Investigation On The Present Situation Of Object Surface Disinfection With High Hand-contact Frequency In ICU And Interventions

Objective:Investigate the present situation of object surface disinfection work with high hand-contact frequency in ICU to understand the persistence of Acinetobacter Bauma and other micro-organisms so as to identify those object surfaces with higher risks of pollution. A series of plausible measures are also to be designed to promote the effectiveness of disinfection work, and reduce the risks of nosocomial infections. Methods:Basing upon the analysis that the major factors leading to high failure rate of disinfection work on object surface with high-hand contact include: incomplete organizational institutions, insufficient training for cleaning staffs, lack of disinfection related knowledge and unfamiliarity with disinfection procedures among cleaning staffs, insufficient length of disinfection work, use of expired quatermary ammonium salt, and poor awareness among medical staffs about the importance of hand hygiene, a series of interventional measures were adopted. These interventions include the implementation of the Management Scheme of Hospital Disinfection Work, the periodical training for cleaning staffs, the promotion of disinfection awareness and skills, the adoption of a multi-dimensional approach towards disinfection work monitoring, and the adjustment of disinfectant. specimens were collected from 145 object surfaces with high hand-contact frequency in ICU at four time points—pre-intervention, intra-intervention, post-intervention and reinforcing. Specimens were collected from 11 types of object surfaces including door handles, bed rails, bed ends, treatment wheels, ECG monitors, infusion pumps, injection pumps, stethoscopes, ventilators, telephones, and computers. Results: nosocomial infection related bacteria were identified in 14 pre-intervention specimens(MRSA in 3 specimens, Acinetobacter Bauma in 2, Escherichia coli in 1, Pseudomonas aeruginosa in 1, klebsiella pneumonia in 1 and yeast like fungi in 6 specimens), representing a positive ratio about 9.3%. Meanwhile, nosocomial infection related bacteria were only identified in 4 intra-intervention specimens(MRSA in 1 specimen, and yeast like fungi in 3 specimens), representing a positive ratio about 3.2%. Such a differences is statistically significant(P=0.042). Acinetobacter Bauma were detected from one specimen from door handles of doctor's office and one specimen from treatment wheels respectively. Both were pan drug resistant Acinetobacters. According to GB 15982-2012, ICU belongs to category-II environment, disinfection work can only be taken as effective when detected bacteria count is 5.0cfu/cm~2 or below. Pre-intervention success rate was found to be 47.4%(65/137), 77.8%(109/140) for the intra-intervention period, 90.4% for the post-intervention period(122/135), and 93.7%(133/142) for the reinforcing period. Such differences were statistically significant(P=0.000). Additionally, nosocomial infection rate also dropped from 6.71% before the intervention to 2.94% after the intervention. The difference was also statistically significant(P<0/05).Conclusion: This research found out important factors leading to the low success rate of disinfection work on object surface with high hand-contact frequency in ICU. Intervention measures were proposed and found effective in increasing the success rate of disinfection work, and reducing the incidence of nosocomial infection. Therefore, this research together with the proposed interventions could provide important insights for the control and management of nosocomial infection.