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Hospital floors a greater source of infection than previously thought
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The floors of patient rooms in hospitals are often contaminated with health-care associated pathogens, suggesting that hospital floors may pose a larger threat of infection than previously thought, according to a survey published in the American Journal of Infection Control.
“Efforts to improve disinfection usually focus on surfaces that are frequently touched (eg, bed rails and call buttons),” Abhishek Deshpande, MD, PhD, of the Medicine Institute Center for Value Based Care, Cleveland Clinic, Cleveland, Ohio, and colleagues wrote. “Although health care facility floors are often heavily contaminated, limited attention has been paid to disinfection of floors because they are not frequently touched.”
The researchers conducted a survey of five Cleveland-area hospitals. Each hospital’s disinfectant routine consisted of having personnel clean high-touch surfaces in C. difficile infection (CDI) isolation rooms with bleach wipes. Hospital floors were cleaned with an ammonia-based solution after patient discharge, and were only cleaned upon admission if the floor was “visibly soiled.” Deshpande and colleagues took cultures from 1-foot-square areas from the patient floor adjacent to the bed and the adjoining bathroom floor, sampling a total of 318 sites in 159 rooms.
Contamination with C. difficile, vancomycin-resistant enterococci (VRE) and MRSA was common, Deshpande and colleagues reported. MRSA and VRE were more common in CDI isolation rooms than in non-CDI rooms (P < .05). C. difficile was identified equally in both CDI and non-CDI rooms (P = .6). The frequency of contamination was similar across all collection sites, the researchers wrote.
Rooms that had been cultured after post-discharge cleaning (n = 50) were less contaminated with MRSA and VRE than those cultured during the patient’s stay (n = 109) (13% vs. 35%; P < .001). These rooms were not significantly less contaminated with C. difficile, however (44% vs. 53%; P = .2).
“We found that floors in patient rooms were frequently contaminated with health care-associated pathogens and demonstrated the potential for indirect transfer of pathogens to hands from fomites placed on the floor,” the researchers wrote. “Further studies are needed to investigate the potential for contaminated hospital floors to contribute to pathogen transmission.” – by Andy Polhamus
Disclosure: Deshpande reports research grants from 3M, Clorox and Steris. Please see the full study for a complete list of all other researchers’ relevant financial disclosures.
Perspective
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The study by Dr. Deshpande and colleagues underscores the risk of transmission of pathogens from hospital floors. The researchers conducted the study in five hospitals in the Cleveland area. They found that floors in patient rooms were frequently contaminated with MRSA, VRE and Clostridium difficile. In addition, it was not unusual for high-touch objects such as medical devices, personal items and linens to be in direct contact with the floor. Furthermore, the researchers identified that touching objects that had been in contact with the floor often resulted in transfer of the pathogens to the hands.
These findings are extremely important from an infection prevention perspective. Because hospital floors have not been considered a “high-touch” surface, they have received little attention. As the authors point out, they may be an underappreciated reservoir for transmission of pathogens. It is essential that health care workers and patients receive education and training on the importance of keeping patient care items and linens off the floor. It is also important that we critically examine potential risks. For example, because many patient beds are placed in the lowermost position for patient safety, patient care items, linens, and devices such as urinary catheter bags may touch the floor. The authors identified that contamination with Clostridium difficile spores occurred in both isolation and nonisolation rooms. However, because sporicidal products are not routinely used on floors, it may be time to critically evaluate both our products and processes for floor cleaning. Finally, the authors note that one limitation of the study was that it was limited to three pathogens. With the proliferation of many significant gram-negative pathogens such as CRE, further studies are needed.
Clearly the role of the environment in transmission of microorganisms is becoming increasingly important. We may be at a critical juncture where we need to reassess our cleaning and low-level disinfection practices to understand gaps and minimize the risk of transmission of health care-associated pathogens to patients.
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