Vetnuus | October 2024 23 Results Unannounced human hospital inspections with ATP testing exhibited failure in 72% of swabs, Malik et al (2003), whilst more recent data (Chang et al 2015) reports an initial (preintervention) failure rate of 57.1%, in contrast in this trial the average failure rate using existing products and current cleaning and disinfection protocols over the three sites was 92%. The level of contamination detected before intervention, i.e. using current in-use cleaning and disinfectant products and methods was 23.3 times the recommended maximum level, with a 92% failure rate, as shown in the Baseline Results in Table 1. The thresholds used were 100 (in public access and clerical areas), 50 in patient-side areas, 25 in intensive care environments, and 10 in food preparation and sterile areas. These thresholds were selected based on research conducted with ‘Hygiena Ensure’ in human hospitals. Using a two-stage sanitisation protocol with the propriety cleaning and disinfectant products, the first post-intervention sampling, (on average 70 days later) the average failure multiple was reduced from 23.3 to 6.9 times, an average of 70.4% reduction in the quantum of contamination was recorded. Following the sharing of results subsequent to the first post-intervention test, each practice had a further 60 days to improve their efforts prior to a further test. At the second post-intervention test, a reduction of contamination levels (start to final test), of 85.8% was achieved with a reduction from 23.3 times to 3.3 times over the maximum recommended level. Stage 1 indicates variance in cleaning and disinfection efficiency between practices. Stage 2 shows improved cleaning and disinfection efficiency of all practices after 45 minutes of training AND understanding and a two stage cleaning and hygiene protocol AND the results and feedback to motivate improvement in cleaning and working practices within the practice. Stage 3 shows yet further improvement, all be it with further progress required. Conclusions Based on this very small feasibility study, it appears that training with understanding, improved hygiene procedures and regular testing, may be able to achieve a >83% reduction in contamination levels within 4 months in UK veterinary practices. We can and should be doing ‘Practice Infection Control’ much better. The author urges the RCVS to push for the Practice Standards Scheme to be made compulsory for all UK Vet Practices. The author believes a larger controlled trial should be undertaken, to provide statistically significant results, with subsequent publication in a peer-reviewed journal. This publication would also detail the levels of contamination detected in different practice areas and on common fomites, as well as advising on the numbers of swabs and required frequency of testing, in different sizes and types of practice. References Bridier A, Briandet R, Thomas V, Dubois-Brissonnet F. (2011).Resistanceofbacterialbiofilmstodisinfectants: a review. Biofouling. 2011 Oct;27(9):1017-32. doi: 10.1080/08927014.2011.626899. PMID: 22011093 Burgess BA, Morley PS (2015) Veterinary Hospital Surveillance Systems. Veterinary Clinics of North America Small Animal Practice. 45(2):235-42, Centres for disease control and prevention (2019). Options for Evaluating Environmental cleaning. https://www.cdc.gov/hai/toolkits/appendicesevaluating-environ-cleaning.html. Chan MC, Lin TY, Chiu YH, Huang TF, Chiu SK, Liu TL, Hung PS, Chang CM, Lin JC, (2015). 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J Hosp Infect, :80, 354-356 Mitchell BG, McGhie A, Whiteley G, Farrington A, Hall L, Halton K, White NM, (2020) Evaluating bio-burden of frequently touched surfaces using Adenosine Triphosphate bioluminescence (ATP): Results from the Researching Effective Approaches to Cleaning in Hospitals (REACH) trial. Infection, Disease & Health, :25, 3, 168-174. Parvin F, Hu H, Whiteley GS, Glasbey T, Vickery K,(2019). Difficulty in removing biofilm from dry surfaces. J Hosp Inf, 103: 4, 465-467 Singaravelu, A., Leggett, B., & Leonard, F. C. (2023). Improving infection control in a veterinary hospital: a detailed study on patterns of faecal contamination to inform changes in practice. Irish Veterinary Journal, 76(1), 4. Acknowledgements The author is indebted to support from Hygiena in respect of the supply of all the ATP swabs, to Health & Hygiene for supplying F10 cleaning and disinfection products and making fogging equipment available, also to the owners and managers of the practices for their willingness to be involved and to all the enthusiastic and hardworking staff in all the practices for their dedication to improving their own standards. v RESULTS TABLE 1b Article
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