William A. Rutala

University of North Carolina at Chapel Hill | UNC

Background We conducted a quantitative analysis of the microbial burden and prevalence of epidemiologically important pathogens (EIP) found on long-term care facilities (LTCF) environmental surfaces. Methods Microbiological samples were collected using Rodac plates (25cm2/plate) from resident rooms and common areas in five LTCFs. EIP were defined...

In healthcare settings, contaminated surfaces play an important role in the transmission of nosocomial pathogens potentially resulting in healthcare-associated infections (HAI). Pathogens can be transmitted directly from frequent hand-touch surfaces close to patients or indirectly by staff and visitors. HAI risk depends on exposure, extent of conta...

A novel wall-mounted far ultraviolet-C (UV-C) light technology providing automated delivery of far UV-C only when people are not present reduced methicillin-resistant Staphylococcus aureus in a patient room and equipment room. The safety feature that discontinues far UV-C output when people are detected was effective in preventing far UV-C exposure...

Background Current methods for reprocessing duodenoscopes, including double high-level disinfection, are not effective in eliminating bacterial contamination. Thus, there is a need to develop effective and safe sterilization technologies for duodenoscopes. Methods We examined the effectiveness of a new hydrogen peroxide gas plasma sterilizer desig...

Contaminated surfaces may be a source of transmission for the globally emerging pathogen, Candida auris . Because floors may be a source of C. auris contamination on hands, strategies for inactivating or removing C. auris from floors were investigated. A sporicidal disinfectant and UV-C were most effective in inactivating C. auris on floors.

We compared the effectiveness of 4 sampling methods to recover Staphylococcus aureus, Klebsiella pneumoniae and Clostridioides difficile from contaminated environmental surfaces: cotton swabs, RODAC culture plates, sponge sticks with manual agitation, and sponge sticks with a stomacher. Organism type was the most important factor in bacterial recov...

In a randomized trial, adjunctive ultraviolet-C light treatment with a room decontamination device and sodium hypochlorite delivered via an electrostatic sprayer were similarly effective in significantly reducing residual healthcare-associated pathogen contamination on floors and high-touch surfaces after manual cleaning and disinfection. Less time...

Individuals treated with dialysis are at high risk for healthcare-associated infections. We conducted a literature review of outbreaks associated with water in hemodialysis during years 2011-2021 to understand the role of water as a source of infections for patients receiving hemodialysis with a focus on the risks associated with dialysis water and...

Background We hypothesized that sampling tools with the largest surface area would be the most efficient at recovering bacteria. To test this hypothesis, we evaluated four different sampling methods to see which was most effective at recovering bacteria from common environmental surfaces. Methods At UNC Medical Center, a 951 bed academic facility,...

The surface environment in COVID-19 patient’s rooms may be persistently contaminated despite disinfection. A continuously active disinfectant demonstrated excellent sustained antiviral activity following a 48-hour period of wear and abrasion exposures with reinoculations. Reductions of >4-log 10 were achieved within a 1-minute contact time for SARS...

Respiratory viruses can be transmitted by fomite contact, but no data currently exist on the transfer of enveloped viruses. The transfer efficiency of human coronavirus from various hard surfaces ranged from 0.46% to 49.0%. This information can be used to model the fomite transmission of enveloped viruses.

This chapter focuses on zoonoses that are defined as diseases and infections that are transmitted between vertebrate animals and humans. It analyzes how zoonotic diseases can be transmitted to humans through bites and scratches, direct contact, aerosols, arthropod vectors, or contamination of food or water. It also outlines reasons for the increase...

All invasive procedures involve contact by a medical device or surgical instrument with a patient's sterile tissue or mucous membranes. The level of disinfection is dependent on the intended use of the object: critical, semicritical, or noncritical. New issues and practices can affect the risk of infection associated with devices and surfaces. Endo...

Background Background: Contaminated hospital room environmental surfaces and noncritical medical devices are a potential source of transmission of healthcare pathogens including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Technologies that provide continuous decontamination between episodes of manual cleaning and disinfection coul...

We evaluated the ability of an ultraviolet-C (UV-C) room decontamination device to kill Candida auris and C. albicans . With an organic challenge (fetal calf serum), the UV-C device demonstrated the following log 10 reductions for C. auris of 4.57 and for C. albicans of 5.26 with direct line of sight, and log 10 reductions for C. auris of 2.41 and...

We evaluated the robustness of sterilization technologies when spores and bacteria were placed on “dirty” instruments and overlaid with blood. The results illustrate that steam sterilization is the most effective sterilization technology with the largest margin of safety, followed by ethylene oxide and hydrogen peroxide gas plasma.

Objectives: Shedding of Clostridioides difficile spores from infected individuals contaminates the hospital environment and contributes to infection transmission. We assessed whether antibiotic selection impacts C. difficile shedding and contamination of the hospital environment. Methods: In this prospective, unblinded, randomized controlled tri...

We report 2 episodes of potential SARS-CoV-2 transmission from infected van drivers to passengers despite masking and physical distancing. Whole genome sequencing confirmed relatedness of driver and passenger SARS-CoV-2. With the heater operating, fluorescent microspheres were transported by airflow >3 meters from the front to the back of the van.

We examined microbial burden on hospital room environmental sites after standard (Quaternary ammonium [Quat]) or enhanced disinfection (Quat/ultraviolet light [UV-C], Bleach, or Bleach/UV-C). An enhanced terminal room disinfection reduced microbial burden of epidemiologically-important pathogens on high-touch surfaces in patient rooms, especially s...

Background The relative contribution of Clostridioides difficile colonization or infection in contamination of the hospital environment is poorly understood. Methods We performed a prospective cohort study of patients with diarrhea who were tested for C. difficile infection via PCR and enzyme immunoassay (EIA) to compare C. difficile environmental...

We investigated the microbial burden on the operating room environment when patients on contact precautions for a multidrug-resistant pathogen received surgery. Our study demonstrated that the perioperative environment was contaminated with aerobic bacteria and methicillin-resistant Staphylococcus aureus (MRSA) after surgery, and that MRSA persiste...

Background: Most medical and surgical devices used in healthcare facilities are made of materials that are sterilized by heat (ie, heat stable), primarily steam sterilization. Low-temperature sterilization methods developed for heat and moisture sensitive devices include ethylene oxide gas (ETO), hydrogen peroxide gas plasma (HPGP), vaporized hydro...

Background: Well-designed infection prevention programs include basic elements aimed at reducing the risk of transmission of infectious agents in healthcare settings. Although most acute-care facilities have robust infection prevention programs, data are sporadic and often lacking in other healthcare settings. Infection control assessment tools wer...

Background: The contaminated healthcare environment, including operating rooms (ORs), can serve as an important role in transmission of healthcare-associated pathogens. Studies are very limited regarding the level of contamination of ORs during the surgery of a patient on contact precautions and the risk to the next surgery patient after standard r...

Background: Surgical instruments that enter sterile tissue should be sterile because microbial contamination could result in disease transmission. Despite careful surgical instrument reprocessing, surgeons and other healthcare personnel (HCP) describe cases in which surgical instruments have been contaminated with organic material (eg, blood). Alth...

Background: Clostridioides difficile is a major cause of antibiotic-associated colitis and the most common healthcare-associated pathogen in the United States. Interrupting the known transmission mechanisms of C. difficile in hospitals requires appropriate hand hygiene, disinfection of potentially contaminated surfaces, and patient equipment. Howev...

Background: Candida auris is an emerging fungal pathogen that is often resistant to major classes of antifungal drugs. It is considered a serious global health threat because it has caused severe infections with frequent mortality in over a dozen countries. C. auris can survive on healthcare environmental surfaces for at least 7 days, and it causes...

The healthcare environment serves as one of the possible routes of transmission of epidemiologically important pathogens, but the role of the contaminated environment on SARS-CoV-2 transmission remains unclear. We reviewed survival, contamination, and transmission of SARS-CoV-2 via environmental surfaces and shared medical devices as well as enviro...

Objective Our primary objective was to determine the effectiveness of two enhanced disinfection strategies compared to standard disinfection: “near-UV” light (Arm 1) and a persistent organosilane quaternary ammonium disinfectant (Arm 2) using a triple-blind study design. Our secondary objective was to characterize environmental contamination of out...

Objective Our primary objective was to determine the effectiveness of two enhanced disinfection strategies compared to standard disinfection: “near-UV” light (Arm 1) and a persistent organosilane quaternary ammonium disinfectant (Arm 2) using a triple-blind study design. Our secondary objective was to characterize environmental contamination of out...

Background Acinetobacter is an important opportunistic pathogen causing healthcare-associated infections and outbreaks in burn patients. The healthcare environment can be persistently contaminated despite routine room cleaning/disinfection and recontaminated via healthcare personnel and patients. The aim of this study was to investigate the microbi...

Reply to Randal W. Eveland regarding comparative evaluation of the microbicidal activity of low-temperature sterilization technologies to steam sterilization - William A. Rutala, Maria F. Gergen, Emily E. Sickbert-Bennett, David J. Weber

Reply to Eric Schlote regarding “Evaluation of dilute hydrogen peroxide technology for continuous room decontamination of multidrug-resistant organisms” - William A. Rutala, Hajime Kanamori, Maria F. Gergen, Emily E. Sickbert-Bennett, Deverick J. Anderson, Daniel J. Sexton, David J. Weber, for the CDC Prevention Epicenters Program

Objective To compare the microbicidal activity of low-temperature sterilization technologies (vaporized hydrogen peroxide [VHP], ethylene oxide [ETO], and hydrogen peroxide gas plasma [HPGP]) to steam sterilization in the presence of salt and serum to simulate inadequate precleaning. Methods Test carriers were inoculated with Pseudomonas aeruginos...

Clonal Mycobacterium mucogenicum isolates (determined by molecular typing) were recovered from 19 bronchoscopic specimens from 15 patients. None of these patients had evidence of mycobacterial infection. Laboratory culture materials and bronchoscopes were negative for Mycobacteria . This pseudo-outbreak was caused by contaminated ice used to provid...

Background Clostridioides difficile is a leading cause of healthcare-associated infection. Despite multimodal prevention efforts, in-hospital transmission continues to occur. In this study, we tested whether the choice of treatment can reduce C. difficile shedding and contamination of the inpatient environment. Methods We conducted a prospective,...

Background Environmental contamination in outpatient clinics is poorly understood. Methods We performed a microbiological analysis of surfaces in wound and pulmonary outpatient clinics at a tertiary care center. Cultures were obtained with pre-moistened cellulose sponges from three locations (Exam bed/chair, patient chair, physician area/chair) be...

Evaluation of dilute hydrogen peroxide technology for continuous room decontamination of multidrug-resistant organisms - William A. Rutala, Hajime Kanamori, Maria F. Gergen, Emily E. Sickbert-Bennett, Deverick J. Anderson, Daniel J. Sexton, David J. Weber, for the CDC Prevention Epicenters Program

A novel disinfectant studied using an EPA protocol demonstrated sustained antimicrobial activity (ie, 3-5 log10 reduction) in 5 minutes after 24 hours for Staphylococcus aureus, vancomycin-resistant Enterococcus, Candida auris, carbapenem-resistant Escherichia coli and antibiotic-susceptible E. coli, and Enterobacter spp. Only ∼2 log10 reduction oc...

Over the past decade, there is excellent evidence in the scientific literature that contaminated environmental surfaces and noncritical patient care items play an important role in the transmission of several key health care-associated pathogens including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Acinetobacter,...

Semicritical medical devices are defined as items that come into contact with mucous membranes or nonintact skin (eg, gastrointestinal endoscopes, endocavitary probes). Such medical devices require minimally high-level disinfection. As many of these items are temperature sensitive, low-temperature chemical methods must be used rather than steam ste...

The contaminated surface environment in the rooms of hospitalized patients is an important risk factor for the colonization and infection of patients with multidrug-resistant pathogens. Improved terminal cleaning and disinfection have been demonstrated to reduce the incidence of health care–associated infections. In the United States, hospitals gen...

Millions of gastrointestinal endoscopes are performed each year in the United States. Gastrointestinal endoscopes become highly contaminated during use (ie, internal channels contain 7-10-log10 enteric microorganisms). Currently, endoscopes (eg, bronchoscopes and gastrointestinal endoscopes) are classified as semicritical items because they contact...

All invasive procedures involve contact by a medical device or surgical instrument with a patient's sterile tissue or mucous membranes. The level of disinfection or sterilization is dependent on the intended use of the object. Critical (items that contact sterile tissue, such as surgical instruments), semicritical (items that contact mucous membran...

Despite the widespread use of disinfectants and antiseptics in hospitals, acquired resistance to current disinfectants has rarely been reported. Germicides, as with medications, should only be used when their benefit as demonstrated by scientific studies exceeds possible risks to human health or the environment.

Candida auris is an emerging fungal pathogen that is often resistant to major classes of antifungal drugs. It is considered a serious global health threat because it can cause severe infections with frequent mortality in more than a dozen countries. It can survive on healthcare environmental surfaces for at least 7 days and can cause outbreaks in h...

Background The healthcare environment serves as a reservoir or a source for outbreaks. Single outbreaks via an environmental reservoir have often been described in healthcare settings, while the trend of these multiple outbreaks has not been understood well. Here, we investigated the epidemiologic features of outbreaks associated with the healthcar...

Background Hospital room environmental surfaces can be contaminated with healthcare-associated pathogens even if terminal room cleaning/disinfection is implemented. We examined the microbiological burden on hospital room environmental sites after standard or enhanced terminal room disinfection. Methods Microbial data from the Benefits of Enhanced...

Background Environmental contamination plays an important role in the transmission of MRSA, VRE, and C. difficile. Suboptimal compliance with hand hygiene or inappropriate glove use can result in indirect transfer of these pathogens to patients. This study evaluates a novel disinfectant that claims to kill microbes on surfaces for ≥24 hours. Metho...

Background There is a lack of data on environmental surface contamination in long-term care facilities (LTCF), despite multiple reports of outbreaks of multi-drug-resistant organisms in these settings. Therefore, we conducted a quantitative analysis of the microbial burden and prevalence of epidemiologically important pathogens (EIP) found on LTCF...

Objective Hospital environmental surfaces are frequently contaminated by microorganisms. However, the causal mechanism of bacterial contamination of the environment as a source of transmission is still debated. This prospective study was performed to characterize the nature of multidrug-resistant organism (MDRO) transmission between the environment...

We evaluated the ability of high-intensity visible violet light with a peak output of 405 nm to kill epidemiologically important pathogens. The high irradiant light significantly reduced both vegetative bacteria and spores at some time points over a 72-hour exposure period.

Healthcare facility-onset Clostridium difficile infections (HO-CDI) are an important national problem, causing increased morbidity and mortality, with longer and more costly hospital stays. HO-CDI is an important metric for the Center for Medicare and Medicaid Service's (CMS) performance measures. Hospitals that fall into the worst-performing quart...

In this prospective study, we monitored 4 epidemiologically important pathogens (EIPs): methicillin-resistane Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Clostridium difficile, and multidrug-resistant (MDR) Acinetobacter to assess the effectiveness of 3 enhanced disinfection strategies for terminal room disinfection agains...

We measured the disinfection of MRSA and Clostridium difficile spores using an ultraviolet C (UV-C) device, and we correlated those results to measurements and computer simulations of UV-C surface intensity. The results demonstrate both large differences in UV light intensity across various surfaces and how this leads to significant differences in...

Susceptibility to germicides for carbapenem/colistin-resistant Enterobacteriaceae is poorly described. We investigated the efficacy of multiple germicides against these emerging antibiotic-resistant pathogens using the disc-based quantitative carrier test method that can produce results more similar to those encountered in healthcare settings than...

Background: The hospital environment is a source of pathogen transmission. The effect of enhanced disinfection strategies on the hospital-wide incidence of infection has not been investigated in a multicentre, randomised controlled trial. We aimed to assess the effectiveness of four disinfection strategies on hospital-wide incidence of multidrug-r...

Cambridge Core - Infectious Disease - Practical Healthcare Epidemiology - edited by Ebbing Lautenbach

Surface Disinfection: Treatment Time (Wipes and Sprays) Versus Contact Time (Liquids) - Volume 39 Issue 3 - William A. Rutala, David J. Weber

Background: Single outbreaks have often been reported in health care settings, but the frequency of outbreaks at a hospital over time has not been described. We examined epidemiologic features of all health care-associated outbreak investigations at an academic hospital during a 5-year period. Methods: Health care-associated outbreak investigati...

OBJECTIVE To summarize and discuss logistic and administrative challenges we encountered during the Benefits of Enhanced Terminal Room (BETR) Disinfection Study and lessons learned that are pertinent to future utilization of ultraviolet (UV) disinfection devices in other hospitals DESIGN Multicenter cluster randomized trial SETTING AND PARTICIPAN...

Self-monitoring by Environmental Services May Not Accurately Measure Thoroughness of Hospital Room Cleaning - Lauren P. Knelson, Gemila K. Ramadanovic, Luke F. Chen, Rebekah W. Moehring, Sarah S. Lewis, William A. Rutala, David J. Weber, Daniel J. Sexton, Deverick J. Anderson, The CDC Prevention EpiCenters Program

Background Escherichia coli sequence type 131 (ST131), associated with CTX-M-15-type extended-spectrum β-lactamases (ESBLs), predominates globally among multidrug-resistant (MDR) E. coli. Among MDR E. coli ST131 isolates from North Carolina and other US regions, we explored genetic associations of the H30Rx and H30R1 subclones with IncF-type plasmi...

Background Candida auris is an emerging fungal pathogen that is often resistant to major classes of antifungal drugs and can survive on healthcare environmental surfaces, and is now a serious global health threat. It remains unclear whether C. Auris is also resistant to germicides (e.g., disinfectants, antiseptics). In this study, we investigated g...

Background Continuous disinfection of the hospital surface environment may be ideal for infection prevention since the environmental surfaces are repeatedly contaminated with healthcare-associated pathogens. We used light-emitting diode (LED) disinfection technology to investigate its germicidal activity as continuous room decontamination against m...

Background Contaminated environmental surfaces are involved in the transmission of epidemiologically important pathogens. It remains unknown which level of microbial load can contribute to healthcare-associated infections (HAI). We used microbiological data obtained from the Benefits of Enhanced Terminal Room (BETR) Disinfection Study to investigat...

Background Carbapenem-resistant Enterobacteriaceae (CRE), conferring broad resistance to most β-lactam antibiotics, are involved in healthcare-associated outbreaks via medical equipment and environmental surfaces. Colistin-resistant Enterobacteriaceae carrying the mcr-1 are currently a global health concern since colistin is often a last-line antib...

Background Healthcare room environmental surfaces can be frequently and continuously contaminated with multidrug-resistant organisms (MDROs) that can persist in the environment for a prolonged time. Here, we used a dilute hydrogen peroxide (DHP) gas system for continuous room decontamination and experimentally examined the germicidal efficacy of th...

Background Single outbreaks due to a specific pathogen(s) and a reservoir have often been reported in healthcare settings, but the frequency of multiple outbreaks at an academic hospital over time and the value of routine molecular typing have not been analyzed. Here, we examined epidemiologic features of healthcare-associated outbreak investigatio...

OBJECTIVE To determine whether antimicrobial-impregnated textiles decrease the acquisition of pathogens by healthcare provider (HCP) clothing. DESIGN We completed a 3-arm randomized controlled trial to test the efficacy of 2 types of antimicrobial-impregnated clothing compared to standard HCP clothing. Cultures were obtained from each nurse partic...

Escherichia coli sequence type 131 (ST131) predominates globally among multidrug-resistant (MDR) E. coli . We used whole-genome sequencing (WGS) to investigate 63 MDR E. coli isolates from 7 North Carolina community hospitals (2010-2015). Of these, 39 (62%) represented ST131, including 37 (95%) from the ST131- H 30R subclone: 10 (27%) from its H 30...

Can Copper-Coated Surfaces Prevent Healthcare-Associated Infections? - Volume 38 Issue 7 - David J. Weber, Jonathan A. Otter, William A. Rutala

Several genera of Gram-positive bacilli are capable of causing a varietyhuman infection including Bacillus, Listeria, Erysipelothrix, Lactobacillus, Corynebacterium, Gardnerella, Actinomyces, and Nocardia. Several genera of Gram-positive bacilli are capable of causing a variety of human infections including Bacillus, Listeria, Erysipelothrix, Lacto...

Patient-care items can serve as a source or reservoir for healthcare associated pathogens in hospitals. We reviewed healthcare-associated outbreaks from medical equipment and provided infection prevention recommendations. Multiple healthcare-associated outbreaks via a contaminated patient-care item were identified, including infections with multidr...

Ventilator-associated pneumonia (VAP) is a frequent complication of severe burn injury. Comparing the current ventilator-associated event-possible VAP definition to the pre-2013 VAP definition, we identified considerably fewer VAP cases in our burn ICU. The new definition does not capture many VAP cases that would have been reported using the pre-2...