Soft-Surface Contamination

What’s wrong with this picture: a nurse enters a hospital room, does a thorough handwashing, pulls back the privacy curtains and attends to a patient?

The hard-to-spot flaw in this scenario is that the nurse’s conscientious efforts at hand hygiene are compromised by one simple, everyday act – touching the privacy curtains after washing her hands.

According to a growing body of published, peer-reviewed evidence, those curtains may often harbor infectious microorganisms, such as MRSA and vancomycin-resistant Enterococcus (VRE) – and these opportunistic bacterial strains can hitch a ride on the hands of nurses.
This unwitting transfer of pathogens could potentially increase the incidence of HAIs (healthcare-associated infections),which currently afflict approximately one out of every 20 hospitalized patients and can lead to dire consequences. HAIs cause 100,000 deaths annually in the U.S. – more than deaths due to car crashes and HIV/AIDs combined.

The speed with which soft surfaces in the hospital environment can become contaminated was revealed in a recently reported study at the University of Iowa Hospitals in Iowa City. The results of the study were sobering: within 1 week of being laundered, 92 percent of hospital privacy curtains studied were contaminated.2

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Nursing’s Dirty Laundry

In one study, more than 60 percent of nurses’ scrubs had MRSA on them.

Those results echo findings from an earlier study conducted at the Cleveland VA Medical Center, which showed that 42 percent of hospital privacy curtains studied were contaminated with VRE; 22 percent with MRSA and 4 percent with Clostridium difficile.

Meanwhile, a report from researchers at the Hospital of Saint Raphael in New Haven, CT, confirmed that, when healthcare workers touch contaminated environmental surfaces, they are likely to transmit pathogens to patients.3

Results from a just released study presented at the 2011 annual meeting of the Infectious Disease Society of America have made an explicit link between a reduction in bioburden on hospital surfaces and reduced infection rates.4

Research Implications

While further research is needed, there are a number of implications for nurses and hospitals nationally.

  • Since privacy curtains are one of the most commonly touched soft surfaces in the patient environment, nurses need to heighten their awareness about the possible pathogens hiding in these fabrics, and many healthcare workers may have to change long-ingrained habits.
  • As the University of Iowa Hospital study suggests, nurses should wash their hands after touching privacy curtains and before touching patients. Such a protocol can be time-consuming, however, at a time when hospital administrators and managers are already grappling with scheduling and staffing constraints. 

  • While healthcare facilities have long focused on disinfecting hard surfaces, such as bed rails, over-bed tables and door knobs, and sterilizing medical devices (catheters for example), they will face increasing pressures to address the condition of the entire patient environment. That means hospitals may need to expand their multi-layered attack on HAIs to fighting contamination on soft surfaces such as bedding and scrubs, as well as privacy curtains and other materials. 

  • The rapid rate at which soft surfaces can become contaminated in a hospital setting poses a challenge to conventional approaches to managing privacy curtains, including schedules for laundering and/or replacement. Some hospitals clean their curtains every few months, while others may only do so when they are obviously soiled; but all healthcare facilities will need to re-examine their approach to cleaning and maintaining these textiles. 

Strategic Considerations

When it comes to reducing bioburden in the patient environment, there is, unfortunately, no “silver bullet.” Microbial contamination is endemic in the hospital setting, in spite of the Herculean efforts made by both clinicians and environmental services staff over the past several years.

Consider the challenge: whether colonized or infected, many patients bring pathogens with them when they enter the hospital. The environment can be further compromised by visitors, delivery people, service technicians and even clinicians who may carry unwelcome microbial guests with them as they move through the hospital.

In such a scenario, the robust and consistent application of proper hand hygiene is top priority. That said, healthcare workers and hospital management should also consider every available tool and approach to reducing bioburden on soft surfaces. The options are many, ranging from the use of hydrogen peroxide mists to intense exposure to ultraviolet light to fabrics and textiles that incorporate one or more antimicrobial elements.

All have their positive qualities as well as their limitations. With budgets tight, how should institutions evaluate their options? Here are some questions nursing directors and administrators should ask themselves and potential vendors about their solutions:

  • Is there clinical evidence that the solution reduces bioburden specifically on soft surfaces? 

  • Are there any harmful side effects or unintended consequences associated with the solution? 

  • What are the incremental costs of implementing the solution? 

  • Does the solution require additional staff training or education? 

  • What impact does the approach have on bed or room availability? Does it increase “down time” between patients? 

Every institution will need to determine which approach, or group of approaches, is right for their particular situation. The above questions, however, may provide a useful analytical framework for those decisions.

As with most subjects in healthcare, more published, peer-reviewed clinical data is needed on the transmission of pathogens from soft surfaces to patients in hospitals. While that research is under way, healthcare workers involved in patient care must continue their multi-pronged attack on HAIs by making the patient environment as clean and healthy as possible.

References for this article can be accessed here.

Bill O’Neill is vice president of infection control applications for PurThread Technologies Inc., Princeton, NJ.

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