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Friday, February 21, 2014

ESBL + Male Gender = Dirty Environment

As I penned the title to this week's blog, the irony was not lost on me as I live in a household of males: husband, son, cat and even the fish.  Being the chief kitty litter and fish bowl cleaner I know what those to can do and for anyone who has children, I'm sure I do not have to describe the mess an active 5 year old boy can make - particularly since we've entered the LEGO phase of our lives.  As for my husband, he's a lost cause....

Thinking that the male gender makes for a dirty environment and finding the scientific evidence to support your theory are two entirely different things altogether!  But Freeman et al spelt it out in black and white in their recently published study titled "Predictors of hospital surface contamination with Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae: patient and organism factors".  The study as you've likely surmised is not about how dirty men make their environment, but rather an investigation to determine if the rates of environmental contamination are higher with ESBL K. pneumoniae (ESBL-KP) or ESBL E. coli (ESBL-EC).

Before delving into the study, I do not want to assume that everyone knows what ESBL or extended-spectrum β-lactamase organisms are.  In a nutshell, they are gram-negative bacteria that produce an enzyme, beta-lactamase that can break down commonly used antibiotics, such as penicillin and cephalosporins, making infections with ESBL producing bacteria more difficult to treat.  E.coli and Klebsiella pneumoniae are common producers of ESBL, and they usually cause urinary tract infections (UTIs) and bacteraemia.

Before trying to blame their associated ability to contaminate the environment with the fact that these are antibiotic resistant organisms (AROs) recall my blog Doors , Keys and Sledgehammers which discussed the fact that antibiotic resistance does not equal chemical resistance.  A bug is a bug in terms of disinfectant efficacy...as long as the disinfectant is used correctly and contact times are met - but we'll save that for another blog. 

Nor should you think that your EVS department cannot play a vital in stopping the spread of ESBLs or other AROs as the NIH facility in Bethesda, MD proved that enhanced cleaning can stop an outbreak.  Read the Fancy that - Implementing Tougher Cleaning Standards Halts Outbreak to learn more about that story.

The moral of the story, I mean study, as presented by Freeman and his colleagues is that patients with ESBL-KP or ESBL-EC are more likely to contaminate their hospital room with viable bacteria and they can do so more effectively if colonized or infected with ESBL-KP as compared to ESBL-EC.  As the researcher stated, one possible explanation for the fact that ESBL-KP made for a dirtier environment could be due to the intrinsic biological differences between E. coli and K. pneumoniae.  In keeping with the title of the blog, they found that there was an association between male gender and environmental contamination that trended towards significance possible reflecting gender-based differences in hygiene practices.  As ESBL's are known to cause UTIs perhaps that fact that many men do not clean their hands after using the facilities and we all know women always wash their hands!

Nor did prior cleaning seem to have a significant effect on contamination rates in part perhaps because cleaning was inadequate (and contact time was not met) or due to the fact that recontamination occurred rapidly post cleaning.  In the end, ESBL-KP environmental contamination seems to be higher than ESBL-EC which may help to explain the corresponding differences in transmission rates between the two organisms.

This bodes the question, should we consider increasing the frequency of cleaning and disinfection to at least twice per day?  The CDC recommends increasing cleaning and disinfection to three times per day for Norovirus.  Perhaps we need to consider this with all organisms that have shown the ability to contaminate the environment and lead to colonization or infection?  You run the numbers, which will save the facility more money? Increasing cleaning frequency (manpower and chemical use) and decreasing HAI rates or maintaining status quo and paying for HAIs which in recent figures I have seen cost a facility upwards of $19 Million per year!

Bugging Off!


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