It isn’t every day that I get to discuss two of my most favorite subjects — infection prevention and forensic science — in the same conversation, but a news item from the wires caught my eye and I wanted to share it with you. Medical investigators in the Netherlands report they are employing traditional forensic techniques to identify potential infection risks in the healthcare environment.
Researcher Paul Bergervoet and colleagues1 took a page from the hit show “CSI: Crime Scene Investigation” and used a luminescent chemical called luminol to find blood in dialysis units. Luminol works by temporarily fluorescing a bright blue when it comes in contact with blood. Bergervoet and his team found traces of blood on numerous high-touch surfaces including telephones, computer keyboards, side tables, cabinet handles and the floor — even though some of these surfaces purportedly had been cleaned.
The results of this experiment were published in the Journal of Hospital Infection, and the researchers say they hope other hospitals will consider luminol as a tool to help fight bloodborne pathogens and help educate healthcare professionals about the realities of cross contamination and hand transfer. Healthcare workers often think twice about not washing their hands when they can see strong visual evidence of lingering pathogens on inanimate surfaces that can sicken and kill. As Bergervoet comments, “The aim of this article is to... monitor cleaning and disinfection procedures and alert healthcare workers to the possibility of contamination of the hospital environment with blood.”
Hospitals can “get their glow on” further by considering the awareness of germs created by researchers who are using a flourescent indicator to illustrate the lack of thorough environmental cleaning in hospitals. A fluorescent indicator material may be applied on the surface and can be measured through exposure to ultraviolet light. Researchers in Boston2 used an invisible flourescent marker to target standardized high-touch surfaces in hospital rooms; the marker was formulated to be inconspicuous yet readily removed by housekeeping products. Evaluation of 1,404 surface objects in 157 rooms in three hospitals revealed that 47 percent of targets had been cleaned by using routine cleaning/disinfecting techniques. Educational interventions were implemented, leading to sustained improvement in cleaning of all objects and more than a two-fold improvement in cleaning of surfaces previously cleaned less than 85 percent of the time.
Researchers in the United Kingdom assessed cleanliness in more than 100 environmental surfaces in an operating room and a hospital ward using microbiological methods and a bioluminescence agent. The researchers discovered that 76 percent of these surfaces carried a microbial load and were “unacceptable” after cleaning. It’s important to note that only 18 percent of the surfaces were considered unacceptable when researchers visually inspected them and didn’t rely on the fluorescent agent — much like most hospital housekeeping staff do.
Technology is an important tool in the fight against healthcare-acquired infections (HAIs); while not all hospitals will be able to adopt these CSI-like techniques, these new methods certainly open the door to rethinking how to ensure compliance with hand hygiene and environmental surface cleaning.
Until next month, bust those bugs!
Kelly M. Pyrek
Editor in Chief
1. Bergervoet PWM, van Riessen N, Sebens FW, and van der Zwet WC. Application of the forensic luminol for blood and infection control. J Hosp Infect. 2008.
2. Carling PC, Briggs JL, Perkins J, Highlander D. Improved cleaning of patient rooms using a new targeting method. Clin Infect Dis. 2006 Feb 1;42(3):385-8. Epub 2005 Dec 29.