I thought hand hygiene was the most important factor in cross-transmission. Is hospital mattress disinfection really that crucial?
Absolutely. While hand hygiene remains the most important factor in germ transmission, it is impossible to maintain clean hands if the environment is not adequately disinfected. Weber et al. reported that 20-40% of HAI’s have been attributed to cross infection via the hands of care staff,34 highlighting the importance of hand hygiene. However, hands become contaminated not only from direct contact with the patient, but also by touching contaminated environmental surfaces. In fact, Guerrero et al. showed that gloved hands pick up C. diff from commonly touched environmental surfaces just as easily as they do from commonly examined skin sites.35 As research shows, mattresses very often remain contaminated even after terminal cleaning.1-5 Since mattresses are the 2nd most touched surface by caregivers in the ICU and 4th most touched on med-surg units,36 it’s easy to see how hands can become contaminated when caring for the patient. Therefore, transmission to the patient via the hands of hospital staff can occur even when following the WHO’s recommendations on hand hygiene if the mattress is not adequately disinfected.37 In addition to this dilemma, transmission could also occur directly from the mattress to the patient if the mattress remains contaminated from previous patients. Because patients have intimate contact with the mattress throughout their entire stay, it is critical that we provide them with a clean and safe mattress surface to prevent germ transmission.
References
1. de Andrade D, Angerami ELS, Padovani CR. A bacteriological study of hospital beds before and after disinfection with phenolic disinfectant. Rev Panam Salud Publica. 2000;7(3):179-184. doi:10.1590/s1020-49892000000300007
2. Fernando FSL, Ferreira AM, Colombo TE, Rubio FG, Almeida, MTG. Fungal contamination of hospital mattresses before and following cleaning and disinfection. Acta Paul Enferm. 2013;26(5):485-491.
3. Hu H, Johani K, Gosbell IB, et al. Intensive care unit environmental surfaces are contaminated by multidrug-resistant bacteria in biofilms: combined results of conventional culture, pyrosequencing, scanning electron microscopy, and confocal laser microscopy. J Hosp Infect. 2015;91(1):35–44. doi:10.1016/j.jhin.2015.05.016
4. Viana RH, dos Santos SG, Oliveira AC. Recovery of resistant bacteria from mattresses of patients under contact precautions. Am J Infect Control. 2016;44(4):465-469. doi:10.1016/j.ajic.2015.10.027
5. Vickery K, Deva A, Jacombs A, Allan J, Valente P, Gosbell IB. Presence of biofilm containing viable multiresistant organisms despite terminal cleaning on clinical surfaces in an intensive care unit. J Hosp Infect. 2012;80(1), 52-55. doi:10.1016/j.jhin.2011.07.007
34. Weber DJ, Rutala WA, Miller MB, Huslage K, Sickbert-Bennett E. Role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species. Am J Infect Control. 2010;38(5):S25-S33. doi:10.1016/j.ajic.2010.04.196
35. Guerrero DM, Nerandzic MM, Jury LA, Jinno S, Chang S, Donskey CJ. Acquisition of spores on gloved hands after contact with the skin of patients with Clostridium difficile infection and with environmental surfaces in their rooms. Am J Infect Control. 2012;40(6):556-558. doi:10.1016/j.ajic.2011.08.002
36. Huslage K, Rutala WA, Sickbert-Bennett E, Weber DJ. A quantitative approach to defining “high-touch” surfaces in hospitals. Infect Control Hosp Epidemiol. 2010;31(8):850-853. doi:10.1086/655016 37. Hand Hygiene: Why, How and When? World Health Organization.https://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf. Revised August 2009. Accessed February 16, 2021.