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20 INFECTION CONTROL & PATIENT SAFETY Soiled Linens Could be Surface C. diff Contamination Source By Anuja Vaidya D irty linens from healthcare facilities may be a source of environmental Clostridium difficile contamination, according to a paper published in FEMS Microbi- ology Letters. In 2015, researchers examined linens at a laundry facility that services six hospitals, 30 local outpatient clinics and the Washington National Primate Research Center, all located in the Seattle area. They collected 240 sur- face samples from dirty areas, which handle soiled clinical linens, and from clean areas, which process and fold the clean linens. Of the samples taken from surfaces in the dirty areas, 23 percent tested positive for C. diff. Only 2 percent of samples from the clean areas test- ed positive for C. diff — these came from a small area where soiled linen is handled in small batches. Thus, the study found that the dirty linens were the likely source of the environmental contamination in the laundry. The researchers do, however, note a number of study limitations, includ- ing the inherently poor recovery of microbes from environmental surfac- es, difficulty in culturing C. diff spores, as well as differences in recommend- ed incubation times and media used. "This research supports the idea that it's possible for the soiled hospital lin- ens to contaminate the environment with C. difficile, which is the number one cause of hospital associated diar- rhea," said Marilyn Roberts, PhD, study author and professor of environmen- tal and occupational health sciences at the University of Washington's pub- lic health school in Seattle. n Robotic Instruments Are Nearly Impossible to Clean Completely, Study Shows By Anuja Vaidya R emoving all contamination from robotic surgical instru- ments, even after cleaning multiple times, is close to impossi- ble, according to a study in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America. Researchers examined 132 robot- ic and ordinary instruments over a 21-month period. They collected the instruments immediately after use to determine the level of contamination. The researchers used in-house clean- ing methods, including manual pro- cedures with ultrasonication following the manufacturers' instructions. Robotic instruments, with their com- plex structures, have a greater pro- tein residue and lower cleaning ef- ficacy as compared to conventional tools, the study found. The cleanings were 97.6 percent effective for robot- ic instruments and 99.1 percent ef- fective for ordinary instruments. The study authors suggest establishing new cleaning standards that include re- peatedly measuring residual protein, in- stead of only measuring contamination levels once after cleaning. "These instruments are wonderful tools that allow surgeons to operate with care; but completely decontam- inating them has been a challenge for hospitals," Yuhei Saito, RN, lead author of the study and assistant professor at the University of Tokyo Hospital. "By implementing new cleaning proce- dures using repeated measurements of the level of contamination on an instrument more than once, we could potentially save many patients from future infections." n Survey Shows Poor Adherence to CLABSI Prevention Guidelines Worldwide By Heather Punke F ew hospitals worldwide follow com- mon central line recommendations designed to reduce the number of central line-associated bloodstream infec- tions, according to survey results published in Antimicrobial Resistance & Infection Con- trol. Physicians and nurses in intensive care units in 95 countries completed an online survey between June and October 2015 on their practices related to central line in- sertion, maintenance and measurement of CLABSIs. Researchers analyzed responses from 14 middle income and 27 high income countries. e survey revealed the following: • Availability of written clinical guidelines for CLABSI prevention — 80 percent of middle income, 81 percent of high income countries • Compliance with a bundle of recom- mended central line insertion practices — 23 percent of MICs, 60 percent of HICs • Daily assessment of central line necessity — 60 percent of MICs, 73 percent of HICs "is international study shows that there is clear interest and awareness in the ICU community for CLABSI prevention in high and middle income countries, but imple- mentation and adherence to existing guide- lines on insertion and maintenance of [cen- tral lines] need to be reinforced at [the] ICU level," the authors concluded. e main areas for improvement related to CLABSI prevention uncovered by the sur- vey include full barrier precautions, daily assessment of central line necessity and use of data to monitor progress in preventive actions, the study concluded. n