant Staphylococcus aureus
- MRSA
• The pre-screening showed one patient colonised with MRSA.
Four environmental sites were contaminated with MRSA, however,
they were not linked to the positive patient.
• The screening after introduction of Active8 showed only
two bed sites and the sitting room with MRSA. They were linked
to two patients repeatedly positive for MRSA within the last month.
Another patient was carrier of MRSA, but the immediate environment
was not contaminated with MRSA (figures on pages 4 and 5).
Extended Spectrum Beta-Lactamase producers - ESBL
• Initially no patients or sites had enterobacteriaceae
( coliforms ) resistant to 3rd generation cephalosporins (ESBL).
The post screening revealed four sites with ESBL, but no patients
were carrier of ESBL.
Vancomycin Resistant Enterococci (VRE)
• Initially two patients and five sites were positive which
was reduced to no patients and three sites positive for VRE.
Acinetobacter baumanii resistant to carbapenems
& Clostridium difficile
• None were isolated
• No damage to inanimate surfaces were seen.
DISCUSSION
Before the introduction of Active8 MRSA were found sporadically
spread out in the ward without any links to patients carrying
MRSA. After cleaning with Active8 this was changed and only the
environment immediate around an MRSA positive patient were contaminated.
Many patients are carrier of or infected by MRSA on admission.
It is therefore to be expected that such patients will for a short
time contaminate the immediate adjacent environment until the
patients themselves have been decontaminated. The two patients
in bed B1 and B2 were both heavily contaminated and MRSA has repeatedly
been isolated during the preceding month. The occurrence of VRE
were also reduced, however, some unexplained new contamination
with ESBL was seen.
IN CONCLUSION, Active8 is effective in reducing the prevalence
of MRSA and VRE without harming the physical environment.
TABLE 1
| |
MRSA |
ESBL |
VRE |
| AREA |
Pre |
Post |
Pre |
Post |
Pre |
Post |
| Bed Frame |
1 |
1 |
0 |
1 |
1 |
0 |
| Floor around the bed |
1 |
2 |
0 |
0 |
1 |
1 |
| Locker |
0 |
0 |
0 |
1 |
1 |
0 |
| Light above the bed |
0 |
1 |
0 |
1 |
3 |
1 |
| Ledge of the rear of the
bed |
0 |
0 |
0 |
4 |
2 |
0 |
| TV line, patient |
1 |
0 |
0 |
0 |
2 |
0 |
| Curtains |
0 |
2 |
0 |
0 |
0 |
2 |
| |
MRSA |
ESBL |
VRE |
| AREA |
Pre |
Post |
Pre |
Post |
Pre |
Post |
| Nurses station |
0 |
0 |
0 |
0 |
0 |
0 |
| Medication trolley |
0 |
0 |
0 |
0 |
0 |
0 |
| Murses computer keyboard |
1 |
0 |
0 |
0 |
0 |
0 |
| Equipment room |
0 |
0 |
0 |
0 |
0 |
1 |
| Clean utility |
0 |
0 |
0 |
0 |
0 |
0 |
| Sluice |
0 |
0 |
0 |
0 |
0 |
0 |
| Mop |
0 |
0 |
0 |
0 |
0 |
0 |
| Bucket |
0 |
0 |
0 |
0 |
0 |
0 |
| Dressing trolley |
0 |
0 |
0 |
0 |
0 |
0 |
| Resus trolley |
0 |
0 |
0 |
0 |
0 |
0 |
| Patient sitting area |
0 |
1 |
0 |
0 |
1 |
0 |
| Medication room |
0 |
0 |
0 |
0 |
0 |
0 |
| Patient - pool |
1 |
3 |
0 |
0 |
2 |
0 |
The isolation of MRSA, ESBL and VRE from patients and surfaces
of equipment and inanimate objects
|
