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East Kilbride, United Kingdom

Dancer S.J.,Hairmyres Hospital
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2011

More evidence is emerging on the importance of the clinical environment in encouraging hospital infection. This review considers the role of cleaning as an effective means to control infection. It describes the location of pathogen reservoirs and methods for evaluating hospitals' cleanliness. Novel biocides, antimicrobial coatings and equipment are available, many of which have not been assessed against patient outcome. Cleaning practices should be tailored to clinical risk, given the wide-ranging surfaces, equipment and building design. There is confusion between nursing and domestic personnel over the allocation of cleaning responsibilities and neither may receive sufficient training and/or time to complete their duties. Since less labourious practices for dirt removal are always attractive, there is a danger that traditional cleaning methods are forgotten or ignored. Few studies have examined detergent-based regimens or modelled these against infection risk for different patient categories. Fear of infection encourages the use of powerful disinfectants for the elimination of real or imagined pathogens in hospitals. Not only do these agents offer false assurance against contamination, their disinfection potential cannot be achieved without the prior removal of organic soil. Detergent-based cleaning is cheaper than using disinfectants and much less toxic. Hospital cleaning in the 21st century deserves further investigation for routine and outbreak practices. © 2011 Springer-Verlag. Source

Gillespie A.,Western Infirmary of Glasgow | Moir J.S.,Western Infirmary of Glasgow | Miller R.,Hairmyres Hospital
Journal of Foot and Ankle Surgery | Year: 2014

Complex regional pain syndrome (CRPS) is an uncommon complication of orthopedic surgery, and few investigators have considered the incidence in foot and ankle surgery. In the present retrospective cohort study of 390 patients who had undergone elective foot and/or ankle surgery in our department from January to December 2009, the incidence of postoperative CRPS was calculated and explanatory variables were analyzed. A total of 17 patients (4.36%) were identified as meeting the International Association for the Study of Pain criteria for the diagnosis of CRPS. Of the 17 patients with CRPS, the mean age was 47.2 ± 9.7years, and 14 (82.35%) were female. All the operations were elective, and 9 (52.94%) involved the forefoot, 3 (17.65%) the hindfoot, 3 (17.65%) the ankle, and 2 (11.76%) the midfoot. Twelve patients (70.59%) had new-onset CRPS after a primary procedure, and 5 (29.41%) had developed CRPS after multiple surgeries. Three patients (17.65%) had documented nerve damage intraoperatively and thus developed new-onset CRPS type 2. Blood test results were available for 14 patients (82.35%) at a minimum of 3months postoperatively, and none had elevated inflammatory markers. Five of the patients (29.41%) were smokers, and 8 (47.06%) had had a pre-existing diagnosis of anxiety and/or depression. From our findings, we recommend that middle-age females and those with a history of anxiety or depression, who will undergo elective foot surgery, should be counseled regarding the risk of developing CRPS during the consent process. We recommend similar studies be undertaken in other orthopedic units, and we currently are collecting data from other orthopedic departments within Scotland. © 2014 American College of Foot and Ankle Surgeons. Source

Petti S.,University of Rome La Sapienza | Polimeni A.,University of Rome La Sapienza | Dancer S.J.,Hairmyres Hospital
American Journal of Infection Control | Year: 2013

Background: Environmental contamination and transmission of methicillin-resistant Staphylococcus aureus (MRSA) have been reported in dental health care settings. National professional dental associations recommend controlling surface contamination using disposable barriers or disinfection. Because these procedures may be costly, impractical, and/or toxic, we compared their effect against traditional detergent-based cleaning for decontaminating a dental chair sprayed with MRSA. Methods: Five MRSA strain suspensions were aerosolized to give a density of approximately 10 colony-forming units/cm 2 MRSA on the dental chair 5 minutes after dispersal. Three different decontamination protocols were applied: protocol 1: disposable barriers positioned before aerosol production and removed after 5 minutes; protocol 2: disinfection (wipe-rinse method) with 1:10 dilution of 5.25% to 6.15% sodium hypochlorite solution; protocol 3: cleaning (wipe-rinse method) with a sodium-lauryl-sulphate-based detergent. Contact plates containing Mannitol Salt Agar were used to assess the level of MRSA contamination. Results: All 3 protocols decreased MRSA surface load by >99%. Residual densities on the dental chair were 0.030 ± 0.010 (protocol 1), 0.029 ± 0.09 (protocol 2), and 0.030 ± 0.011 (protocol 3) colony-forming units/cm 2. Conclusion: Cleaning (wipe-rinse method) using a sodium-lauryl-sulphate-based detergent demonstrated equivalence with disposable barrier placement or disinfection-based protocol for reducing MRSA contamination on dental chairs. This has practical and cost implications for controlling MRSA transmission in dental health care settings. Source

Dancer S.J.,Hairmyres Hospital
Journal of Hospital Infection | Year: 2010

In response to the rising tide of hospital-acquired infections (HAIs) in UK hospitals, governmental health departments have introduced dress codes for healthcare staff. These include measures such as the use of short sleeves, no wristwatches or jewellery, and avoidance of ties and white coats. Although hospital pathogens have been found on such items, there is no evidence that they play a major role in transmitting HAIs and these policies have received much criticism. This Leader examines the evidence underpinning the new dress codes and concludes that there is insufficient evidence to justify recent policies. Dress codes appear to have been imposed more for political purposes than in deference to effective infection control. In addition, the UK 'zero tolerance' mandate towards HAI does not balance personal accountability against a failing healthcare system. These policies may try to impose good practice but over-reliance on cheap, short-term solutions will not adequately address longer-term problems with HAI. © 2009 The Hospital Infection Society. Source

There is increasing interest in the role of cleaning for managing hospital-acquired infections (HAI). Pathogens such as vancomy-cin-resistant enterococci (VRE), methicillin-resistant Staphylo-coccus aureus (MRSA), multiresistant Gram-negative bacilli, no-rovirus, and Clostridium difficile persist in the health care environment for days. Both detergent- and disinfectant-based cleaning can help control these pathogens, although difficulties with measuring cleanliness have compromised the quality of published evidence. Traditional cleaning methods are notoriously inefficient for decontamination, and new approaches have been proposed, including disinfectants, steam, automated dispersal systems, and antimicrobial surfaces. These methods are difficult to evaluate for cost-effectiveness because environmental data are not usually modeled against patient outcome. Recent studies have reported the valueof physically removing soil using detergent, compared with more expensive (and toxic) disinfectants. Simple cleaning methods should be evaluated against nonmanual disinfection using standardized sampling and surveillance. Given worldwide concern over escalating antimicrobial resistance, it is clear that more studies on health care decontamination are required. Cleaning schedules should be adapted to reflect clinical risk, location, type of site, and hand touch frequency and should be evaluated for cost versus benefit for both routine and outbreak situations. Forthcoming evidence onthe roleof antimicrobial surfaces could supplement infection prevention strategies for health care environments, including those targeting multidrug-resistant pathogens. © 2014, American Society for Microbiology. All Rights Reserved. Source

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