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The Effectiveness of Disinfecting Protocols in Osteopathic Family Medicine Offices

Journal: Journal of Osteopathic Medicine Date: 2023/12, 123(12):Pages: A106-A107. doi: Subito , type of study: cross sectional study

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2023-2000/html)

Keywords:

cross sectional study [597]
disinfection [3]
family medicine [25]
protocol [35]
USA [1086]

Abstract:

Statement of Significance: Healthcare-associated infections (HAIs) are a public health threat.(1) Despite efforts to curb HAIs in hospital environments, outpatient settings, notably in osteopathic family medicine, have not received the same degree of attention.(2-5) Osteopathic family medicine offices, as centers for holistic care, highlight the crucial role of simple disinfection protocols like thorough cleaning between patient appointments in reducing disease transmission and enhancing overall patient health. To assess the effectiveness of the current disinfection protocols in osteopathic family medicine offices. Research Methods: A cross-sectional study evaluating disinfection practices on 18 active examination tables in an Osteopathic family medicine office was conducted. Two high-touch surfaces, namely the mid-torso region (Location A) and table edge (Location B), were the focal points of the study. Initial samples were collected post-morning disinfection by Environmental Services, and terminal samples gathered post-day’s end disinfection by the medical staff. ATP bioluminescence assays were performed using AccuPoint Advanced HC Reader, which quantified ATP, indicating contamination levels in the samples. All samplers were handled and tested as per manufacturer’s instructions, with ATP level of 500 RLU/100cm2 deemed the benchmark threshold for interpretation. A preliminary trial was conducted to confirm the internal validity of ATP bioluminescence measurements. The statistical analysis involved Shapiro-Wilks and Wilicoxin signed rank tests, with significance set at p < 0.05. Cohen’s d test was used to calculate the effect size, identifying meaningful differences in initial and terminal sample RLUs. Data Analysis: In our disinfection protocol validity trial, significant reductions in pathogen levels were observed in both selected locations following the disinfection procedure. For Location A (Mid-torso), the pre-disinfection pathogen levels (Median=2250 RLU, Range=551-5900 RLU, N=18) were significantly reduced post-disinfection to Median=175.5 RLU, Range=3-391 RLU, N=18, with z=5.40, p<0.00001. Despite this reduction, the terminal sample showed a decrease in pass rate from an initial 94.4% (17 out of 18 samples < 500 RLUs) to 83.3% (15 out of 18 samples < 500 RLUs). The Wilcoxon signed rank test revealed no significant difference in estimated pathogen levels between initial (Median=134 RLU, Range=4-946 RLU, N=18) and terminal samples (Median=193 RLU, Range=1-690 RLU, N=18), with z=0.11, p=0.9124 and a small effect size, d=0.04. Similarly, Location B (Edge) saw a significant reduction in pathogen levels from pre-disinfection (Median=2225 RLU, Range=701-7201 RLU, N=18) to post-disinfection (Median=221 RLU, Range=5-530 RLU, N=18), with z=5.40, p<0.00001. Unlike Location A, however, Location B had no successful disinfection (0 out of 18 samples < 500 RLUs) in both initial and terminal samples. The Wilcoxon signed rank test indicated no significant difference in pathogen levels between the initial (Median=2257 RLUs, Range=932-5825 RLUs, N=18) and terminal samples (Median=2095 RLUs, Range=891-5540 RLUs, N=18), with z=-0.57, p=0.61 and a small effect size, d=0.12. Conclusion: The findings from this study reveal a significant disparity in outcomes between the two sample locations, Location A (Mid-torso) and Location B (Edge). Location A demonstrated a relatively low failure rate in both initial and terminal samples, indicating successful outcomes. In contrast, Location B consistently displayed a 100% failure rate, emphasizing the need for more care and attention when cleaning the edge of the examination to ensure better outcomes. By prioritizing adequate disinfection protocols, including thorough cleaning between patients, osteopathic family medicine offices can effectively prevent disease transmission, promote patient safety, and align with the principles of holistic and patient-centered care.


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