Dental News - Study uncovers abysmally low adherence to sterilization protocols

Dental Tribune International

Thu. 29. November 2018

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ARLINGTON, Va., U.S.: The importance of sterilization in the dental practice and operating room cannot be underestimated. In a new study, researchers have found that adherence to proven protocols for disinfecting hands, patients’ skin and surfaces could help to halt the spread of dangerous Staphylococcus aureus pathogens from controlled spaces and beyond.

Despite the solid evidence supporting improved practices for hand hygiene, vascular access, and patient skin disinfection, researchers from the University of Iowa Hospitals and Clinics have reported that adherence to preventive measures is abysmal. They suggested that the poor practices may help to explain why up to 7 percent of patients undergoing surgery continue to contract at least one postoperative infection.

With the increased spread of antibiotic-resistant S. aureus pathogens from acute care settings to healthy members of the community, the researchers identified and characterized the epidemiology of particularly pathogenic S. aureus sequence types (STs) in the operating room. “The increase in the spread of S. aureus pathogens beyond the acute care setting is alarming, but we know that there are evidence-based practices that can address this critical patient safety issue,” said the study’s lead author, Dr. Randy W. Loftus from the Department of Anesthesia. “The goal of the study was to increase awareness around the transmission of the different strains, with the aim of improving compliance with proven infection control measures.”

In the study, S. aureus isolates were collected from three academic medical centers. After this, transmission dynamics for hypertransmissible, strong biofilm-forming, antibiotic-resistant and virulent STs were assessed using a systematic phenotypic and genomic approach combined with a new software platform. The transmission story for these key pathogens was then mapped and reported.

The researchers found that S. aureus ST 5 is a more pathogenic strain associated with increased strength of biofilm formation and increased risk of transmission and infection. Two of the ST 5 isolates were linked by whole-cell genome analysis to postoperative infection, something the researchers believe is an alarming finding that likely underestimates the true magnitude of the problem. The combination of ST 5 pathogenicity, an aging patient population, and increasingly complex surgical procedures may help to explain the increase in the community spread of invasive methicillin-resistant S. aureus infections.

Unsurprisingly, the researchers confirmed patient skin surfaces and healthcare provider hands as sources of ST 5 pathogen transmission. They suggested that strict compliance with processes to decolonize patients of bacteria before surgery and to maintain hand hygiene compliance during surgery will likely help control the spread of this important strain characteristic. They noted as well that operating room environmental surfaces were linked with transmission, indicating the importance of continually assessing the effectiveness of environmental cleaning protocols.

The study, titled “High-risk Staphylococcus aureus transmission in the operating room: A call for widespread improvements in perioperative hand hygiene and patient decolonization practices,” was published in the October issue of the American Journal of Infection Control.

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