Patients, staff and visitors who are incubating or are infected with influenza (contagious period ranges from 1 day before symptom onset to 5-7 days after being sick1) can introduce the virus into healthcare settings.
The influenza virus can survive on non-porous surfaces for 24-48 hrs
1. Salgado CD, Farr BM, Hall KK, Hayden FG. (2002). Influenza in the acute hospital setting. The Lancet Infectious Diseases (2), pp145-55.
Disease
Influenza illness is characterized by the following signs and symptoms:
Fever
Headache
Myalgia
Cough
Sore throat
Runny nose.
Prevention
Preventing the transmission of influenza in the hospital environment requires the prompt detection and isolation of patients with new respiratory symptoms.
Staff and visitors that are sick should stay home so they do not expose vulnerable persons in the hospital.
Vaccinating patients and staff is a good way to prevent sickness and/or reduce severity of illness.
1. Bridges CB, Kuehnert MJ, Hall CB. (2003). Transmission of Influenza: Implications for control in health care settings. Clinical Infectious Diseases. (37), pp1094-1101.
Effective Cleaning
Routine cleaning and disinfection of surfaces in the hospital environment is important for reducing the risk of influenza transmission. Strong adherence to hospital and/or manufacturers protocols for cleaning is advised. All potential hospital-approved disinfectants should be verified for influenza virus kill claims.
Products containing the following chemicals can kill influenza1:
Patients who carry MRSA, or have an infection with the bacteria, serve as hospital reservoirs. When a healthcare provider has cared for a patient with MRSA but does not effectively clean their hands afterwards, then there is risk for MRSA transmission.
Similarly, when equipment comes into contact with MRSA positive patients and is not effectively cleaned afterwards, then there is risk for MRSA transmission.
Survival in Hospital Environment
MRSA can survive on a variety of hospital surfaces for various amounts of time. MRSA has been found on hospital curtains, over-bed tables, bed-railings, patient charts, and healthcare provider uniforms, to name a few.
Studies of MRSA survival rates on fabrics indicate that MRSA can survive anywhere from 4-21 days on cotton and 2-14 days on terrycloth, depending on the size of inoculum. Survival rate on polyester was anywhere from 1-40 days.
1. Chen KH, Chen LR, Wang YK. (2014). Contamination of medical charts: An important source of potential infection in hospitals. PLoS One, 18;9(2):e78512
2. Hardy KJ, Oppenheim BA, Gossain S, Gao F, Hawkey PM. (2006). A study of the relationship between environmental contamination with Methicillin-Resistant Staphylococcus aureus (MRSA) and patient’s acquisition of MRSA. Infection Control and Hospital Epidemiology, 27(2), pp127-32.
3. Neely AN, Maley MP. (2000). Survival of Enterococci and Staphylococci on hospital fabrics and plastic. Journal of Clinical Microbiology, (38)(2), pp724-6.
Disease
People who have MRSA but display no signs or symptoms are said to be colonized. Colonization is a risk factor for clinical infection.
Clinical infections with MRSA can be serious, and in some cases result in death.
Routine cleaning and disinfection of surfaces in the hospital environment is critical to reducing the risk of MRSA transmission.
Strong adherence to hospital and/or manufacturers protocols for cleaning is advised. All potential hospital-approved disinfectants should be verified for MRSA kill claims.
Patients who carry VRE, or have an infection with the bacteria, serve as hospital reservoirs. When equipment and spaces are not effectively cleaned following contact with a VRE positive patient, then there is risk for VRE transmission. Similarly, when a healthcare provider has cared for a patient with VRE but does not effectively clean their hands afterwards, then there is risk for VRE transmission.
Survival in Hospital Environment
VRE can survive for long periods of time on a variety of hospital surfaces. VRE has been found on medical equipment, bed rails and door knobs.
Studies of VRE survival rates on fabrics indicate that VRE can survive for days to months on cotton (E. faecalis = 18-22 days, E. faecium = 62-90 days), depending on the size of inoculum. VRE survival rates on polyester ranged from 73-80 days for E. faecalis, and 80-90 days for E. faecium.
1. Arias CA, Murray BE. (2012). The rise of Enterococcus: beyond vancomycin resistance. Nature, v10, pp266-78.
2. Neely AN, Maley MP. (2000). Survival of Enterococci and Staphylococci on hospital fabrics and plastic. Journal of Clinical Microbiology, (38)(2), pp724-6.
Disease
People who have VRE but display no signs or symptoms are said to be colonized.
Colonization can contribute to the risk of developing a clinical infection.
Clinical infections with VRE can be serious, and in some cases result in death.
Routine cleaning and disinfection of surfaces in the hospital environment is critical to reducing the risk of VRE transmission.
Strong adherence to hospital and/or manufacturers protocols for cleaning is advised. All potential hospital-approved disinfectants should be verified for VRE kill claims.
Tuberculosis is acquired through Airborne transmission from patients who have pulmonary Tuberculosis (TB).
Hospital Reservoirs
Patients admitted to hospital who are unrecognized for having pulmonary TB are the most significant contributors to transmission in healthcare settings.
Tuberculosis is contagious through airborne transmission, and therefore must be inhaled to cause disease. The bacteria are propelled into the air by talking, breathing, coughing, and through other aerosol-generating procedures performed in healthcare settings (e.g. intubation, sputum induction, etc.). TB can remain suspended in indoor air for long periods of time, but engineering controls effectively remove this bacteria from healthcare settings; Airborne Infection Isolation Rooms (AIIRs) employ negative pressure to direct air, and all infectious particles contained within it, out of the facility.
Disease
Common symptoms of pulmonary TB include, but are not limited, to the following1:
Preventing the transmission of TB in the hospital environment requires the prompt detection and isolation of patients who are suspected or confirmed for pulmonary TB. Hospitals must also ensure that their Airborne Infection Isolation Rooms (AIIRs) are meeting the minimum required negative pressure.
Effective Cleaning
EPA-registered tuberculocidal disinfectant will kill TB.
C.difficile bacteria can be acquired through direct contact
with a person who has C.difficile, or indirect contact
with contaminated surfaces.
Hospital Reservoirs
Patients who carry C.difficile or have a C.difficile infection, serve as hospital reservoirs1. Hospital equipment and contaminated surfaces can become reservoirs when they are not cleaned effectively. When equipment comes into contact with C.difficile positive patients and is not effectively cleaned afterwards, then there is risk for C.difficile transmission
When a healthcare provider has cared for a patient with C.difficile but does not effectively clean their hands afterwards, then there is risk for C.difficile transmission.
C.difficile is difficult to eradicate from healthcare environments because it can survive in its vegetative state, called a spore, for up to 5 months on hard surfaces1. C.difficile easily contaminates the immediate patient environment, and even the greater medical ward. The bacteria has been detected on a variety of surfaces including, but not limited to, over-bed tables, bulletin boards, patient televisions/screens, nursing stations, computer keyboards, and in kitchenettes/nutrition stations2.
1. Association for Professionals in Infection Control & Epidemiology. (2013). Guide to prevention Clostridium difficile infections. Pp 50-66. Retrieved from: www.apic.org.
2. Faires MC, Pearl DL, Berke O, Reid-Smith RJ, Weese JS. (2013). BMC Infectious Diseases, (13)342.
Disease
Some people are colonized with C.difficile, but only after exposure to healthcare interventions, like receiving antibiotics, do they develop an infection1. A C.difficile infection can range in symptoms that include the following:
Abdominal pain/ distension
Diarrhea
Nausea
Fever
Dehydration
Loss of appetite
Severe cases can result in a condition called toxic megacolon, and can lead to death.
1. Lin HJ, Hung YP, Liu HC, Lee JC, Lee CI, Wu YH, Tsai PJ, Ko WC. (2015). Risk factors for Clostridium difficile-associated diarrhea among hospitalized adults with fecal toxigenic C.difficile colonization. Journal of Microbiology, Immunology and Infection, (48), pp 183-9.
Prevention
Preventing the transmission of C.difficile in the hospital environment includes good hand hygiene
practices, the use of additional precautions (e.g. isolation, personal protective equipment
) and enhanced cleaning with agents proven effective against C.difficile spores. As always, routine practices
, or standard precautions
apply.
Effective Cleaning
Routine cleaning and disinfection of surfaces in the hospital environment is critical to reducing the risk of C.difficile transmission. Targeted cleaning with agents proven effective against C.difficile spores should be directed towards spaces where patients with known or suspected C.difficile infection (CDI) currently occupy or have previously occupied. Likewise, equipment that has come into contact with a patient who has or is suspected of CDI should be cleaned with an agent proven effective against C.difficile spores.
ESBLs and CPEs are a variety of bacteria that have acquired antibiotic resistance mechanisms. The bacteria are spread through direct contact
with a person who has an ESBL or CPE, or indirect contact
with contaminated surfaces.
Hospital Reservoirs
Patients who carry an ESBL or CPE, or have an infection with the bacteria, can serve as hospital reservoirs. The hospital environment, however, has also been found to play a role in the transmission of ESBL-equipped bacteria. Contaminated sinks and drains have both been implicated with outbreaks in Intensive Care Units (ICUs).
As with other antibiotic-resistant organisms (AROs), hands and equipment can become contaminated with ESBL and CPE bacteria and serve as vehicles for transmission if they are not effectively sanitized.
1. Roux D, Aubier B, Cochard H, Quentin R, van der Mee-Marquet N. (2013). Contaminated sinks in intensive care units: an underestimated source of extended-spectrum beta-lactamase-producing Enterobacteriaceae in the patient environment. Journal of Hospital Infection Control (85), pp106-11.
2. Lowe C, Willey B, O’Shaughnessy A, Lee W, Lum M, Pike K, Larocque C, Dedier H, Dales L, Moore C, McGeer A. (2012). Outbreak of Extended-Specrum -Lactamase-producing Klebsiella oxytoca Infection Associated with Contaminated Handwashing Sinks. Emerging Infectious Diseases (18)8, pp1242-7.
Survival in Hospital Environment
Survival in the hospital environment is variable for ESBLs and CPE and is highly dependent on the type of bacteria that has acquired the resistance. The genetic elements that make it possible for antibiotic resistance are, in many cases, at the expense of fitness to the organism, which means that they do not survive as well as antibiotic sensitive strains.
1. Andersson DI, Hughes D. (2010). Antibiotic resistance and its cost: is it possible to reverse resistant? Nature (8), pp260-71.
Disease
People who have an ESBL or CPE but display no signs or symptoms are said to be colonized.
Colonization can contribute to the risk of developing a clinical infection.
Clinical infections with ESBLs and CPE can be serious, and in some cases result in death.
ESBLs and CPE cause the same infections that other bacteria can cause and include, but are not limited to, urinary tract infections, skin/soft tissue infections, pneumonia, blood stream infections, and sepsis.
Routine cleaning and disinfection of surfaces with hospital-approved disinfectant is critical to reducing the risk of ESBL and CPE transmission. Strong adherence to hospital and/or manufacturers protocols for cleaning is advised.
Content created by Claudia Crussell-Balogh, CIC, MHSc.
×Droplet Transmission: Transmission that occurs as result of large, respiratory droplets containing infectious agents that come into contact with mucous membranes (e.g. eyes, nose, mouth/throat membranes) of a susceptible host. Droplets can be expelled during coughing, sneezing, laughing and some types of medical procedures (e.g. suctioning), but, as result of their size, typically only travel up to two meters before falling to the ground. Droplets have the potential to land on medical equipment and environmental surfaces, which creates risk for Indirect Contact transmission. Influenza is an example of an infection that spreads through Droplet and Contact transmission.
×Direct Contact: A type of Contact transmission where there is a human-to-human pathway. For example, contact with a person who has scabies can result in direct transmission.
×Indirect Contact: A type of Contact transmission where an inanimate object, or fomite, is contaminated and serves as a vehicle for distribution of the pathogen. For example, a vitals monitor that is used on a patient with MRSA and is not cleaned properly afterwards can become contaminated and result in the indirect transmission of MRSA.
×Additional Precautions: A set of precautions applied to patients who are suspected or confirmed for a pathogen for which those additional precautions effectively reduce the risk of transmission to the healthcare provider and/or other patients. Common additional precautions include Contact Precautions, Droplet-Contact Precautions and Airborne Precautions. Each additional precaution has its own set of practices to be followed.
×Routine Practices / Standard Precautions: A set of practices that should be employed by all healthcare providers in all healthcare settings with all patients, regardless of their condition. These precautions include good Hand Hygiene, the appropriate use of Personal Protective Equipment (PPE), effective cleaning of the patient care environment and equipment, safe handling of linen, waste and sharps (e.g. needles), and the appropriate assignment of patients to accommodations (e.g. private room if they have high potential to contaminate the environment).
×Routine Practices / Standard Precautions: A set of practices that should be employed by all healthcare providers in all healthcare settings with all patients, regardless of their condition. These precautions include good Hand Hygiene, the appropriate use of Personal Protective Equipment (PPE), effective cleaning of the patient care environment and equipment, safe handling of linen, waste and sharps (e.g. needles), and the appropriate assignment of patients to accommodations (e.g. private room if they have high potential to contaminate the environment).
×Hand Hygiene: Practices involving the cleaning and sanitizing of hands prior to and following patient care activities.
×Direct Contact: A type of Contact transmission where there is a human-to-human pathway. For example, contact with a person who has scabies can result in direct transmission.
×Indirect Contact: A type of Contact transmission where an inanimate object, or fomite, is contaminated and serves as a vehicle for distribution of the pathogen. For example, a vitals monitor that is used on a patient with MRSA and is not cleaned properly afterwards can become contaminated and result in the indirect transmission of MRSA.
×Colonization: The acquisition of a pathogen, but no related signs or symptoms as result.
×Hand Hygiene: Practices involving the cleaning and sanitizing of hands prior to and following patient care activities.
×Personal Protective Equipment (PPE): Includes gowns, gloves, masks, and any other wearable equipment that protects individuals from exposure to pathogens, blood, or body fluids.
×Additional Precautions: A set of precautions applied to patients who are suspected or confirmed for a pathogen for which those additional precautions effectively reduce the risk of transmission to the healthcare provider and/or other patients. Common additional precautions include Contact Precautions, Droplet-Contact Precautions and Airborne Precautions. Each additional precaution has its own set of practices to be followed.
×Routine Practices / Standard Precautions: A set of practices that should be employed by all healthcare providers in all healthcare settings with all patients, regardless of their condition. These precautions include good Hand Hygiene, the appropriate use of Personal Protective Equipment (PPE), effective cleaning of the patient care environment and equipment, safe handling of linen, waste and sharps (e.g. needles), and the appropriate assignment of patients to accommodations (e.g. private room if they have high potential to contaminate the environment).
×Routine Practices / Standard Precautions: A set of practices that should be employed by all healthcare providers in all healthcare settings with all patients, regardless of their condition. These precautions include good Hand Hygiene, the appropriate use of Personal Protective Equipment (PPE), effective cleaning of the patient care environment and equipment, safe handling of linen, waste and sharps (e.g. needles), and the appropriate assignment of patients to accommodations (e.g. private room if they have high potential to contaminate the environment).
×Direct Contact: A type of Contact transmission where there is a human-to-human pathway. For example, contact with a person who has scabies can result in direct transmission.
×Indirect Contact: A type of Contact transmission where an inanimate object, or fomite, is contaminated and serves as a vehicle for distribution of the pathogen. For example, a vitals monitor that is used on a patient with MRSA and is not cleaned properly afterwards can become contaminated and result in the indirect transmission of MRSA.
×Colonization: The acquisition of a pathogen, but no related signs or symptoms as result.
×Hand Hygiene: Practices involving the cleaning and sanitizing of hands prior to and following patient care activities.
×Personal Protective Equipment (PPE): Includes gowns, gloves, masks, and any other wearable equipment that protects individuals from exposure to pathogens, blood, or body fluids.
×Additional Precautions: A set of precautions applied to patients who are suspected or confirmed for a pathogen for which those additional precautions effectively reduce the risk of transmission to the healthcare provider and/or other patients. Common additional precautions include Contact Precautions, Droplet-Contact Precautions and Airborne Precautions. Each additional precaution has its own set of practices to be followed.
×Routine Practices / Standard Precautions: A set of practices that should be employed by all healthcare providers in all healthcare settings with all patients, regardless of their condition. These precautions include good Hand Hygiene, the appropriate use of Personal Protective Equipment (PPE), effective cleaning of the patient care environment and equipment, safe handling of linen, waste and sharps (e.g. needles), and the appropriate assignment of patients to accommodations (e.g. private room if they have high potential to contaminate the environment).
×Routine Practices / Standard Precautions: A set of practices that should be employed by all healthcare providers in all healthcare settings with all patients, regardless of their condition. These precautions include good Hand Hygiene, the appropriate use of Personal Protective Equipment (PPE), effective cleaning of the patient care environment and equipment, safe handling of linen, waste and sharps (e.g. needles), and the appropriate assignment of patients to accommodations (e.g. private room if they have high potential to contaminate the environment).
×Airborne Transmission: Transmission that occurs as result of tiny, respiratory droplet nuclei particles (1-5 microns in diameter), which enter a susceptible host through inhalation. Droplet nuclei can be expelled during all activities that pass air out of the nose/mouth (e.g. talking, laughing, coughing, etc.) as well as during aerosol-generating medical procedures (e.g. intubation, suctioning, sputum induction, etc.). Once in the air, particles can remain suspended for long periods of time. Tuberculosis is an example of an infection that spreads through Airborne transmission.
×Direct Contact: A type of Contact transmission where there is a human-to-human pathway. For example, contact with a person who has scabies can result in direct transmission.
×Indirect Contact: A type of Contact transmission where an inanimate object, or fomite, is contaminated and serves as a vehicle for distribution of the pathogen. For example, a vitals monitor that is used on a patient with MRSA and is not cleaned properly afterwards can become contaminated and result in the indirect transmission of MRSA.
×Hand Hygiene: Practices involving the cleaning and sanitizing of hands prior to and following patient care activities.
×Personal Protective Equipment (PPE): Includes gowns, gloves, masks, and any other wearable equipment that protects individuals from exposure to pathogens, blood, or body fluids.
×Routine Practices / Standard Precautions: A set of practices that should be employed by all healthcare providers in all healthcare settings with all patients, regardless of their condition. These precautions include good Hand Hygiene, the appropriate use of Personal Protective Equipment (PPE), effective cleaning of the patient care environment and equipment, safe handling of linen, waste and sharps (e.g. needles), and the appropriate assignment of patients to accommodations (e.g. private room if they have high potential to contaminate the environment).
×Routine Practices / Standard Precautions: A set of practices that should be employed by all healthcare providers in all healthcare settings with all patients, regardless of their condition. These precautions include good Hand Hygiene, the appropriate use of Personal Protective Equipment (PPE), effective cleaning of the patient care environment and equipment, safe handling of linen, waste and sharps (e.g. needles), and the appropriate assignment of patients to accommodations (e.g. private room if they have high potential to contaminate the environment).
×Direct Contact: A type of Contact transmission where there is a human-to-human pathway. For example, contact with a person who has scabies can result in direct transmission.
×Indirect Contact: A type of Contact transmission where an inanimate object, or fomite, is contaminated and serves as a vehicle for distribution of the pathogen. For example, a vitals monitor that is used on a patient with MRSA and is not cleaned properly afterwards can become contaminated and result in the indirect transmission of MRSA.
×Colonization: The acquisition of a pathogen, but no related signs or symptoms as result.
×Hand Hygiene: Practices involving the cleaning and sanitizing of hands prior to and following patient care activities.
×Personal Protective Equipment (PPE): Includes gowns, gloves, masks, and any other wearable equipment that protects individuals from exposure to pathogens, blood, or body fluids.
×Additional Precautions: A set of precautions applied to patients who are suspected or confirmed for a pathogen for which those additional precautions effectively reduce the risk of transmission to the healthcare provider and/or other patients. Common additional precautions include Contact Precautions, Droplet-Contact Precautions and Airborne Precautions. Each additional precaution has its own set of practices to be followed.
×Routine Practices / Standard Precautions: A set of practices that should be employed by all healthcare providers in all healthcare settings with all patients, regardless of their condition. These precautions include good Hand Hygiene, the appropriate use of Personal Protective Equipment (PPE), effective cleaning of the patient care environment and equipment, safe handling of linen, waste and sharps (e.g. needles), and the appropriate assignment of patients to accommodations (e.g. private room if they have high potential to contaminate the environment).
×Routine Practices / Standard Precautions: A set of practices that should be employed by all healthcare providers in all healthcare settings with all patients, regardless of their condition. These precautions include good Hand Hygiene, the appropriate use of Personal Protective Equipment (PPE), effective cleaning of the patient care environment and equipment, safe handling of linen, waste and sharps (e.g. needles), and the appropriate assignment of patients to accommodations (e.g. private room if they have high potential to contaminate the environment).
