The contamination of surfaces in the environment associated with a higher risk of hospital infections. Bacteria and viruses can live on inanimate surfaces for up to several months and in the absence of adequate environmental hygiene measures and hand hygiene practices, hospital environment may become a reservoir for serious pathogens.  
​Flu viruses 
Flu viruses capable of being transferred to hands and causing an infection can survive on hard surfaces for 24 hours. Infectious flu viruses can survive on tissues for only 15 minutes Flu viruses can also survive as droplets in the air for several hours; low temperatures increase their survival in the air.
Stomach bugs
There are many bugs that can cause a stomach/bowel issues. These include bacteria such as E. coli, Salmonella, Clostridium difficile and Campylobacter, as well as viruses such as norovirus and rotavirus. Salmonella and campylobacter survive for short periods of around 1-4 hours on hard surfaces or fabrics. Norovirus and C. difficile, however, can survive for much longer. In one study, C. difficile was shown to survive for five months. Norovirus can survive for days or weeks on hard surfaces. When someone with norovirus vomits, the virus is distributed in small droplets in the air. These droplets can settle on surfaces, causing the virus to spread.
 MRSA and other multidrug resistant organisms
The MRSA and other MDR organisms can survive for days to up to 8 weeks on surfaces. They can live on surfaces for longer than some other bacteria and viruses because they survive better without moisture. Generally, MDR bacteria survive for longer on hard surfaces than on soft surfaces.
Herpes 
Herpes viruses from cold sores around the mouth can survive for two hours on the skin. If your patient has a cold sore, encourage the patient not to touch it. If patient does touch it, ensure hand washing immediately afterwards

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Central line-associated bloodstream infections (CLABSIs) result in thousands of deaths each year and billions of dollars in added costs to the U.S. healthcare system, yet these infections are preventable.
Strategies to Prevent CLABSI include the following:
1. Perform hand hygiene before insertion
2. Use maxima
3. l sterile barrier precautions (mask, cap, gown, sterile gloves, and sterile full body drape)
4. Central Lines (SC, IJ, PICC) and inserted under sterile technique with, patient must be covered with maximal barrier drape
5. Choose the best insertion site to minimize infections and noninfectious complications, avoid femoral site
6. Use central line insertion kit with antimicrobial catheters
7. The Most Important Measure - physician daily line necessity and line removal if unnecessary
8. Central Line Insertion Checklist is completed after insertion
9. Ethicon BioPatch impregnated CHG dressing
10. SwabCap alcohol cap protectors for injection hubs
11. Scrub the Hub for 15 seconds when accessing injection hubs
​12. Daily body cleanse with Sage CHG impregnated washcloths in the I

Updated guidelines on the diagnosis and treatment of Clostridium difficile (C. diff.) have been published. Diagnosis and treatment of C. diff. has evolved significantly since the last guidelines were published in 2010.
C. diff. is diagnosed based on a patient’s medical history, signs and symptoms, combined with test results. The optimal method for laboratory diagnosis of C. diff. is the subject of debate and depends on how carefully patients are selected for testing. The updated guidelines recommend only testing patients with new onset and unexplained diarrhea (three or more unformed stools in 24 hours).
While immunoassays were the most common diagnostics employed previously, molecular testing – which has its pros and cons – is now used by more than 70 percent of hospital labs. Molecular tests can help rule out C. diff. infection, as well as reduce transmission by detecting C. diff. colonization in patients with diarrhea from other causes. But because they are very sensitive and can lead to over diagnosis, when there are no pre-agreed institutional criteria that limit testing to patients with significant unexplained diarrhea of three or more unformed stools in 24 hours, the guidelines recommend that a C. diff. common antigen test and a stool toxin test (such as an immunoassay) be used as part of a two- or three-step test process.
Not everyone diagnosed with C. diff. requires treatment. The guidelines include new recommendations for treatment when warranted, including:

• Vancomycin or fidaxomicin – Antibiotics vancomycin or fidaxomicin should be used for initial treatment of even mildC. diff., rather than metronidazole, which the previous guidelines recommended as first-line therapy. Research shows the cure rates are higher for vancomycin and fidaxomicin than for metronidazole.
• Fecal microbiota transplantation (FMT) – The guidelines recommend FMT for treatment of people with two or more recurrences of C. diff. and for whom traditional antibiotic treatment has not worked. FMT is a new treatment since the last guidelines were published but is not approved by the Food and Drug Administration (FDA). However, FDA has issued Guidance for Industry regarding the use of FMT to treat C. diff. infection not responsive to standard therapies. FMT involves transferring fecal bacteria from a healthy person’s stool to the gut of a person with recurrent C. diff., to replenish the good bacteria and control the disease-causing bacteria.

The guidelines include the same suggestions for preventing the spread of C. diff. as the 2010 guidelines – including isolating infected patients and ensuring healthcare workers and visitors use gloves and gowns – but also call for increased attention to antibiotic stewardship to reduce the unwarranted use of the drugs. While nearly all antibiotics predispose people to C. diff., some are of particular concern, including the fluoroquinolones, cephalosporins and clindamycin.
The new guidelines also include recommendations for epidemiologic surveillance, diagnosis, and treatment of C. diff. in children, which the 2010 guidelines did not address.

​C. difficile has been reported as one of the most common causes of health careassociated infections in U.S. hospitals, thus it is important to know if the practice of providing these patients prophylactic CDI therapy is effective. CDI is expensive to treat and more importantly, it is associated with significant morbidity and mortality. Attributable mortality ranges between 5% and 10%. Furthermore, it was recently estimated that the inpatient cost of one episode of recurrent CDI was $11,631, with an overall cost to the health care system of $4.8 billion annually. Literature evaluating the role of secondary prophylaxis in high-risk patients is sparse. However, there are few recently published studies indicating that prophylaxis with oral vancomycin had an impact on the incidence of recurrent CDI. One of the studies was conducted at the University of Indiana Medical School. There were 203 patients with a history of CDI meeting criteria as high risk included in the study. The results demonstrated that one of 71 patients (1%) given oral prophylaxis experienced recurrence of C. difficile compared with 35 (37%) out of 132 patients not given the prophylaxis (p <0.001). Similarly, Wong and colleagues presented a study that included patients who were treated with antibiotics for a non-CDI indication 14 to 90 days following an initial CDI diagnosis. Patients receiving prophylaxis relapsed less often than the control group (6.25% vs. 19.3%; P = .003) — a 67.6% risk reduction. 

Hand-carriage of pathogens remains one of the most significant challenges in the healthcare settings because it is so pervasive and is inextricably linked to the state of cleanliness of surfaces in the patient-care environment.
Huslage, et al. (2010) remind us that, "In the global infection control community, it is widely accepted that contaminated environmental surfaces, contaminated equipment, and contaminated hands of healthcare workers all have been linked to the transmission of several pathogens, which has led to individual cases and multiple outbreaks of healthcare-acquired infection."

C. difficile forms spores that are resistant to many disinfectants and can persist in the hospital environment for months.  Approximately 500,000 people contract C. diff while in the hospital every year in the U.S., and nearly 15,000 die directly from the infection. Immunocompromised patients are more susceptible to infections than other inpatients.
 
Several new cleaning tactics—on top of all the scrubbing, mopping, spraying, and wiping performed by Environmental Services (EVS) professionals—have been implemented at hospitals across the U.S to help reduce transmission of such infections, but which new methods are the most effective  and practical has remained unclear. New research from Perelman School of Medicine at the University of Pennsylvania helped to fill that gap.
 
The study found that treating empty patient rooms with ultraviolet C light disinfection robots can substantially reduce the rate of C. difficile infections in high-risk patients who will later occupy the rooms.
For the study, researchers conducted the disinfection technique and monitored its impact on C. diff infection rates over a one-year period (February 2014 to January 2015) across three units at the Hospital of the University of Pennsylvania in Philadelphia. The addition of UV disinfection to infection prevention protocols was associated with a 25 percent reduction in C. diff infection rates among new patients in the three study units. Concurrently, C. difficile rates increased by 16 percent in units outside of the study.
 
The findings of this study have real implications for both healthcare facilities and patients. The effectiveness and efficiency of UV-C robots make it a practical and cost effective technology that will benefit hospitals around the country and save people's lives.

Pegues DA, et al. Infect Control Hosp Epidemiol. 2016;doi:10.1017/ice.2016.222