Sunday, March 31, 2013

Decontamination of Hospital Privacy Curtains

by Bill Rutala, M.S., M.P.H., Ph.D. 
Over the past decade, substantial scientific evidence has accumulated that contamination of environmental surfaces in hospital rooms plays an important role in the transmission of several key healthcare-associated pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), Clostridium difficile, multidrug-resistant Acinetobacter spp., and norovirus.1, 2  All of these pathogens have been demonstrated to persist in the environment for hour to days (and in some cases months), to frequently contaminate the surface environment and medical equipment in the rooms of colonized or infected patients, to transiently colonize the hands of healthcare personnel (HCP), to be associated with person-to-person transmission via the hands of HCP, and to cause outbreaks in which environmental transmission was deemed to play a role. Furthermore, hospitalization in a room in which the previous patient had been colonized or infected with MRSA, VRE, Clostridium difficile, multidrug-resistant Acinetobacter spp., or multidrug-resistant Pseudomonas has been shown to be a risk factor for colonization or infection with the same pathogen for the next patient admitted to the room.2

            Hospital curtains that surround patients’ beds to provide privacy have been shown to be contaminated and can be a source of pathogens on the HCP hands.3, 4  Since HCP are less likely to perform hand hygiene after contact with inanimate objects such as curtains than direct contact with patients, the pathogens on the curtains can travel to patients via the contaminated hands of HCP.    Since privacy curtains are normally not changed until visible contaminated or at some routine frequency (e.g., 3 months), they may represent a reservoir for epidemiologically important healthcare-associated pathogens such as MRSA, VRE, Acinetobacter, C. difficile or other multidrug-resistant pathogens. 
We recently evaluated the ability of a new, improved hydrogen peroxide (1.4%) product in decontaminating privacy curtains that are contaminated with MRSA, VRE and other pathogens.  This was done by performing pre-disinfection and post-disinfection cultures of the “grab area” of the edge of the curtain at a height of approximately 3-6 ft from the floor.  After the pre-disinfection cultures had been collected, the curtain was disinfected by spraying the “grab area” 3 times, from a distance of 6-8 inches.
The improved hydrogen peroxide was found to reduce ~98.5% of the pathogens on the privacy curtains.  In the ICU rooms on patients on Contact Precautions the microbial contamination of the curtains ranged from 0-341 with an average of 43 MRSA/VRE per Rodac.  Post-disinfection the MRSA and VRE were completely eliminated (100% reduction). 
All decontamination technologies have both advantages and disadvantages.   A major advantage of improved hydrogen peroxide is its rapid action, high effectiveness and low toxicity.  A disadvantage is it is more expensive than a quaternary ammonium compound in ready-to-use containers.  However, the cost of decontaminating a privacy curtain with improved hydrogen peroxide (product costs for 3 sprays per curtain was about $0.01; 2.5 mls per three sprays) would be far less that removing the curtain and replacing with a new curtain between patients.  Other options to minimize the risk of curtains as reservoirs for healthcare-associated pathogens include: eliminate privacy curtains for patients in private rooms (the door would be used for privacy but would require support of nursing and medical staff); change curtains at discharge of patients on Contact Precautions; or use an antimicrobial privacy curtain.
            In summary, improved hydrogen peroxide would be an alternative to decontaminating privacy curtains between patients. The use of improved hydrogen peroxide could be easily integrated into healthcare practices where the occupancy is high and fast patient room turnaround time is critical.
1.         Weber DJ, Rutala WA, Miller MB, Huslage K, Sickbert-Bennett E. Role of hospital surfaces in the transmission of emerging health care-associated pathogens: Norovirus, Clostridium difficile, and Acinetobacter species. Am J Infect Control 2010;38:S25-33.
2.         Otter JA. The role played by contaminated surfaces in the transmission of nosocomial pathogens. Infect Control Hosp Epidemiol 2011;32:687-99.
3.         Trillis F III EE, Budavich R, Pultz MJ, Donskey CJ. Contamination of hospital curtains with healthcare-associated pathogens. Infect Control Hosp Epidemiol 2008;29:1074-6.
4.         Neely AN, Maley MP. The 1999 Lindberg award. 3% hydrogen peroxide for the gram-positive disinfection of fabrics. Journal of Burn Care & Rehabilitation 1999;20(6):471-7