As I penned the title to this week's blog, the irony was
not lost on me as I live in a household of males: husband, son, cat and even
the fish. Being the chief kitty litter
and fish bowl cleaner I know what those to can do and for anyone who has children,
I'm sure I do not have to describe the mess an active 5 year old boy can make -
particularly since we've entered the LEGO phase of our lives. As for my husband, he's a lost cause....
Thinking that the male gender makes for a dirty
environment and finding the scientific evidence to support your theory are two
entirely different things altogether!
But Freeman et al spelt it out in black and white in their recently
published study titled "Predictors of hospital surface contamination with Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae: patient and organism factors".
The study as you've likely surmised is not about how dirty men make
their environment, but rather an investigation to determine if the rates of environmental
contamination are higher with ESBL K. pneumoniae (ESBL-KP) or ESBL E. coli
(ESBL-EC).
Before delving into the study, I do not want to assume
that everyone knows what ESBL or extended-spectrum β-lactamase organisms
are. In a nutshell, they are
gram-negative bacteria that produce an enzyme, beta-lactamase that can break
down commonly used antibiotics, such as penicillin and cephalosporins, making
infections with ESBL producing bacteria more difficult to treat. E.coli and Klebsiella pneumoniae are common
producers of ESBL, and they usually cause urinary tract infections (UTIs) and
bacteraemia.
Before trying to blame their associated ability to
contaminate the environment with the fact that these are antibiotic resistant
organisms (AROs) recall my blog Doors , Keys and Sledgehammers which discussed
the fact that antibiotic resistance does not equal chemical resistance. A bug is a bug in terms of disinfectant
efficacy...as long as the disinfectant is used correctly and contact times are
met - but we'll save that for another blog.
Nor should you think that your EVS department cannot play
a vital in stopping the spread of ESBLs or other AROs as the NIH facility in
Bethesda, MD proved that enhanced cleaning can stop an outbreak. Read the Fancy that - Implementing Tougher Cleaning Standards Halts Outbreak to learn more about that story.
The moral of the story, I mean study, as presented by
Freeman and his colleagues is that patients with ESBL-KP or ESBL-EC are more
likely to contaminate their hospital room with viable bacteria and they can do
so more effectively if colonized or infected with ESBL-KP as compared to
ESBL-EC. As the researcher stated, one
possible explanation for the fact that ESBL-KP made for a dirtier environment
could be due to the intrinsic biological differences between E. coli and K.
pneumoniae. In keeping with the title of
the blog, they found that there was an association between male gender and
environmental contamination that trended towards significance possible
reflecting gender-based differences in hygiene practices. As ESBL's are known to cause UTIs perhaps that
fact that many men do not clean their hands after using the facilities and we
all know women always wash their hands!
Nor did prior cleaning seem to have a significant effect
on contamination rates in part perhaps because cleaning was inadequate (and
contact time was not met) or due to the fact that recontamination occurred
rapidly post cleaning. In the end,
ESBL-KP environmental contamination seems to be higher than ESBL-EC which may
help to explain the corresponding differences in transmission rates between the
two organisms.
This bodes the question, should we consider increasing
the frequency of cleaning and disinfection to at least twice per day? The CDC recommends increasing cleaning and
disinfection to three times per day for Norovirus. Perhaps we need to consider this with all
organisms that have shown the ability to contaminate the environment and lead
to colonization or infection? You run
the numbers, which will save the facility more money? Increasing cleaning frequency (manpower and
chemical use) and decreasing HAI rates or maintaining status quo and paying for
HAIs which in recent figures I have seen cost a facility upwards of $19 Million
per year!
Bugging Off!
Nicole
