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Implementing Enhanced Disinfection Protocols in Medical School OMM Labs

Journal: Journal of Osteopathic Medicine Date: 2023/12, 123(12):Pages: A98-A99. doi: Subito , type of study: longitudinal study

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

Keywords:

disinfection [3]
laboratory [5]
longitudinal study [28]
medical schools [156]
osteopathic medicine [1540]
protocol [35]
USA [1086]

Abstract:

Statement of Significance: Disinfection in healthcare facilities has gained heightened attention due to COVID-19.(1) Our previous research found several limitations in existing Osteopathic Manipulative Medicine (OMM) lab protocols, particularly focusing on high contact areas.(2) Given the high interaction in these labs, optimal disinfection is crucial for the safety of students and faculty. This follow-up study aimed to evaluate the efficacy of an enhanced disinfection protocol to address the identified limitations. To measure the effectiveness of a newly introduced enhanced disinfection protocol by comparing student disinfection results with baseline data. Additionally, we sought to evaluate the retention and consistent implementation of this protocol by the students over a two-week period. Research Methods: This longitudinal, nonrandomized study, tracked the implementation and effectiveness of an enhanced disinfection protocol on 20 Osteopathic Manipulative Medicine (OMM) examination tables. Tables were chosen based on their proximity to the podium and usage by students, maintaining consistency with our previous study.(2) Swab samples were collected from two high-touch areas (Location A: face cradle, Location B: mid-torso region) before and after applying the disinfection protocol. The enhanced disinfection protocol, detailed in five steps, involved thorough cleaning of the face cradle, flat surfaces, perimeter, creases, and adjustment handles of the examination tables. To assess the internal validity of our protocol, samples were collected before and after disinfection, with a 10-minute interval post-disinfection to avoid skewing results due to residual disinfectant. Two rounds of data collection were carried out. Day 1 involved disseminating the protocol among students through a short instructional video and flyers, followed by sample collection. Day 2 data collection, conducted two weeks later, served to assess the organic retention of the protocol by students, who were not informed about the post-class swabbing this time. ATP bioluminescence assays were performed using the AccuPoint Advanced HC Reader (3), which quantifies ATP content from organic matter in the form of relative light units (RLUs). The threshold for interpretation was set at ATP level of 500 RLU/100cm2. Statistical tests involved setting ATP values of less than 500 RLUs as a pass, and those of 500 or more as a failure. Shapiro-Wilks test was used for normality, while a nonparametric Wilcoxon signed rank test compared initial and terminal sample RLUs. Significance was set at p < 0.05. Cohen’s d test helped determine the magnitude of differences in RLUs, with a large effect size classified as d > 0.80. Data Analysis: In the disinfection protocol validity trial, significant reductions in pathogen levels post-disinfection were seen in both locations. For Location A, the initial levels (Median=2673.5 RLU, Range=855-5012 RLU, N=20) reduced post-disinfection to Median=127 RLU, Range=0-315 RLU, N=20, with z=5.40, p<0.00001. Similar reductions were seen in Location B, from initial levels (Median=2038 RLU, Range=612-6020 RLU, N=20) to post-disinfection levels (Median=101.5 RLU, Range=0-312 RLU, N=20), with z=5.40, p<0.00001. Location A’s Day 1 post-disinfection sampling indicated a 95.0% success rate (19 out of 20 samples < 500 RLUs), while Day 2 showed a marked decrease to a 40.0% success rate (8 out of 20 samples < 500 RLUs). Wilcoxon signed rank test revealed significantly higher estimated pathogen levels on Day 2 (Median=703 RLU, Range=23-1345 RLU, N=20) than baseline (Median=127 RLU, Range=0-315 RLU, N=20), with z=-4.18, p<0.00001 and a large effect size, d=1.71. Location B yielded a 100% success rate on Day 1 (20 out of 20 samples < 500 RLUs), reducing to 55.0% on Day 2 (11 out of 20 samples < 500 RLUs). Here, the Wilcoxon signed rank test showed significant increase in estimated pathogen levels on Day 2 (Median=376.5 RLU, Range=15-1467 RLU, N=20) compared to baseline (Median=101.5 RLU, Range=0-312 RLU, N=20), with z=-3.12, p=0.0018 and a large effect size, d=1.24. Conclusion: This study not only validates an enhanced disinfection protocol, significantly reducing potential pathogen levels in OMM labs, but also prompted an institution-wide reform in disinfection practices. The results led to the immediate implementation of the enhanced protocol across all medical education settings in our institution. However, the noticeable decline in adherence over two weeks underscores the necessity for sustained training, monitoring, and reinforcement of these practices. As a result, our institution has committed to ongoing education and adherence assessments. This research reaffirms the critical importance of consistent hygiene practices in medical education, demonstrating that the true effectiveness of a disinfection protocol lies in its regular and meticulous application. The institutional impact of this study highlights the broader implications for maintaining safe learning environments, prompting the continuous refinement of hygiene protocols based on emerging research findings.


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