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Microbial transmission

AORN Journal, Jan, 2008 by Sharon Giarrizzo-Wilson

QUESTION: Our hospital was cited by state inspectors for having a physician's personal camera bag in the OR. The bag is made of a tightly woven, heavy-duty nylon fabric and has protective insulation for a medical-grade camera. The surgeon frequently brings the camera with its bag into the OR to document a patient's reconstructive treatment. If the camera bag does not come into direct contact with the patient, what risk does it present? I have searched AORN's recommended practices and cannot find information to address this situation.

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ANSWER: Porous items that cannot be effectively cleaned (eg, backpacks, fabric bags) should be restricted from the clinical care area to prevent potential cross-contamination to the patient. Although AORN's "Recommended practices for environmental cleaning in the surgical practice setting" does not specifically address personal items, it states that "Equipment from areas outside the OR should be damp dusted before being brought into the OR." (1(p551)

The role of the inanimate environment in disease transmission is being examined closely by infection prevention advocates. Inanimate objects exposed to the health-care environment are susceptible to transient contamination during handling, and subsequently may serve as the vehicle for transmission of microbes. (2) The Centers for Disease Control and Prevention states that direct contact transmission (ie, from body surface to body surface) or indirect contact transmission (ie, via contaminated inanimate objects) are two of the main routes of microorganism transmission. (3,4)

Factors influencing microbial carriage include the nature of the environmental surface and its capacity to support microbial growth. (3-5) The persistence of pathogen survival on porous and nonporous inanimate materials also has been studied and validated by epidemiology scientists since as early as 1878. (6) Current health care research confirms extended survival rates of viruses and gram-positive bacteria, including vancomycin-sensitive and vancomycin-resistant enterococci and methicillin-sensitive and methicillin-resistant Staphylococcus aureus on common hospital objects, including surgical attire. (4-9) One study suggested that fabrics could become vectors for the spread of staphylococcal or enterococcal organisms as the health care worker moves from one patient to the next. (7) Hypothetically, with survival rates of one day or longer, these organisms could be carried into the home, although this was not within the scope of the study. (7)

With the increasing prevalence of health care-associated infection, surface disinfection is a necessary step in the prevention of microbial carriage. (6,7) Strict adherence to the principles of aseptic technique is key to preventing the spread of infection between patients and staff members.

REFERENCES

(1.) Recommended practices for environmental cleaning in the surgical practice setting. In: Standards, Recommended Practices, and Guidelines. Denver, CO: AORN, Inc; 2007:551-557.

(2.) Rutala WA, Webber DJ. The benefits of surface disinfection. Am J Infect Control. 2004;32(4):226-231.

(3.) Sehulster LM, Chinn RYW, Arduino MJ, et al. Guidelines for environmental infection control in health-care facilities. In: Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Atlanta, GA: Centers for Disease Control and Prevention; 2003.

(4.) Cozad A, Jones RD. Disinfection and the prevention of infectious disease. Am J Infect Control. 2003;31 (4):243-254.

(5.) Edmiston CE, Goheen MP, Seabrook GR, et al. Impact of selective antimicrobial agents on staphylococcal adherence to biomedical devices. Am J Surg. 2006;192(3):344-354.

(6.) Assar SK, Block SS. Survival of microorganisms in the environment. In: Block SS, ed. Disinfection, Sterilization, and Preservation. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000:1221-1242.

(7.) Neely A, Maley M. Survival of enterococci and staphylococci on hospital fabrics and plastics. J Clin Microbiol. 2000;38(2):724-726.

(8.) Clay S, Maherchandani S, Malik YS, Goyal SM. Survival of uncommon fomites of feline calicivirus, a surrogate of noroviruses. Am J Infect Control. 2006; 34(1):41-43.

(9.) Knobben BA, van der Mei HC, van Horn JR, Busscher HJ. Transfer of bacteria between biomaterials surfaces in the operating room--an experimental study. J Biomed Mater Res A. 2007;80(4):790-799.

SHARON GIARRIZZO-WILSON

RN, MS, CNOR

PERIOPERATIVE NURSING SPECIALIST

AORN CENTER FOR NURSING PRACTICE

Health Care Industry

Microbial transmission

AORN Journal, Jan, 2008 by Sharon Giarrizzo-Wilson

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