New Study Finds High-Touch Surfaces in Long-Term Care Facilities are Frequently Contaminated with Potentially Infectious Material
Results published in American Journal of Infection Control provide insights for enhancing infection prevention and control programs designed to prevent serious diarrheal illnesses among facility residents
Arlington, Va., February 17, 2022 – Findings from a study published today in the American Journal of Infection Control (AJIC) provide new insights that could help long-term care (LTC) facilities assess the cleanliness of high-touch surfaces, and thereby enhance infection prevention and control measures designed to prevent serious diarrheal diseases and deaths among their residents. The study evaluated the utility of specific hygienic monitoring tools for assessing levels of microbial contamination on high-touch surfaces in 11 LTC facilities in South Carolina.
“Our study is among only four conducted to date evaluating environmental hygiene in LTC facilities,” said Jennifer Cannon, Ph.D., CDC Foundation field employee working with the Centers for Disease Control and Prevention (CDC), and the paper’s lead author. “Increasingly, hospitals are performing routine audits of high-touch surface cleanliness, helping to reduce morbidity and mortality among residents. Our results suggest similar auditing programs would benefit LTC facilities when included as part of their infection prevention programs.”
Diarrheal illnesses caused by norovirus and C. difficile infections (CDI) are among the most frequent healthcare-associated infections in LTC facilities; in the United States, approximately 60% of norovirus outbreaks and more than 50% of all healthcare-associated CDI occur in LTC facilities. Both pathogens can be transmitted by environmental surfaces contaminated with fecal matter. While environmental monitoring using surface hygiene indicators is a valuable tool to help prevent the spread of infection, there are no standard technologies or methodologies, and many monitoring tools are too expensive to be used routinely.
For their study, Dr. Cannon and her colleagues used three tools to evaluate the cleanliness of a minimum of 30 surfaces in each of 11 LTC facilities in South Carolina: adenosine triphosphate (ATP), a bioluminescent chemical reaction that indicates the presence of organic material; norovirus; and crAssphage, a recently discovered DNA bacteriophage that indicates past or present fecal contamination. Their study was the first to utilize crAssphage as a fecal contamination indicator in the LTC setting.
Ninety percent of the high-touch surfaces the researchers tested (n=337) were positive for crAssphage or had organic material levels that resulted in failing ATP cleanliness scores.
Aggregating data from all 11 facilities, Dr. Cannon and colleagues combined the ATP and crAssphage tools to identify the types of surfaces and locations most likely to be contaminated by organic or fecal material:
“This study provides valuable new information that could help LTC facilities monitor their cleaning practices and refine their infection-prevention plans to better protect patients from serious diarrheal illnesses,” said Linda Dickey, RN, MPH, CIC, FAPIC, and 2022 APIC president.