title: The effectiveness of a single-stage versus traditional three-staged protocol of hospital disinfection at eradicating vancomycin-resistant Enterococci from frequently touched surfaces.
abstract: BACKGROUND
  Environmental contamination is a reservoir for vancomycin-resistant enterococcus (VRE) in hospitals.
  
  
  METHODS
  Environmental sampling of surfaces was undertaken anytime before disinfection and 1 hour after disinfection utilizing a sodium dichloroisocyanurate-based, 3-staged protocol (phase 1) or benzalkonium chloride-based, single-stage clean (phase 2). VRE colonization and infection rates are presented from 2010 to 2011, and audits of cleaning completeness were also analyzed.
  
  
  RESULTS
  Environmental samples collected before disinfection were significantly more likely to be contaminated with VRE during phase 1 than phase 2: 25.2% versus 4.6%, respectively; odds ratio (OR), 7.01 (P < .01). Environmental samples collected after disinfection were also significantly more likely to yield VRE during phase 1 compared with phase 2: 11.2% versus 1.1%, respectively; OR, 11.73 (P < .01). Rates of VRE colonization were higher during 2010 than 2011. Cleaning audits showed similar results over both time periods.
  
  
  CONCLUSIONS
  During use of a chlorine-based, 3-staged protocol, significantly higher residual levels of VRE contamination were identified, compared with levels detected during use of a benzalkonium chloride-based product for disinfection. This reduction in VRE may be due to a new disinfection product, more attention to the thoroughness of cleaning, or other supplementary efforts in our institution.
authors.affiliation: Department of Infectious Diseases, Barwon Health, Geelong, Victoria, Australia. friedman.deb@gmail.com
authors.forename: N Deborah
authors.initials: ND
authors.lastname: Friedman
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Walton
authors.forename: Sarah
authors.initials: S
authors.lastname: Boyd
authors.forename: Christopher
authors.initials: C
authors.lastname: Tremonti
authors.forename: Jillian
authors.initials: J
authors.lastname: Low
authors.forename: Kaylene
authors.initials: K
authors.lastname: Styles
authors.forename: Owen
authors.initials: O
authors.lastname: Harris
authors.forename: David
authors.initials: D
authors.lastname: Alfredson
authors.forename: Eugene
authors.initials: E
authors.lastname: Athan
mesh_terms: D001548:Benzalkonium Compounds / Q000494:pharmacology; D004202:Disinfectants / Q000494:pharmacology*; D004203:Disinfection / Q000379:methods*; D016983:Enterococcus / Q000187:drug effects* / Q000302:isolation & purification*; D004783:Environmental Microbiology; D006761:Hospitals; D006801:Humans; D014227:Triazines / Q000494:pharmacology; D020713:Vancomycin Resistance
chemical_list: D001548:Benzalkonium Compounds; D004202:Disinfectants; D014227:Triazines; C011765:troclosene