1150. Cleaning High Touch Surfaces of Patients’ Rooms: Make It Easier, and It Simply Gets Cleaner

Abstract

Background
The healthcare environment has been established as a reservoir for human pathogens and specifically multidrug-resistant organisms (MDRO). High touch surfaces and fomites in a patient’s room mediate transmission between infected and uninfected patients and personnel. Efforts to reduce hospital-associated infections due to MDROs often focus on room cleaning; however, adherence to and thoroughness of cleaning pose significant challenges.

Methods
A crossover trial was implemented in January 2016 (for 15 months) at Assaf Harofeh Medical Center (Israel) in four identical medical units. Single-use wipes (Clinell®; universal wipes and sporicidal wipes for rooms of patients with C. difficile), were compared with common practices which consisted of reusable cloths and bleach (1,000–5,000 ppm). Six-month cleaning and intervention periods were used on units in alternating sequences, separated by washout periods. Cleaning was monitored twice a week (bedrail, bedside table, clinical binder, call button, and lamp switch), by a fluorescent marker system (Clinell®). Comparisons used GEE with clustering for room. Staff were surveyed on intervention feasibility, acceptability, and satisfaction.

Results
Complete cleaning in all five test locations was found in 23% of 400 total assessments and was more common in the intervention group (34% vs. 12%; OR = 3.7; P < 0.001). Cleaning adherence was highest for the bed rail (71%) and lowest for the call button (38%). The use of wipes had the largest effect on adherence for the light switch (59% vs. 26%; OR = 4.2; P < 0.001). Intervention timing was not associated with overall adherence (P = 0.10). 94% of staff reported overall satisfaction of “very good” or “excellent,” and 90% of staff reported that use of the wipes shortened the cleaning process.

Conclusion
The use of cleaning wipes resulted in greater adherence to room cleaning and the method was reported to be acceptable to staff. Future aims of this large study (over 10,000 patients were enrolled and data collection not yet completed) are to determine the impact of this intervention on rates of hospital-acquired infections, MDRO acquisitions, and mortality.

Disclosures
E. T. Martin, Clinell: Grant Investigator, Research grant. D. Marchaim, Clinell: Grant Investigator, Grant recipient.

Full text

S346 • OFID 2018:5 (Suppl 1) • Poster Abstracts
95% CI, 0.14–0.99; P = 0.04.) However, acquisition rates of vancomycin-resistant
Enterococcus spp. and multidrug-resistant Acinetobacter baunmannii had not signi-
cantly decreased. e hazard of acquiring hospital acquired pneumonia during inter-
vention period compared with baseline period was 0.46 (95% CI, 0.23–0.94; P = 0.03).
ere were not signicant reduction in hospital acquired BSI, UTI, and CDAD, aer
photocatalyst antimicrobial coating.
Conclusion. MRSA acquisition rate and hospital acquired pneumonia were sig-
nicantly reduced aer photocatalyst antimicrobial coating. is study provides evi-
dence that photocatalyst antimicrobial disinfection can be an adjunctive measure to
control MRSA acquisition in high incidence setting.
Disclosures. All authors: No reported disclosures.
1150. Cleaning High Touch Surfaces of Patients’ Rooms: Make It Easier, and It
Simply Gets Cleaner
Emily T.Martin, MPH, PhD1; MorDadon, BS2,3; TsiliaLazarovitch, PhD2;
HodayaSaadon, BS2,3; TalMaya, BS2,3; KatieJae, BS3,4; SharonMoscovich, MD3,4;
RonitZaidenstein, MD2,3 and DrorMarchaim, MD2,3; 1Epidemiology, University of
Michigan School of Public Health, Ann Arbor, Michigan, 2Unit of Infection Control,
Assaf Harofeh Medical Center, Zerin, Israel, 3Sackler Faculty of Medicine, Tel-Aviv
University, Tel-Aviv, Israel, 4Assaf Harofeh Medical Center, Zerin, Israel
Session: 135. Healthcare Epidemiology: Environmental and Occupational Health
Friday, October 5, 2018: 12:30 PM
Background. e healthcare environment has been established as a reservoir
for human pathogens and specically multidrug-resistant organisms (MDRO). High
touch surfaces and fomites in a patient’s room mediate transmission between infected
and uninfected patients and personnel. Eorts to reduce hospital-associated infections
due to MDROs oen focus on room cleaning; however, adherence to and thoroughness
of cleaning pose signicant challenges.
Methods. Acrossover trial was implemented in January 2016 (for 15months) at
Assaf Harofeh Medical Center (Israel) in four identical medical units. Single-use wipes
(Clinell®; universal wipes and sporicidal wipes for rooms of patients with C.dicile),
were compared with common practices which consisted of reusable cloths and bleach
(1,000–5,000 ppm). Six-month cleaning and intervention periods were used on units
in alternating sequences, separated by washout periods. Cleaning was monitored twice
a week (bedrail, bedside table, clinical binder, call button, and lamp switch), by a uor-
escent marker system (Clinell®). Comparisons used GEE with clustering for room. Sta
were surveyed on intervention feasibility, acceptability, and satisfaction.
Results. Complete cleaning in all ve test locations was found in 23% of 400 total
assessments and was more common in the intervention group (34% vs. 12%; OR=3.7;
P < 0.001). Cleaning adherence was highest for the bed rail (71%) and lowest for the call
button (38%). e use of wipes had the largest eect on adherence for the light switch
(59% vs. 26%; OR=4.2; P < 0.001). Intervention timing was not associated with overall
adherence (P = 0.10). 94% of sta reported overall satisfaction of “very good” or “excel-
lent,” and 90% of sta reported that use of the wipes shortened the cleaning process.
Conclusion. e use of cleaning wipes resulted in greater adherence to room
cleaning and the method was reported to be acceptable to sta. Future aims of this
large study (over 10,000 patients were enrolled and data collection not yet completed)
are to determine the impact of this intervention on rates of hospital-acquired infec-
tions, MDRO acquisitions, and mortality.
Disclosures. E. T. Martin, Clinell: Grant Investigator, Research grant. D.
Marchaim, Clinell: Grant Investigator, Grant recipient.
1151. ASafer, More Eective Method for Cleaning and Disinfecting GI
Endoscopic Procedure Rooms
BergeinOverholt, MD, Gastroenterology1, KarenReynolds, LPN2 and
DonaldWheeler, PhD3; 1Gastrointestinal Associates, Knoxville, Tennessee, 2Quality
Department, Gastrointestinal Associates, Knoxville, Tennessee and 2SPC Press,
Knoxville, Tennessee
Session: 135. Healthcare Epidemiology: Environmental and Occupational Health
Friday, October 5, 2018: 12:30 PM
Background. Healthcare acquired infections are increasing. Current cleaning and
disinfecting (C&D) methods subject sta to toxic chemicals and can be damaging to
the facility. Hypochlorous acid (HOCl) is a disinfecting solution that is 80–200 times
more eective than bleach in surface disinfection of bacteria yet is nontoxic to humans.
e aim of this study was to determine whether HOCl is as eective as standard clean-
ing methods for C&D GI ambulatory surgery center (ASC) rooms as determined by
ATP (adenosine triphosphate) measurements over a 2-week period.
Methods. Two similar GI ASCs, each with two procedure rooms, were studied.
One ASC received postprocedure STANDARD C&D with quaternary ammonium
compounds in nonwoven fabric for surface wiping of high touch areas followed by
terminal benzalkonium chloride foam/spray on these areas. e second ASC received
HOCl C&D using on-site freshly prepared HOCl, 1,000 ppm. Microber cloths semi-
wet with HOCl were used for wiping surfaces for both C&D. In the HOCl rooms,
aer terminal manual wiping, misting with HOCl of the entire room was performed.
Selected high touch area ATP testing was performed in all rooms before procedures in
the AM and 10 minutes aer terminal manual cleaning. In the HOCL rooms, testing
was also performed 10 minutes aer misting. High touch areas tested in each room
included: endoscopic cart (three locations/cart), both gurney bed rails, computer
mouse (two), working counters (two areas), light switch, door knob. ATP scores were
compared within each site using analysis of means (ANOM).
Results. Aer terminal cleaning, the average ATP score in the HOCl CLEANING
and DISINFECTING study arm was signicantly lower than that for the STANDARD
CLEANING and DISINFECTING rooms (P < 0.0017) (Figure1). In evaluating the eect
of the HOCl misting, the ATP scores in the HOCl rooms had a post cleaning, pre-misting
average score of 2.7. e post misting average score was 1.7, showing that misting pro-
duced a further signicant reduction (improvement) in ATP scores (P =0.01).
Conclusion. HOCl cleaning and disinfection in GI ASCs is more eective than
standard procedures in lowering ATP scores following endoscopic procedures in pro-
cedure rooms. HOCl terminal misting of the rooms further improves the cleaning and
disinfecting results.
Figure1.
Disclosures. B.Overholt, HOCl Solutions: Shareholder, none to date.
1152. Leveraging Human Factors Engineering to Optimize Low-level Disinfection
of Bedside Medical Tools
LoriHandy, MD, MSCE1; OrysiaBezpalko, MPH2; HillaryHei, MPH3; CarlyEhritz,
MSN, RN, ACCNS-P4; SaraTow nse n d , MS-HQS, CIC3 and Julia ShakleeSammons,
MD, MSCE1; 1Perelman School of Medicine, Department of Pediatrics, Division of
Infectious Diseases, Department of Infection Prevention and Control, Children’s
Hospital of Philadelphia, Philadelphia, Pennsylvania, 2Performance Improvement,
Oce of Safety and Medical Operations, Children’s Hospital of Philadelphia,
Philadelphia, Pennsylvania, 3Department of Infection Prevention and Control,
Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, 4Department of
Nursing, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Session: 135. Healthcare Epidemiology: Environmental and Occupational Health
Friday, October 5, 2018: 12:30 PM
Background. Inadequate cleaning and disinfection of shared medical equipment
can lead to healthcare-associated infections and outbreaks. Stethoscopes were iden-
tied as the most commonly used piece of shared equipment at our institution, but
cleaning practices were inconsistent among providers. We aimed to assess provider
attitudes and practices around stethoscope disinfection and to subsequently imple-
ment a test of change (TOC) supported by human factors observations to improve
cleaning consistency and frequency.
Methods. We conducted an anonymous electronic survey via SurveyMonkey
paired with human factors observations in a free-standing children’s hospital. We sur-
veyed physicians, nurses, and advanced practice providers to identify barriers to regular
stethoscope cleaning. Quantitative results, human factors observations, and workow
simulations on a single unit were used to design an intervention to standardize low-level
disinfection. Small mesh baskets holding alcohol prep pads labeled with brightly col-
ored signage were installed by the exit of each patient room on one trial unit. Following
implementation, a postsurvey and direct observations on the unit were conducted.
Results. Of those sur veyed healthcare providers who completed the pre-survey
(n= 383), 92% believed stethoscopes pose an infection risk to patients. However, only
38% of respondents reported cleaning their stethoscope between patient encounters. e
most cited barrier to cleaning was a lack of easily accessible cleaning product (49%). Aer
the unit-based TOC, alcohol from baskets were utilized by 80% of the 25 surveyed pro-
viders; 74% reported increased frequency of cleaning due to accessibility. Additionally,
the brightly colored signage was a visual cue to disinfect equipment. Increased satisfac-
tion of families reinforced the behavior. Direct observations revealed an increased fre-
quency of cleaning while qualitative interviews elicited increased awareness fromsta.
Conclusion. Leveraging human factors engineering to inform the placement and
design of easily accessible disinfection supplies correlated with increased frequency of
stethoscope cleaning by healthcare providers. Future steps include implementation in
all inpatient careareas.
Disclosures. All authors: No reported disclosures.
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