What I find so interesting about the field of infection
control and the prevention of infections is the fact that on almost a daily
basis you can have an "AH-HA" moment that has the potential to change
our current ways of practice.
Ferreting out the "culprit or culprits" that
could be a reservoir for potentially pathogenic organisms is very much like
playing Sherlock. Nothing is elementary; everything has the potential to be the
prime suspect. Our investigations need to move beyond the obvious, we need to
start looking outside of the box and consider that perhaps we have not
identified ALL of the high touch surfaces that have the potential to
contaminate hands.
I think it would be safe to say that most of us do not
give much thought to hospital privacy curtains except to perhaps think
"boy that is an ugly pattern or colour". I would even hedge a bet
that if you were to review your facility's infection prevention and control
policies you would find only a small statement (if anything at all) that
mentions that they should be changed when visibly soiled and/or after
completing a terminal clean of an Isolation Room.
I mean they're curtains for Pete’s sake! Why would we give them another thought? To
answer that question perhaps we should conduct a study that investigates how
many times privacy curtains are touched on a daily basis by healthcare workers
(HCWs), patients and visitors. Like studies that look at the number of cars
that pass through a particular intersection to determine traffic flow etc, I
think we would be blown away by the frequency this seemingly innocuous surface
is touched.
In a study recently published in AJIC, Ohl et al
investigated the persistence of bacterial contamination on privacy curtains
over a 3 week period. Of the 43 curtains
tested in the study, 95.5% showed contamination on at least 1 occasion and the
13 curtains that were changed during this time period showed that within a week
92.3% of the new curtains were found to be contaminated with pathogens
associated with HAIs.
AH-HA moment #1 - CURTAINS ARE CONTAMINATED!!!
Now that we know the curtains are contaminated, what
impact do they play with hand hygiene and how do we clean/disinfect them? Realistically,
HCWs are quite likely to touch the curtains after they have performed HH and
donned gloves but before performing patient care activities. Yes, HH was
completed, but have we now just unwittingly contaminated our hands by touching
the curtain?
AH-HA moment #2 - CURTAINS CAN LIKELY CONTAMINATE
HANDS!
Now, how on earth can we clean/disinfect them or put
procedures into place that can eliminate or reduce contamination? This is where
we need more science; however, there was a poster presented by Price et al at
the 2012 APIC conference that used H2O2 to clean the leading edge of the
curtain where contact was most likely and showed that yes, one can conceivably
implement a cleaning strategy that can help to reduce contamination. Using a 3%
H202 solution did significantly reduce the bio-burden load on the curtain
within 5 minutes and continued to show a decrease up to 2 hrs post application.
Another alternative could be the use of barriers. Similar to a dental operatory
where barrier covers are routinely used, we could consider applying a barrier
cover on the leading edge of the curtain that can be changed perhaps on a daily
basis to help reduce contamination.
AH-HA moment #3 - WE NEED TO IMPLEMENT A PROCESS TO
REDUCE CURTAIN CONTAMINATION
We still have a lot of sleuthing left to do my dear
Watson, but knowing that HCWs, patients and visitors frequently touch curtains
and knowing that touching contaminated surfaces can contaminate hands suggests
the potential for transmission of pathogenic organisms from curtains to hands
to patients. Perhaps we need to consider
that privacy curtains are a high touch surface that can be a significant source
of pathogenic contamination.
Bugging Off!
Nicole
