Reduction in the incidence of hospital-acquired MRSA following the introduction of a chlorine dioxide 275 ppm based disinfecting agent in a district general hospital

G. Conlon-Bingham, M. Aldeyab, M.P. Kearney, M.G. Scott, N. Baldwin, J.C. McElnay

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile are major nosocomial pathogens whose control relies on effective antimicrobial stewardship and infection control practices. This study evaluates the impact of a chlorine dioxidebased disinfectant (275 ppm) on the incidence of hospital-acquired (HA) MRSA and HA-Clostridium difficile infection (CDI) in a district general hospital. Methods: This study was carried out from November 2009 to September 2013. From November 2009 to October 2011 sodium dichloroisocyanurate was used for routine environmental disinfection. In November 2011, this was changed to a chlorine dioxide 275 ppm based disinfectant. This product was introduced into the hospital in a phased manner with intensive training on its use provided to all nursing, nursing auxiliary and hotel services staff. The effect of this change on the incidence of HA-MRSA and HA-CDI was assessed using segmented regression analysis of interrupted time series. In addition, the potential cost savings as a result of this intervention were assessed. Results: The HA-MRSA trend from November 2009 to October 2011 significantly increased (p=0.006). Following the introduction of the chlorine dioxide-based disinfectant there was significant decrease in the HAMRSA trend, with the monthly incidence being reduced by 0.003 cases/100 bed days (p=0.001), equating to an average of four cases per month after 12 months of use This resulted in an annual potential cost saving of £276 000. No significant effect on the incidence of HACDI was observed (coefficient -0.03; p=0.873). Conclusion This study highlights the importance of effective environmental inanimate surface decontamination in controlling the spread of MRSA and the potential cost savings that can be achieved through decreasing HA-MRSA rates.
LanguageEnglish
Pages28-32
Number of pages5
JournalEuropean Journal of Hospital Pharmacy
Volume23
Issue number1
DOIs
Publication statusPublished - 2016

Fingerprint

District Hospitals
Methicillin-Resistant Staphylococcus aureus
General Hospitals
Incidence
Clostridium difficile
Disinfectants
Clostridium Infections
Cost Savings
Nurses' Aides
Decontamination
chlorine dioxide
Chlorine
Disinfection
Infection Control
Nursing
Regression Analysis
Costs and Cost Analysis

Keywords

  • chlorine dioxide
  • Article
  • cost effectiveness analysis
  • environmental impact
  • good clinical practice
  • hospital hygiene
  • hospital infection
  • hospital personnel
  • human
  • infection control
  • major clinical study
  • methicillin resistant Staphylococcus aureus infection
  • patient care
  • polymerase chain reaction
  • staff training

Cite this

Conlon-Bingham, G. ; Aldeyab, M. ; Kearney, M.P. ; Scott, M.G. ; Baldwin, N. ; McElnay, J.C. / Reduction in the incidence of hospital-acquired MRSA following the introduction of a chlorine dioxide 275 ppm based disinfecting agent in a district general hospital. In: European Journal of Hospital Pharmacy. 2016 ; Vol. 23, No. 1. pp. 28-32.
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abstract = "Background: Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile are major nosocomial pathogens whose control relies on effective antimicrobial stewardship and infection control practices. This study evaluates the impact of a chlorine dioxidebased disinfectant (275 ppm) on the incidence of hospital-acquired (HA) MRSA and HA-Clostridium difficile infection (CDI) in a district general hospital. Methods: This study was carried out from November 2009 to September 2013. From November 2009 to October 2011 sodium dichloroisocyanurate was used for routine environmental disinfection. In November 2011, this was changed to a chlorine dioxide 275 ppm based disinfectant. This product was introduced into the hospital in a phased manner with intensive training on its use provided to all nursing, nursing auxiliary and hotel services staff. The effect of this change on the incidence of HA-MRSA and HA-CDI was assessed using segmented regression analysis of interrupted time series. In addition, the potential cost savings as a result of this intervention were assessed. Results: The HA-MRSA trend from November 2009 to October 2011 significantly increased (p=0.006). Following the introduction of the chlorine dioxide-based disinfectant there was significant decrease in the HAMRSA trend, with the monthly incidence being reduced by 0.003 cases/100 bed days (p=0.001), equating to an average of four cases per month after 12 months of use This resulted in an annual potential cost saving of £276 000. No significant effect on the incidence of HACDI was observed (coefficient -0.03; p=0.873). Conclusion This study highlights the importance of effective environmental inanimate surface decontamination in controlling the spread of MRSA and the potential cost savings that can be achieved through decreasing HA-MRSA rates.",
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author = "G. Conlon-Bingham and M. Aldeyab and M.P. Kearney and M.G. Scott and N. Baldwin and J.C. McElnay",
note = "Cited By :1 Export Date: 15 September 2018 Correspondence Address: McElnay, J.C.; Clinical and Practice Research Group, School of Pharmacy, Queen's University BelfastUnited Kingdom; email: j.mcelnay@qub.ac.uk Chemicals/CAS: chlorine dioxide, 10049-04-4 References: Coia, J.E., Duckworth, G.J., Edwards, D.I., Guidelines for the control and prevention of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities (2006) J Hosp Infect, 63, pp. S1-S44; Department of Health, Department for Environment, Food and Rural Affairs, (2013) UK Five Year Antimicrobial Resistance Strategy 2013 to 2018, , https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/244058/20130902_UK_5_year_AMR, London: Department of Health, cited 3 December 2013; Gerding, D.N., Muto, C., Owens, R.C., Measures to control and prevent Clostridium difficile infection (2008) Clin Infect Dis, 46, pp. S46-S49; Huang, S., Datta, R., Platt, R., Risk of acquiring antibiotic resistant bacteria from prior room occupants (2006) Arch Intern Med, 166, pp. 1945-1951; Kramer, A., Schwebke, I., Kampf, G., 2006 How long do nosocomial pathogens persist on inanimate surfaces? A systematic review (2006) BMC Infect Dis, 6, p. 130; Otter, J.A., Vickery, K., Walker, J.T., 2015 Surface attached cells, biofilms and biocide susceptibility: Implications for hospital cleaning and disinfection (2015) J Hosp Infect, 89, pp. 16-27; US Department of Health and Human Services, (2008) Centres for Disease Control and Prevention 2008. Guideline for Disinfection and Sterilization in Healthcare Facilities, , http://www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf, Atlanta, Georgia: Centre for Disease Control, cited 3 Dec. 2013; Aldeyab, M.A., Harbarth, S., Vernaz, N., Quasiexperimental study of the effects of antibiotic use, gastric acid-suppressive agents, and infection control practices on the incidence of Clostridium difficile-associated diarrhea in hospitalized patients (2009) Antimicrob Agents Chemother, 53, pp. 2082-2088; Aldeyab, M.A., Monnet, D.L., L{\'o}pez-Lozano, J.M., Modelling the impact of antibiotic use and infection control practices on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus: A time-series analysis (2008) J Antimicrob Chemother, 62, pp. 593-600; Vernaz, N., Sax, H., Pittet, D., Temporal effects of antibiotic use and hand rub consumption on the incidence of MRSA and Clostridium difficile (2008) J Antimicrob Chemother, 62, pp. 601-607; Hinenoya, A., Awasthi, S.P., Yasuda, N., Chlorine dioxide is a superior disinfectant against multidrug resistant staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii (2015) Jpn J Infect Dis; Thorn, R.M.S., Robinson, G.M., Reynolds, D.M., 2013 Comparative antimicrobial activities of aerosolized sodium hypochlorite, chlorine dioxide and electrochemically activated solutions evaluated using a novel standardised assay (2013) Antimicrob Agents Chemother, 57, pp. 2216-2225; Speight, S., Moy, A., Macken, S., Evaluation of the sporicidal activity of different chemical disinfectants against Clostridium difficile (2011) J Hosp Infect, 79, pp. 18-22; Aldeyab, M., Devine, M., Flanagan, P., Multihospital outbreak of Clostridium difficile Ribotype 027: Epidemiology and analysis of control measures (2011) Infect Control Hosp Epidemiol, 32, pp. 210-219; Cohen, A.L., Calfee, D., Fridkin, S.K., Recommendations for metrics for multidrug-resistant organisms in healthcare settings: SHEA/HICPAC position paper (2008) Infect Control Hosp Epidemiol, 29, pp. 901-912; Mahamat, A., MacKenzie, F.M., Brooker, K., Impact of infection control interventions and antibiotic use on hospital MRSA: A multivariate interrupted time-series analysis (2007) Int J Antimicrob Agents, 30, pp. 169-176; WHO Collaborating Centre for Drug Statistics Methodology, (2012) Guidelines for ATC Classification and DDD Assignment, , Oslo; Hubner, C., Hubner, N.-O., Hopert, K., Analysis of MRSA-attributed costs of hospitalized patients in Germany (2014) Eur J Clin Microbiol Infect Dis, 33, pp. 1817-1822; Weigand, P.N., Nathwani, D., Wilcox, M.H., Clinical and economic burden of Clostridium difficile infection in Europe: A systematic review of healthcare facility acquired infection (2012) J Hosp Infect, 81, pp. 1-14; Interrupted Time Series (ITS) Analyses-SPSS Time Series Analysis, , http://epoc.cochrane.org/epoc-authorresources, accessed 13 Oct. 2014; Stone, S.P., Cooper, B.S., Kibbler, C.C., The ORION statement: Guidelines for transparent reporting of outbreak reports and intervention studies of nosocomial infection (2007) Lancet Infect Dis, 7, pp. 282-288; Datta, R., Platt, R., Yokoe, D.S., Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants (2011) Arch Intern Med, 6, pp. 491-494; Otter, J.A., Yezli, S., French, G., The role played by contaminated surfaces in the transmission of nosocomial pathogens (2011) Infect Control Hosp Epidemiol, 32, pp. 687-699; Otter, J.A., Yezli, S., Salkeld, J.A.G., Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings (2013) Am J Infect Control, 41, pp. S6-S11; Dancer, S., Importance of the environment in methicillin-resistant Staphylococcus aureus acquisition: The case for hospital cleaning (2008) Lancet Infect Dis, 8, pp. 101-113; Williams, G.J., Denyer, S.P., Hosein, I.K., Use of sodium dichloroisocyanurate for floor disinfection (2009) J Hosp Infect, 72, pp. 279-281; Maillard, J.Y., Innate resistance to sporicides and potential failure to decontaminate (2011) J Hosp Infect, 77, pp. 204-209; Jeanes, A., Rao, G., Osman, M., Eradication of persistent environmental MRSA (2005) J Hosp Infect, 61, pp. 85-86; Loo, V.G., Bourgault, A.M., Poirier, L., Host and pathogen factors for Clostridium difficile infection and colonization (2011) N Engl J Med, 365, pp. 1693-1703",
year = "2016",
doi = "10.1136/ejhpharm-2014-000608",
language = "English",
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issn = "2047-9956",
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Reduction in the incidence of hospital-acquired MRSA following the introduction of a chlorine dioxide 275 ppm based disinfecting agent in a district general hospital. / Conlon-Bingham, G.; Aldeyab, M.; Kearney, M.P.; Scott, M.G.; Baldwin, N.; McElnay, J.C.

In: European Journal of Hospital Pharmacy, Vol. 23, No. 1, 2016, p. 28-32.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Reduction in the incidence of hospital-acquired MRSA following the introduction of a chlorine dioxide 275 ppm based disinfecting agent in a district general hospital

AU - Conlon-Bingham, G.

AU - Aldeyab, M.

AU - Kearney, M.P.

AU - Scott, M.G.

AU - Baldwin, N.

AU - McElnay, J.C.

N1 - Cited By :1 Export Date: 15 September 2018 Correspondence Address: McElnay, J.C.; Clinical and Practice Research Group, School of Pharmacy, Queen's University BelfastUnited Kingdom; email: j.mcelnay@qub.ac.uk Chemicals/CAS: chlorine dioxide, 10049-04-4 References: Coia, J.E., Duckworth, G.J., Edwards, D.I., Guidelines for the control and prevention of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities (2006) J Hosp Infect, 63, pp. S1-S44; Department of Health, Department for Environment, Food and Rural Affairs, (2013) UK Five Year Antimicrobial Resistance Strategy 2013 to 2018, , https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/244058/20130902_UK_5_year_AMR, London: Department of Health, cited 3 December 2013; Gerding, D.N., Muto, C., Owens, R.C., Measures to control and prevent Clostridium difficile infection (2008) Clin Infect Dis, 46, pp. S46-S49; Huang, S., Datta, R., Platt, R., Risk of acquiring antibiotic resistant bacteria from prior room occupants (2006) Arch Intern Med, 166, pp. 1945-1951; Kramer, A., Schwebke, I., Kampf, G., 2006 How long do nosocomial pathogens persist on inanimate surfaces? A systematic review (2006) BMC Infect Dis, 6, p. 130; Otter, J.A., Vickery, K., Walker, J.T., 2015 Surface attached cells, biofilms and biocide susceptibility: Implications for hospital cleaning and disinfection (2015) J Hosp Infect, 89, pp. 16-27; US Department of Health and Human Services, (2008) Centres for Disease Control and Prevention 2008. Guideline for Disinfection and Sterilization in Healthcare Facilities, , http://www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf, Atlanta, Georgia: Centre for Disease Control, cited 3 Dec. 2013; Aldeyab, M.A., Harbarth, S., Vernaz, N., Quasiexperimental study of the effects of antibiotic use, gastric acid-suppressive agents, and infection control practices on the incidence of Clostridium difficile-associated diarrhea in hospitalized patients (2009) Antimicrob Agents Chemother, 53, pp. 2082-2088; Aldeyab, M.A., Monnet, D.L., López-Lozano, J.M., Modelling the impact of antibiotic use and infection control practices on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus: A time-series analysis (2008) J Antimicrob Chemother, 62, pp. 593-600; Vernaz, N., Sax, H., Pittet, D., Temporal effects of antibiotic use and hand rub consumption on the incidence of MRSA and Clostridium difficile (2008) J Antimicrob Chemother, 62, pp. 601-607; Hinenoya, A., Awasthi, S.P., Yasuda, N., Chlorine dioxide is a superior disinfectant against multidrug resistant staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii (2015) Jpn J Infect Dis; Thorn, R.M.S., Robinson, G.M., Reynolds, D.M., 2013 Comparative antimicrobial activities of aerosolized sodium hypochlorite, chlorine dioxide and electrochemically activated solutions evaluated using a novel standardised assay (2013) Antimicrob Agents Chemother, 57, pp. 2216-2225; Speight, S., Moy, A., Macken, S., Evaluation of the sporicidal activity of different chemical disinfectants against Clostridium difficile (2011) J Hosp Infect, 79, pp. 18-22; Aldeyab, M., Devine, M., Flanagan, P., Multihospital outbreak of Clostridium difficile Ribotype 027: Epidemiology and analysis of control measures (2011) Infect Control Hosp Epidemiol, 32, pp. 210-219; Cohen, A.L., Calfee, D., Fridkin, S.K., Recommendations for metrics for multidrug-resistant organisms in healthcare settings: SHEA/HICPAC position paper (2008) Infect Control Hosp Epidemiol, 29, pp. 901-912; Mahamat, A., MacKenzie, F.M., Brooker, K., Impact of infection control interventions and antibiotic use on hospital MRSA: A multivariate interrupted time-series analysis (2007) Int J Antimicrob Agents, 30, pp. 169-176; WHO Collaborating Centre for Drug Statistics Methodology, (2012) Guidelines for ATC Classification and DDD Assignment, , Oslo; Hubner, C., Hubner, N.-O., Hopert, K., Analysis of MRSA-attributed costs of hospitalized patients in Germany (2014) Eur J Clin Microbiol Infect Dis, 33, pp. 1817-1822; Weigand, P.N., Nathwani, D., Wilcox, M.H., Clinical and economic burden of Clostridium difficile infection in Europe: A systematic review of healthcare facility acquired infection (2012) J Hosp Infect, 81, pp. 1-14; Interrupted Time Series (ITS) Analyses-SPSS Time Series Analysis, , http://epoc.cochrane.org/epoc-authorresources, accessed 13 Oct. 2014; Stone, S.P., Cooper, B.S., Kibbler, C.C., The ORION statement: Guidelines for transparent reporting of outbreak reports and intervention studies of nosocomial infection (2007) Lancet Infect Dis, 7, pp. 282-288; Datta, R., Platt, R., Yokoe, D.S., Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants (2011) Arch Intern Med, 6, pp. 491-494; Otter, J.A., Yezli, S., French, G., The role played by contaminated surfaces in the transmission of nosocomial pathogens (2011) Infect Control Hosp Epidemiol, 32, pp. 687-699; Otter, J.A., Yezli, S., Salkeld, J.A.G., Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings (2013) Am J Infect Control, 41, pp. S6-S11; Dancer, S., Importance of the environment in methicillin-resistant Staphylococcus aureus acquisition: The case for hospital cleaning (2008) Lancet Infect Dis, 8, pp. 101-113; Williams, G.J., Denyer, S.P., Hosein, I.K., Use of sodium dichloroisocyanurate for floor disinfection (2009) J Hosp Infect, 72, pp. 279-281; Maillard, J.Y., Innate resistance to sporicides and potential failure to decontaminate (2011) J Hosp Infect, 77, pp. 204-209; Jeanes, A., Rao, G., Osman, M., Eradication of persistent environmental MRSA (2005) J Hosp Infect, 61, pp. 85-86; Loo, V.G., Bourgault, A.M., Poirier, L., Host and pathogen factors for Clostridium difficile infection and colonization (2011) N Engl J Med, 365, pp. 1693-1703

PY - 2016

Y1 - 2016

N2 - Background: Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile are major nosocomial pathogens whose control relies on effective antimicrobial stewardship and infection control practices. This study evaluates the impact of a chlorine dioxidebased disinfectant (275 ppm) on the incidence of hospital-acquired (HA) MRSA and HA-Clostridium difficile infection (CDI) in a district general hospital. Methods: This study was carried out from November 2009 to September 2013. From November 2009 to October 2011 sodium dichloroisocyanurate was used for routine environmental disinfection. In November 2011, this was changed to a chlorine dioxide 275 ppm based disinfectant. This product was introduced into the hospital in a phased manner with intensive training on its use provided to all nursing, nursing auxiliary and hotel services staff. The effect of this change on the incidence of HA-MRSA and HA-CDI was assessed using segmented regression analysis of interrupted time series. In addition, the potential cost savings as a result of this intervention were assessed. Results: The HA-MRSA trend from November 2009 to October 2011 significantly increased (p=0.006). Following the introduction of the chlorine dioxide-based disinfectant there was significant decrease in the HAMRSA trend, with the monthly incidence being reduced by 0.003 cases/100 bed days (p=0.001), equating to an average of four cases per month after 12 months of use This resulted in an annual potential cost saving of £276 000. No significant effect on the incidence of HACDI was observed (coefficient -0.03; p=0.873). Conclusion This study highlights the importance of effective environmental inanimate surface decontamination in controlling the spread of MRSA and the potential cost savings that can be achieved through decreasing HA-MRSA rates.

AB - Background: Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile are major nosocomial pathogens whose control relies on effective antimicrobial stewardship and infection control practices. This study evaluates the impact of a chlorine dioxidebased disinfectant (275 ppm) on the incidence of hospital-acquired (HA) MRSA and HA-Clostridium difficile infection (CDI) in a district general hospital. Methods: This study was carried out from November 2009 to September 2013. From November 2009 to October 2011 sodium dichloroisocyanurate was used for routine environmental disinfection. In November 2011, this was changed to a chlorine dioxide 275 ppm based disinfectant. This product was introduced into the hospital in a phased manner with intensive training on its use provided to all nursing, nursing auxiliary and hotel services staff. The effect of this change on the incidence of HA-MRSA and HA-CDI was assessed using segmented regression analysis of interrupted time series. In addition, the potential cost savings as a result of this intervention were assessed. Results: The HA-MRSA trend from November 2009 to October 2011 significantly increased (p=0.006). Following the introduction of the chlorine dioxide-based disinfectant there was significant decrease in the HAMRSA trend, with the monthly incidence being reduced by 0.003 cases/100 bed days (p=0.001), equating to an average of four cases per month after 12 months of use This resulted in an annual potential cost saving of £276 000. No significant effect on the incidence of HACDI was observed (coefficient -0.03; p=0.873). Conclusion This study highlights the importance of effective environmental inanimate surface decontamination in controlling the spread of MRSA and the potential cost savings that can be achieved through decreasing HA-MRSA rates.

KW - chlorine dioxide

KW - Article

KW - cost effectiveness analysis

KW - environmental impact

KW - good clinical practice

KW - hospital hygiene

KW - hospital infection

KW - hospital personnel

KW - human

KW - infection control

KW - major clinical study

KW - methicillin resistant Staphylococcus aureus infection

KW - patient care

KW - polymerase chain reaction

KW - staff training

U2 - 10.1136/ejhpharm-2014-000608

DO - 10.1136/ejhpharm-2014-000608

M3 - Article

VL - 23

SP - 28

EP - 32

JO - European Journal of Hospital Pharmacy

T2 - European Journal of Hospital Pharmacy

JF - European Journal of Hospital Pharmacy

SN - 2047-9956

IS - 1

ER -