Linda Sullivan

Quaternary Ammonium Disinfectant Issues Encountered in an Environmental Services Department.

We identified several factors affecting the use of quaternary ammonium-based (Quat) disinfectant in our facility. Microfiber wipers, cotton towels, and 1 of 2 types of disposable wipes soaked in a Quat disinfectant revealed significant binding of the disinfectant. Concentrations of Quat delivered by automated disinfectant dispensers varied widely.

Prospective cluster controlled crossover trial to compare the impact of an improved hydrogen peroxide disinfectant and a quaternary ammonium-based disinfectant on surface contamination and health care outcomes.

HighlightsAn improved hydrogen peroxide disinfectant yielded less surface contamination than a quaternary ammonium disinfectant.Improved hydrogen peroxide disinfectant yielded surfaces with no growth more often than a quaternary ammonium disinfectant.A composite health care outcome measure was lower with improved hydrogen peroxide disinfectant than with quaternary ammonium disinfectant. Background: Quaternary ammonium–based (Quat) disinfectants are widely used, but they have disadvantages. Methods: This was a 12‐month prospective cluster controlled crossover trial. On 4 wards, housekeepers performed daily cleaning using a disinfectant containing either 0.5% improved hydrogen peroxide (IHP) or Quat. Each month, 5‐8 high‐touch surfaces in several patient rooms on each ward were tagged with a fluorescent marker and cultured before and after cleaning. Hand hygiene compliance rates and antimicrobial usage on study wards were obtained from hospital records. Outcomes included aerobic colony counts (ACCs), percent of wiped surfaces yielding no growth after cleaning, and a composite outcome of incidence densities of nosocomial acquisition and infection caused by vancomycin‐resistant enterococci, methicillin‐resistant Staphylococcus aureus, and Clostridium difficile infection. Statistical analysis was performed using χ2 test, Fisher exact test, Welch test, and logistic regression methods. Results: Mean ACCs per surface after cleaning were significantly lower with IHP (14.0) than with Quat (22.2) (P = .003). The proportion of surfaces yielding no growth after cleaning was significantly greater with IHP (240/500; 48%) than with Quat (182/517; 35.2%) (P < .0001). Composite incidence density of nosocomial colonization or infection with IHP (8.0) was lower than with Quat (10.3) (incidence rate ratio, 0.77; P = .068; 95% confidence interval, 0.579‐1.029). Conclusions: Compared with a Quat disinfectant, the IHP disinfectant significantly reduced surface contamination and reduced a composite colonization or infection outcome.

Impact of an Improved Hydrogen Peroxide (IPH) Disinfectant versus a Quaternary Ammonium-based (Quat) Disinfectant on Surface Contamination and Healthcare Outcomes

CPD. In the first five weeks, the REDCap attestation results were used to provide on-site training to four clinics. CONCLUSIONS: Tabletop sterilizer compliance is difficult to achieve and monitor due to complexity and lack of centralization. Consolidating reprocessing in a CPD is a feasible solution for optimizing performance. For clinics unable to transition reprocessing to a CPD, electronic tools can be used by IPC to centralizemonitoring and ensure compliance.

Quaternary ammonium compounds (QAC) issues encountered in an environmental services (EVS) department

QAC are the most common agents used in the United States for disinfection of healthcare surfaces. Recently, concern arose over the ability of cloths to bind QAC. Both microfiber cloths and cotton cloths are available in our facility.

1020Unintentional Hypothermia as a Risk Factor for Abdominal Hysterectomy-Related Surgical Site Infection

Background. Unintentional perioperative hypothermia is a risk factor for surgical site infection (SSI) for various surgical procedures, but few data are available regarding its role in SSI related to abdominal hysterectomy. We conducted a study to assess the potential role of hypothermia as a risk factor for abdominal hysterectomy-related SSIs. Methods. A case-control study included all 37 SSIs related to abdominal hysterectomy procedures performed in 2013 at Yale-New Haven Hospital. 100 randomly selected patients who did not develop SSIs after abdominal hysterectomy in 2013 served as controls. An intraoperative temperature < 36.0 C was defined as hypothermia. Variables recorded included the number of each patient’s temperature readings reported in EPIC EMR that were < 36.0 C, age, BMI, presence of diabetes mellitus or cancer, surgical approach (laparoscopic or robotic-assisted vs open) and operative procedure time. Statistical analysis included chi-square tests, Mann-Whitney tests and forward stepwise logistic regression. Results:. Intraoperative temperature records were available for 35/37 cases and 99/ 100 controls. There were no significant differences between cases and controls with respect to age, BMI, presence of diabetes mellitus or cancer, or procedure time by univariate analysis. Nineteen (54%) of cases, but only 33(33.3%) of controls had > 50% of intraoperative temperatures < 36.0 C (p = 0.029) The mean number of intraoperative temperatures in the hypothermic range for cases (5.97) was significantly greater than that for controls (4.46) (p = 0.015) Overall, 50 (96%) of 52 patients with > 50% of temperatures < 36.0 C met SCIP-INF-10 criteria for normothermia. A logistic regression model using the single best predictor of SSI (the number of hypothermic temperatures) was significant (p < 0.05). When surgical approach was added to the model, it was still significant (p < 0.05). Therefore, the number of hypothermic temperatures and the surgical approach were the best predictors of SSI. Conclusion. The results suggest that hypothermia is also a significant risk factor for abdominal hysterectomy-related SSIs, and that continued efforts are needed to minimize hypothermia during abdominal hysterectomy procedures. Disclosures. J. Boyce, 3M Company: Collaborator, Consultant, Investigator, Scientific Advisor and Speaker’s Bureau, Consulting fee, Research grant, Research support and Speaker honorarium; Gojo Industries: Consultant, Investigator and Scientific Advisor, Consulting fee, Research grant and Speaker honorarium; Clorox Company: Consultant, Investigator and Scientific Advisor, Consulting fee, Research grant, Research support and Speaker honorarium

A retrospective study of the accuracy of surgical care improvement project metrics for documenting normothermia.

A retrospective study of a systematic sample of 150 patients who underwent abdominal surgery revealed that 53 (35.3%) had all intraoperative temperatures in the hypothermic range (<36.0°C). Fifty-two (98.1%) of the 53 patients met 1 or both surgical care improvement project criteria for normothermia. Improved metrics are needed to assure normothermia.