C Difficile Could be Transmitted Through "Non-Critical Items"


These non-critical items are often used on multiple patients, and a lack of knowledge about proper cleaning and disinfection could contribute to the spread of C difficile.


Emily Bowe

Pathogens such as C difficile could be transmitted through non-critical items, which means that proper disinfection of these tools are crucial, according to a recent report. These non-critical items are those that come into contact with intact skin only and are handled by healthcare facility personnel, often being used on multiple patients.

Investigators from the Virginia Commonwealth University Health System evaluated the limitations of knowledge about the disinfection of noncritical items in the intensive care unit (ICU) and non-ICU staff members. Using an 18-question anonymous survey that employed a scale as well as multiple choice questions, the investigators collected 146 responses between January and June of 2017. About half came from ICU staff (in respiratory and surgical wards) and half came from non-ICU staff members (in cardiology and acute care oncology units). Most of the survey participants were nurses (n = 111), though certified nurse aides (n = 12) and environmental services staff (n = 1) also participated. There were 22 responders who didn’t identify their expertise.

The study authors determined that non-ICU staff members seemed significantly more knowledgeable about which personnel was responsible for disinfecting the non-critical items as well as where to access information on how to store the disinfected non-critical items. Only 6% of responders could correctly identify a non-critical item, the authors wrote.

Nearly all participants agreed that equipment should be disinfected between uses with different patients (99%) and that same group also agreed that the equipment should be disinfected before being stored in a clean utility room. The investigators also found that 96% of providers thought high-touch surfaces should be cleaned at least once daily; 4% did not agree.

Nearly half of the surveyed workers did not know how to determine shelf life for disinfectants, and 12% did not know how to use different disinfectants to clean hospital equipment, the authors wrote. A quarter of the responders didn’t know the difference between cleaning, sterilizing, disinfecting, and decontaminating.

“Several surprising observations included the general low understanding of effective cleaning and a significantly lower reported knowledge about where to access information regarding personnel responsible for cleaning certain non-critical items on the ICU units surveyed,” study author Emily Bowe, Virginia Commonwealth University Health System, Richmond, VA, told MD Magazine®. “The implications of our findings suggest a lack of educational material about non-critical items classification and barriers to the access of information regarding non-critical item disinfection responsibilities, specifically in ICUs.”

Some of the barriers to disinfection included lack of space, lack of time, and lack of supplies, according to 41%, 54%, and 20% of those surveyed, respectively.

“These findings could change the way physicians treat their patients by implementing more informative and available education material regarding the classification and personnel responsible for cleaning non-critical items,” Bowe continued. “Additionally, physicians should be more conscious of hand hygiene after direct contact with non-critical items and high contact surfaces even with indirect patient contact, as small numbers of pathogens can be acquired on health care provider’s hands after contact.”

The paper, “Disinfection of noncritical equipment on units with high hospital-onset Clostridium difficile infections” was published in the American Journal of Infection Control.

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