PICU terminal cleaning fails to decontaminate air ducts, floors
Research presented at the annual conference of the Association for Professionals in Infection Control and Epidemiology, or APIC, suggests that although terminal cleaning can effectively reduce the presence of pathogens in the pediatric ICU that could cause health care-acquired infections like MRSA and enteric bacteria, certain surfaces remain contaminated — namely, air ducts and floors.
In their study, David Levine, PT, PhD, DPT, FAPTA, a professor at the University of Tennessee at Chattanooga, and colleagues first identified the 10 most contaminated surfaces in the PICU: bed rails, the floor by the sink, stethoscopes, return air ducts, the bath basin, computer keyboard and mouse, cell phones, Pyxis touch screen, equipment handles and the bedside table.
The researchers swabbed these sites before and 48 hours after terminal cleaning to determine the presence of common pathogens like MRSA, Pseudomonas species and enteric bacteria.
S taphylococcus aureus was the most commonly detected bacteria in the PICU before terminal cleaning, with 47% of swabs for that bacteria testing positive. MRSA was identified in 23% of swabs, enteric bacteria in 20% and nonspecific bacteria in 43%.
The researchers observed a 23% decrease in the presence of S. aureus 48 hours after cleaning, and no MRSA was detected. Decreases were also observed among enteric bacteria (10%) and nonspecific bacteria (37%). No Pseudomonas species were detected before or after terminal cleaning in the PICU.
After terminal cleaning, the floors near the sink and the return air ducts were the most contaminated areas (P < .05), according to the researchers.
Levine told Infectious Diseases in Children that air ducts are a common source of contamination, and he was not surprised by the findings.
“Environmental services technicians do not routinely clean air ducts, and with varying degrees of built-up dust in the vents, there is no reason for background contamination to vary,” he said. “It is also not on the CDC checklist to do during a terminal clean. Better filtration continues to be developed and will help.”
Study researcher Henry G. Spratt, PhD, a professor in biology, geology and environmental science at the University of Tennessee at Chattanooga, also told Infectious Diseases in Children that the research team has been collecting data on the decontamination of floors for more than a year in the PICU, and for nearly 6 months in a hematology/oncology unit. He said this information could help determine whether cleaning protocols should be changed, and if an ultraviolet C device that treats people’s shoes as they enter the room can help to improve the cleanliness of floors. – by Katherine Bortz
Levine D, et al. Effectiveness of a cleaning protocol on environmental contamination in a pediatric intensive care unit (ASR-2). Presented at: APIC 2019; June 12-14, 2019; Philadelphia.
Disclosures: Levine and Spratt report no relevant financial disclosures.