Reiniging en desinfectie van ruimten

Initiatief: SRI Aantal modules: 10

Reinigingsdoeken

Uitgangsvraag

Wat is het verschil in effectiviteit tussen reinigen met microvezeldoeken en reinigen met andere (conventionele)reinigingsdoeken?

Aanbeveling

  • Weeg bij de keuze uit een reinigingsdoek financiële haalbaarheid, gebruiksvriendelijkheid en het gebruik van milieubelastende materialen af.
  • Er is onvoldoende wetenschappelijk bewijs om op basis van effectiviteit een specifieke reinigingsdoek aan te bevelen.

Overwegingen

Voor- en nadelen van de interventie en de kwaliteit van het bewijs

De systematische literatuuranalyse heeft het effect van microvezeldoeken vergeleken met andere reinigingsdoeken (kant-en-klare doekjes, katoenen doeken en conventionele reinigingsdoeken). De kwaliteit van het bewijs van het effect van microvezeldoeken vergeleken met andere reinigingsdoeken is beoordeeld als zeer laag vanwege het kleine aantal studies en de heterogeniteit in studieopzet. Op basis van cruciale uitkomstmaten kan daarom geen besluit worden genomen of microvezeldoeken of andere reinigingsdoeken de voorkeur hebben in het reinigingsproces. Er lijkt wel een trend zichtbaar waarbij microvezeldoeken resulteren in een grotere reductie van het aantal kolonievormende eenheden en relative light units (RLU’s). Het is echter onduidelijk of deze trend ook een klinisch relevant verschil in de praktijk betreft. Daarnaast is onbekend of deze trend standhoudt na langdurig (her)gebruik van microvezeldoeken. De geïncludeerde studie van Diab-Elschahawi (2010) suggereert dat microvezeldoeken al na twintig wasbeurten een afname in effectiviteit laten zien als het gaat om het verwijderen van S. aureus of E. coli van oppervlakken. 

 

Microvezeldoek

In de praktijk worden zowel disposable- als reusable microvezeldoeken gebruikt.

 

Het is in het kader van duurzaamheid echter belangrijk een afweging te maken tussen de noodzaak voor het gebruik van disposable microvezeldoeken ten opzichte van reusable microvezeldoeken. Indien reusable microvezeldoeken worden gebruikt dienen deze direct na gebruik (verzadiging met vuil) te worden gewassen (zie richtlijn ‘Linnengoed’). Volg hierbij de instructies van de fabrikant. 

 

Andere reinigingsdoeken

Andere (katoenen en conventionele) reinigingsdoeken worden kant-en-klaar door de fabrikant geleverd of worden door de gebruiker vooraf geïmpregneerd met zepen en/of andere oppervlakactieve detergentia. Ze moeten direct na het uitpakken/aanraken gebruikt worden volgens voorschrift van de fabrikant. Als de dispenser waarin kant-en-klare reinigingsdoeken zijn opgeslagen niet goed wordt afgesloten zal door verlies van vochtigheid de werking verminderen.

 

Gooi gebruikte kant-en-klare reinigingsdoekjes direct na gebruik weg als afval (disposable) of in de waszak (reusable) om de uitgroei van micro-organismen en een opeenhoping van stof en vuil te voorkomen.

 

Waarden en voorkeuren van gebruikers

Zorginfecties kunnen ernstige gevolgen hebben voor patiënten. Adequate reiniging van de omgeving van de patiënt verlaagt de kans op besmetting van (andere) patiënten en zorgmedewerkers met ziekteverwekkers vanuit de omgeving en daarmee de kans op zorginfecties.

 

Omdat er geen eenduidig besluit wordt genomen of microvezeldoeken of andere reinigingsdoeken de voorkeur hebben in het reinigingsproces wordt er geen directe invloed voorzien op het niveau van de individuele patiënt.

 

Kosten (middelenbeslag) 

Reinigingsdoeken zijn variabel in kosten. Ook de tijd die nodig is voor het reinigen van een ruimte en bijbehorende standaardinrichting door microvezeldoeken en andere reinigingsdoeken kan variëren. In Nederlandse zorgorganisaties verschilt het budget dat beschikbaar is voor reinigen. Een zorginstelling kan hierin een eigen keus maken over welke reinigingsdoeken worden aangeschaft voor het reinigingsproces. 

 

Aanvaardbaarheid, haalbaarheid en implementatie

De aanvaardbaarheid en haalbaarheid van het reinigen van ruimten en bijbehorende standaardinrichting in deze ruimten in zorgorganisaties is niet kwalitatief of kwantitatief onderzocht. Er kan eveneens geen eenduidig besluit worden genomen of microvezeldoeken of andere reinigingsdoeken de voorkeur hebben in het reinigingsproces. Een zorginstelling zal daarom zelf een afweging moeten maken met betrekking tot de noodzaak en (financiële) haalbaarheid van reinigingsdoeken voor een effectieve en goede reiniging.

 

In de keuze voor een reinigingsdoek kan echter wel worden meegenomen dat mogelijk de tijd voor reinigen korter is wanneer gebruik gemaakt wordt van kant-en-klare reinigingsdoeken. Doordat ze direct te gebruiken zijn, zorgen kant-en-klare reinigingsdoeken voor een hogere compliance (Wiemken, 2014). 

 

Duurzaamheid

In het reinigingsproces wordt vaak gebruik gemaakt van disposable materialen. Daarnaast is het gebruik van reinigingsmiddelen vaak milieubelastend. Het is dus belangrijk een afweging te maken tussen de noodzaak voor het gebruik van disposable - en reusable materialen en het gebruik van milieubelastende middelen. Deze afweging moet vanuit infectiepreventieoogpunt verantwoord gebeuren en zal afhangen van de risico’s per zorgsetting. Duurzaamheid mag niet ten koste gaan van patiëntveiligheid. Bij gebruik van reusable reinigingsdoeken is het essentieel dat het wasproces met betrekking hergebruik van reinigingsdoeken goed is geborgd. Zie hiervoor tevens de richtlijn ‘Linnengoed (in ontwikkeling)’.

Onderbouwing

De afgelopen jaren zijn verschillende microvezeldoeken op de markt gekomen. Een reinigingsdoek mag een microvezeldoek worden genoemd als het vezels bevat die kleiner zijn dan 12 µm. Deze microvezels houden micro-organismen (vegetatieve bacteriën en/of schimmels en/of gisten en/of virussen en/of bacteriesporen) vast in de vezelstructuur. De microvezeldoek moet volgens voorschrift van de fabrikant klamvochtig gebruikt worden met schoon water. Een reinigingsmiddel mag niet worden gebruikt. Het reinigingsmiddel hecht zich namelijk aan de microvezels, waardoor deze hun werking verliezen. Naast microvezeldoeken zijn er ook andere reinigingsdoeken op de markt gekomen. Kant-en-klare reinigingsdoeken zijn vooraf geïmpregneerd met zepen en/of andere oppervlakte-actieve detergentia. Deze zepen en/of andere oppervlak actieve detergentia kunnen ook door de gebruiker actief op de doek gebracht worden. 

 

Het is momenteel onduidelijk wat het verschil is in effectiviteit tussen reinigen met microvezeldoeken en reinigen met kant-en-klare of andere reinigingsdoeken. 

Effectivity

Very low GRADE

The evidence is very uncertain about the effectivity of microfiber cloths in removing microorganisms compared to cotton cloths, general-purpose cloths, and conventional cloths. 

Sources: Diab-Elschahawi (2010), Hron (2019), Trajtman (2015), Wiemken (2014), Wren (2008)

 

Visual clean

Very low GRADE

The evidence is very uncertain about the effectivity of microfiber cloths compared to ready to use wipes and conventional cloths on the outcome measure visual clean. 

Sources: Wiemken (2014)

Description of studies

Diab-Elschahawi (2010) conducted an experiment to investigate the decontamination capacity of 4 different types of cleaning cloths (microfiber cleaning cloth, cotton cloth, sponge cloth, and disposable paper towels) in wet or dry conditions. Furthermore, all cloths were reprocessed 10 to 20 times and then analyzed for decontaminating abilities. Ceramic tiles (5x5cm) were contaminated with Staphylococcus aureus (ATCC 6538) and Escherichia coli (ATCC 8739) (5x107 colony-forming units (CFU) per ml; left to dry for 1 hour). All cloths were tested in dry and wet (with distilled water) conditions. Wiping was performed in a meander-like pattern, starting in the upper left corner, turning four times, and ending in the lower right corner. Reprocessing of the cloths was done in a washer disinfector and a laundry dryer (90°C for 5 minutes) up to 20 times. The test suspension remaining on the tiles was recovered from the tile surfaces by shaking the surfaces in Petri dishes filled with 10 mL casein-soya-lactose broth. Aliquots of this suspension were then plated on Tryptic Soy Agar and incubated for 48 hours at 35°C before CFUs were counted. Outcome measures were S. aureus and E. coli colony-forming units (CFUs) remaining on the tiles after wiping. 

 

Hron (2019) conducted an experiment to investigate the cleaning efficacy of 11 different samples of cloths (single-use wipes (50% rayon/50% polyester), 100% rayon, 100% polyester, 100% greige cotton (6.8 MJ kg-1), 100% greige cotton (8.9 MJ kg-1), 100% greige cotton (10.1 MJ kg-1), 100% greige cotton scoured and bleached, 80% polyester/20% greige cotton, 20% polyester/80% greige cotton, 80% rayon/20% greige cotton, and 20% rayon/80% greige cotton) in dry or wet (1ml of ultrapure water) condition. Stainless-steel plates were contaminated with either a protein contaminant (500 μl of 5% fetal bovine serum in phosphate buffered saline, dried overnight) or a hydrophobic residue (paraffin wax bead 50 ± 2 mg, melted and dried for 30 min). Wiping was performed by a machine performing 16 movements (71.3r/min, 9 kPa for protein, and 12kPa for hydrophobic residue). The outcome measure for the protein contaminant was protein uptake (mg/ml) of wipes, measured by putting wipes in phosphate buffered saline. For hydrophobic residue, a scale was used to measure the weight of the plate after wiping. 

 

Trajtman (2015) conducted an experiment to assess the removal of Clostridium difficile spores on surfaces cleaned by microfiber cloths compared with cotton cloths. The test surface consisted of ceramic tiles (2.2x2.2 cm) contaminated with C. difficile (2.3x104 spores/site (CFUs), dried overnight). Before assessing the outcome, tiles were sprayed with either phosphate buffer saline (PBS) or a hydrogen peroxide 0.01% cleaning agent. Transfer of C. difficile was also studied, by contaminating cloths directly with C. difficile. Wiping was performed by a machine. Each test cloth or ceramic carrier was placed in a 50 mL sterile conical tube containing 10 mL of sterile PBS. The tube was mixed by vortexing for 1 minute, sonicated 3 times for 5 seconds each time, followed by 1 minute of vortexing. The eluent was serially diluted 1:10 from 10-1-10-5 in PBS with a pH of 7.5. One hundred mL of the 10-2-10-4 dilutions were inoculated onto Clostridium difficile Monobactam Norfloxacin agar using the spread plate technique and incubated for 48 hours at 37°C. Outcome measures were C. difficile CFUs remaining on the ceramic tiles after wiping with microfiber cloths and cotton cloths, after wiping with cloths used twice, and after wiping with contaminated cloths. 

 

Wiemken (2014) conducted an experiment to evaluate the compliance related to using ready-to-use (RTU) disinfectant wipes compared with the bucket method. The bucket method refers to the traditional use of cleaning cloths saturated with diluted sodium hypochlorite cleaner/disinfectant in a bucket. Timeliness and cost-savings were also investigated. Cleaning with a cleaning cloth and bucket with sodium hypochlorite cleaner/disinfectant solutions was compared with ready-to-use (RTU) wipes impregnated with sodium hypochlorite cleaner/disinfectant solutions on 6 pre-specified areas in a patient room. Employees with environmental service responsibilities were randomized to one of both wiping methods. The outcome was measured as compliance: 0 points for total miss of the area, 1 point for partial miss, and 2 points for completely removing the fluorescent marker. 

 

Wren (2008) conducted an experiment comparing the ability to remove several types of organisms by ultramicrofiber (UMF)-woven cloths and conventional cloths moistened with water. UMF cloths were 80% polyamide and 20% polyester fiber. Five types of surfaces were used: 100 cm2 of a rough tile, a smooth tile, laminated worktops (new and worn), and stainless-steel surfaces. Surfaces were each inoculated with four microorganisms separately: methicillin-resistant Staphylococcus aureus (MRSA), Acinetobacter calcoaceticus var. baumannii (ACCB), Klebsiella oxytoca (K. oxytoca) in logarithmic phase growth, or spores of Clostridium difficile. Bacterial suspensions were made in phosphate-buffered saline (PBS) with or without 7% BSA, and 100 µL was subsequently used to inoculate areas of each surface. Wiping was performed as described by the manufacturer. Outcome measures were microorganisms remaining on the wiped surfaces based on CFUs after incubation of contact-plates and biological residue based on adenosine triphosphate (ATP) measurements, expressed in RLUs. CFUs were counted by placing contact-plates on the test area after wiping, and then incubating the plates (48 hours, 37°C). The test surfaces were swapped immediately after wiping and the adenosine triphosphate (ATP) level on the swabs was expressed in RLUs. 

 

Results 

Because of the heterogeneity in study designs and outcome measures, pooling of data was not possible. Where possible, independent sample t-tests were performed on the post-wiping results. For the purpose of this guideline, the results for different microorganisms were pooled to obtain an overall effect estimate.

 

Effectivity
CFUs

Colony-forming units (CFUs) were reported in three studies (Diab-Elschahawi, 2010; Trajtman, 2015; Wren, 2008). CFUs are a quantitative unit of measurement to estimate the number of microorganisms present on a surface. The results for the percentage reduction in CFU counts are presented in Table 1.1. When used wet, microfiber cloths resulted in a statistically significant larger reduction of CFUs from surfaces compared to other cleaning cloths in all studies. When used dry, a smaller reduction was seen for microfiber cloths compared to other cleaning cloths; however, no independent sample t-tests could be performed to test for statistical significance.

 

RLUs

Relative light units (RLUs) were reported in one study (Wren, 2008). An RLU is a quantitative unit of measure that is used to express the amount of adenosine triphosphate (ATP), a molecule that is used as indicator for the presence of biological residues on surfaces. An overview of the calculated percentage reduction of RLUs is presented in Table 1.2. No t-tests could be performed due to lack of information on standard deviation.

 

Other measures

Hron (2019) measured the effectivity of the wipes by calculating the protein uptake (mg/mL) and the paraffin wax uptake (mg). They report that, when used in a dry state, the greige cotton 6.8 MJ/kg wipe removed the most protein and removed statistically significantly more protein than the 50% rayon/50% polyester single-use wipe. The polyester wipe, the greige cotton 8.9 MJ/kg wipe, the 80% polyester/20% greige cotton wipe, and the 80% rayon/20% greige cotton wipe had a significantly lower protein uptake compared to the single-use wipe when used in a dry state (data not shown). When used in a wet state, the polyester wipe, the greige cotton 6.8 MJ/kg wipe, the greige cotton 10.1 MJ/kg wipe, the 80% polyester/20% greige cotton wipe, and the 20% polyester/80% greige cotton wipe had significantly lower protein uptake when compared to the single-use wipe. 

 

Regarding the paraffin wax experiment using dry wipes, Hron (2019) reported that the polyester wipe had a significantly lower paraffin wax uptake (mg) when compared to the single-use wipe. Furthermore, the greige cotton 6.8 MJ/kg wipe, the greige cotton 10.1 MJ/kg wipe, and the 20% polyester/80% greige cotton wipe had a significantly higher paraffin wax uptake when compared to the single-use wipe. 

 

Visual clean

Wiemken (2014) reported a visually clean outcome measure: compliance. The average compliance points for RTU wipes were: 10.6 (SD 1.3) versus the average for the bucket method: 8.1 (SD 2.4) (P=.017). This resulted in a statistically significant mean difference of 2.50 compliance points (95% CI 0.072 to 4.28) in favor of using RTU wipes. 

 

Tabel 1.1: Overview of the pooled percentage reduction of CFUs from test surfaces per included study

Study 

Test surface

Wet or dry

 

Microfiber cloth 

% mean difference (SD)

Other cleaning cloth

% mean difference (SD)

p-value

Diab-Elschahawi (2010)

Ceramic tiles 5x5 cm

wet

n

8

8

 
   

% reduction

99.97

99.92

 
 

dry

n

8

8

 
   

% reduction

97.37

97.74

 

Trajtman (2015)

Ceramic tiles 2.2x2.2 cm

wet (desinfectant)

n

6

6

 
   

% reduction

99.65

98.22

 

Wren (2008) - Microorganism in PBS alone

New laminate high touch surface

wet (deionized water)

n

9

9

 
   

% reduction

99.64 (0.50) 

57.40 (43.11)

0.0096 

Old laminate high touch surface

wet (deionized water)

n

9

9

 
   

% reduction

99.98 (1.27)

62.51 (27.85)

0.0011

Steel tile

wet (deionized water)

n

9

9

 
   

% reduction

99.27 (1.16)

71.02 (26.87)

0.0062

Wren (2008) - Microorganism in PBS with 7% bovine serum albumin

Smooth tile

wet (deionized water)

n

18

18

 
   

% reduction

100.00 (0)

83.18 (13.95)

<0.0001

Rough tile

wet (deionized water)

n

18

18

 
   

% reduction

99.85 (0.18)

88.31 (7.49)

<0.0001

New laminate worktop

wet (deionized water)

n

18

18

 
   

% reduction

99.96 (0.10)

96.44 (5.44)

0.0097 

Steel tile

wet (deionized water)

n

18

18

 
     

% reduction

100.00 (0)

87.49 (7.39)

<0.0001

 

Tabel 1.2: Overview of the pooled percentage reduction of RLUs from test surfaces per included study

Study

Test surface

Wet or dry

 

Microfiber cloth 

% mean difference

Other cleaning cloth

% mean difference

Wren (2008) - Microorganism in PBS alone

Laminated worktop

wet (deionized water)

n

9

9

   

% reduction

96.59

69.46

Steel tile

wet (deionized water)

n

9

9

   

% reduction

98.39

79.74

Smooth tile

wet (deionized water)

n

9

9

   

% reduction

98.92

86.54

Rough tile 

wet (deionized water)

n

9

9

   

% reduction

98.47

78.45

Wren (2008) - Microorganism in PBS with 7% bovine serum albumin

Laminated worktop

wet (deionized water)

n

9

9

 

 

% reduction

93.78

87.14

Steel tile

wet (deionized water)

n

9

9

 

 

% reduction

94.90

82.65

Smooth tile

wet (deionized water)

n

9

9

 

 

% reduction

92.52

87.32

Rough tile 

wet (deionized water)

n

9

9

 

 

% reduction

83.48

77.35

 

Level of evidence of the literature

The level of evidence regarding the outcome measure effectivity started at low and was downgraded to very low because of the number of included experiments (imprecision; -1). 

A systematic review of the literature was performed to answer the following question: what is the difference in efficacy between a (reusable) microfiber cloth and other cleaning cloths?

 

P: Cleaning of patient-related surfaces and areas
I: Cleaning with a microfiber cloth 
C: Cleaning with a different (non-microfiber/ready-to-use) cleaning cloth 
O: Effectivity, visual clean

 

Relevant outcome measures

The guideline development group considered effectivity and visually clean as a critical outcome measure for decision-making. 

 

A priori, the working group did not define the outcome measures listed above but used the definitions used in the studies. 

 

Search and select (methods)

The databases Medline (via OVID), Embase (via embase.com), Web of Science, and Cinahl, were searched with relevant search terms from 1 January 2000 until 21 March 2022. The detailed search strategy is available upon reasonable request via info@sri-richtlijnen.nl

 

The systematic literature search resulted in 304 hits. Seventeen studies were initially selected based on title and abstract screening. After reading the full text, 12 studies were excluded (see the table with reasons for exclusion under the tab Methods), and 5 studies were included (Diab-Elschahawi, 2010; Hron, 2019; Tajtman, 2015; Wiemken, 2014; Wren, 2008). The summary of literature, results and evidence tables are included below under the tab Onderbouwing.

 

Results

Five studies were included in the analysis of the literature. Important study characteristics and results are summarized in the evidence tables. The assessment of the risk of bias is summarized in the risk of bias tables. Results were obtained from boxplots by using an online data extraction tool (https://automeris.io/WebPlotDigitizer). Cotton cloths, general-purpose cloths, and conventional cloths were included as relevant cleaning cloths. Sponges and paper towels were excluded from this analysis.

  1. Diab-Elschahawi M, Assadian O, Blacky A, Stadler M, Pernicka E, Berger J, Resch H, Koller W. Evaluation of the decontamination efficacy of new and reprocessed microfiber cleaning cloth compared with other commonly used cleaning cloths in the hospital. Am J Infect Control. 2010 May;38(4):289-92. doi: 10.1016/j.ajic.2009.09.006. Epub 2010 Jan 31. PMID: 20123151.
  2. Hron RJ, Hinchliffe DJ, Mattison CP, Condon BD. The effect of cotton fiber inclusion on the hard surface cleaning capacity of nonwoven substrates. Journal of Engineered Fibers and Fabrics. January 2019. doi:10.1177/1558925019889620
  3. Trajtman AN, Manickam K, Alfa MJ. Microfiber cloths reduce the transfer of Clostridium difficile spores to environmental surfaces compared with cotton cloths. Am J Infect Control. 2015 Jul 1;43(7):686-9. doi: 10.1016/j.ajic.2015.03.002. Epub 2015 Apr 20. PMID: 25907782.
  4. Wiemken TL, Curran DR, Pacholski EB, Kelley RR, Abdelfattah RR, Carrico RM, Ramirez JA. The value of ready-to-use disinfectant wipes: compliance, employee time, and costs. Am J Infect Control. 2014 Mar;42(3):329-30. doi: 10.1016/j.ajic.2013.09.031. PMID: 24581022.
  5. Wren MW, Rollins MS, Jeanes A, Hall TJ, Coën PG, Gant VA. Removing bacteria from hospital surfaces: a laboratory comparison of ultramicrofibre and standard cloths. J Hosp Infect. 2008 Nov;70(3):265-71. doi: 10.1016/j.jhin.2008.07.017. PMID: 18801594.
Evidence-tabel

Evidence table for intervention studies (randomized controlled trials and non-randomized observationalstudies [cohort studies, case-control studies, case series])

Study reference

Study characteristics

Patient characteristics 

Intervention (I)

Comparison / control (C)

 

Outcome measures and effect size 

Comments

Diab-Elschahawi (2010)

Type of study: experiment

 

Funding and conflicts of interest: “Supported by the research fund of the Division of Hospital Hygiene,

Medical University of Vienna.”

Test surface/area: Standardized ceramic tiles measuring 5x5 cm

 

Microorganism:Staphylococcus aureus (ATCC 6538) and Escherichia coli (ATCC 8739), 5x107 colony-forming units (CFU) per ml, 0.1 ml per tile; left to dry for 1 hour

 

 

Describe intervention (treatment/procedure/test):

 

Cleaning with 5x5 cm microfiber cleaning cloth, cotton cloth, sponge cloth

 

Wiping: meander-like pattern, starting left upper corner, turning 4 times, ending right lower corner

 

Dry and wet (with distilled water)

 

Microfiber cloths, cotton cloths, and sponge cloths were reprocessed in a washer disinfector and a laundry dryer (90°C for 5 minutes) up to 20 times

Describe control (treatment/procedure/test):

 

Cleaning with disposable paper towels

 

Wiping: meander-like pattern, starting left upper corner, turning 4 times, ending right lower corner

 

Dry and wet (with distilled water)

 

Outcome measures and effect size (include 95%CI and p-value if available):

CFUs: microbial load from a surface / decontamination: tested by shaking the tiles in a petri dish with glass pearls, and then incubated on agar.

 

New microfiber better than new cotton (P=.0012; regression coefficient = 1.0766), new sponge (P=.001; regression coefficient = 1.0971), and disposable paper towels (P=.0001; regression coefficient = 1.5455).

 

After processing, no difference between main effect of cloths. Cotton cloths better than microfiber cloths (S. aureus P=.0334; regression coefficient = 20.4332; E coli P=.0014; regression coefficient = 20.7847). Sponge better than microfiber (S. aureus P=.0263; regression

Coefficient = 20.4531).

Conclusions: decontamination capacity higher when used wet versus dry (for all cloths)

 

No difference in decontamination efficacy between cloths.

 

 

Hron (2019)

Type of study: experiment

 

Funding and conflicts of interest: “The author(s) received no financial support for the research, authorship, and/or publication of this article.”

Test surface/area: 

Stainless steel plate

 

Microorganism:

2 experiments:

- protein contaminant: 500 μl of 5% fetal bovine serum in phosphate buffered saline, left to dry overnight

- hydrophobic residue: paraffin wax bead 50 ± 2 mg, melted and dried for 30 min

Describe intervention (treatment/procedure/test):

 

Cleaning with 10 in-house nonwoven fabrics (energy of hydroentanglement 4.8 MJ/kg): 

2. 100% rayon 

3. 100% polyester

4. 100% greige cotton (6.8 MJ/kg)

5. 100% greige cotton (8.9 MJ/kg)

6. 100% greige cotton (10.1 MJ/kg)

7. 100% greige cotton scoured and bleached

8. 80% polyester/20% greige cotton

9. 20% polyester/80% greige cotton

10. 80% rayon/20% greige cotton

11. 20% rayon/80% greige cotton

 

Protein contaminant:

Dry and wet (1 mL of ultrapure water)

Wiping: by machine, 16 movements, 71.3r/min, 9 kPa

 

Hydrophobic residue:

Dry 

Wiping: by machine, 16 movements, 71.3r/min, 12 kPa 

Describe control (treatment/procedure/test):

 

Cleaning with 

1. single use wipes (50% rayon/50% polyester)

 

Protein contaminant:

Dry and wet (1 mL of ultrapure water)

Wiping: by machine, 16 movements, 71.3r/min, 9 kPa

 

Hydrophobic residue:

Dry 

Wiping: by machine, 16 movements, 71.3r/min, 12 kPa

Outcome measures and effect size (include 95%CI and p-value if available):

 

Protein contamination

After wiping, wipes were put in saline and incubated. Then they performed protein analysis.

Dry wipes

Wipes 3, 5, 8, and 10 had significantly lower protein (mg/ml) uptake, compared to wipe 1 (single use wipes). 

Wipe 4 had significantly higher protein (mg/ml) uptake, compared to wipe 1.

 

Wet wipes

Wipes 3, 4, 6, 8, and 9 had significantly lower protein (mg/ml) uptake, compared to wipe 1 (single use wipes). 

 

Hydrophobic residue:

Removal of wax was measured by placing the sample on a scale 

Dry wipes 

Wipe 3 had significantly lower paraffin (mg) uptake, compared to wipe 1. 

Wipes 4, 6, and 9 had significantly higher paraffin (mg) uptake, compared to wipe 1. 

No numbers are given. Only descriptions of results and boxplots.

Trajtman (2015)

Type of study: experiment

 

Funding and conflicts of interest: none to report

Test surface/area: 

On ceramic tiles (2.2x2.2 cm)

On microfiber cloths

On cotton cloths 

 

Microorganism:

Clostridium difficile 765, 2.3x106

spores/mL; 100 mL/site to provide 2.3x10spores/site (CFUs), dried overnight

Describe intervention (treatment/procedure/test):

 

Cleaning with microfiber cloths (16 cm2)

 

Wiping: done by machine: 1.5-1.77 N and 10 rotations

 

Before assessing the outcome, tiles were sprayed with either phosphate buffer saline (PBS) or with a hydrogen peroxide 0.01% cleaning agent.

Describe control (treatment/procedure/test):

 

Cleaning with cotton cloths (16 cm2

 

Wiping: done by machine: 1.5-1.77 N and 10 rotations

 

Before assessing the outcome, tiles were sprayed with either phosphate buffer saline (PBS) or with a hydrogen peroxide 0.01% cleaning agent.

Outcome measures and effect size (include 95%CI and p-value if available):

CFUs: tiles and wipes were placed in liquid, this was then incubated on agar. CFUs were counted, and expressed as log10 (cfu/cm2)

 

Cotton cloths transfer significantly more spores than microfiber cloths between wet ceramic surfaces regardless of using a detergent (P = .0261 and P = .0001).

Trajtman used cleaning agents in the study with the purpose of disinfecting, leading to somewhat indirect results. However, due to the small contribution of the study to the final results, it was decided downgrading is not needed.

Wiemken (2014)

Type of study: experiment

 

Funding and conflicts of interest: “Supported by Clorox Healthcare, which did not play a role in data collection, analysis, writing, or critical review of the study data or manuscript.

Conflicts of interest: None to report.”

Test surface/area: 6 pre-specified areas in a patient room

 

Microorganism:

Fluorescent marker 

 

Describe intervention (treatment/procedure/test):

 

Cleaning with towel and bucket with sodium hypochlorite cleaner/disinfectant solutions

 

Wiping: by randomized participant

Describe control (treatment/procedure/test):

 

Cleaning with ready-to-use (RTU) wipes with sodium hypochlorite cleaner/disinfectant solutions

Outcome measures and effect size (include 95%CI and p-value if available):

Compliance: residual fluorescent marker viewable under an ultraviolet light (0 point = complete miss of area; 1 point = partial miss; 2 points = completely removing fluorescent marker). A total of 12 points could be rewarded.

 

Mean (SD) compliance, RTU versus bucket 

Sink countertop             1.8 (0.67)             1.1 (0.78)

Bedside table    1.9 (0.33)   1.8 (0.44)

In-room dresser             2 (0)     1.3 (0.71)

Medicine cabinet             1.8 (0.67)            1.6 (0.73)

Wall-mounted cabinet 1.9 (0.33)         1.3 (0.87)

Toilet               1.2 (0.97)   1 (0.87)

Average compliance points: 

RTU: 10.6 (SD 1.3)

Bucket 8.1 (SD 2.4) 

P =.017

 

Time of cleaning and disinfecting:

RTU: 178.1 seconds (SD 98.2)

Bucket: 230.9 seconds (SD 96.0)

P=0.003

 

Time-related cost savings for using RTU wipes: (15 rooms per day, 20 min per room, $10 per hour): $38.58 (95%CI: $34.07-$41.08) per employee per day

 

Wren (2008)

Type of study: experiment

 

Funding and conflicts of interest:

Test surface/area: 

100 cm2 of:

- a rough tile 

- a smooth tile 

- laminated worktops (new and worn (aged >10 years, taken from a ward in the closed Middlesex Hospital, London)

- stainless steel surfaces

 

Microorganism:

- meticillin- resistant Staphylococcus aureus (MRSA)

- Acinetobacter calcoaceticus var. baumannii (ACCB)

- Klebsiella oxytoca (K. oxytoca) in logarithmic phase growth 

- spores of Clostridium difficile

All in PBS, 100 ul on area, dried for 2 hours

Describe intervention (treatment/procedure/test):

 

Cleaning with ultramicrofibre (UMF)-woven cloths (80% polyamide/ 20% polyester fibre)

 

Wet: deionized water

 

Wiping: as prescribed by manufacturer.

Describe control (treatment/procedure/test):

 

Cleaning with conventional cloths (JC)

 

Wet: deionized water

 

Wiping: as prescribed by manufacturer.

Outcome measures and effect size (include 95%CI and p-value if available):

CFUs: contact plates on areas were incubated 

 

RLUs: by ATP swabbing of surface

 

Laminated worktop (new): CFUs

In 28 of 36 experiments, ultra-microfiber cloths were able to completely remove all bacteria of bacterial spores (MRSA, ACCB, K. oxytoca, and C. difficile) from surfaces (new and old laminated surfaces, and steel tiles). Whereas conventional cloths were only able to remove all bacteria of bacterial spores in two of 36 experiments. When bacteria (MRSA, ACCB, and K. oxytoca) were suspended in 7% bovine serum albumin, ultra-microfiber cloths were able to completely remove all bacteria 20 of 24 experiments, and conventional cloths were not able to remove all bacteria from surfaces (smooth tile, rough tile, new laminated worktop, steel tile

 

 

 

Exclusietabel

Reference

Reason for exclusion

Cobbett CV. Are current cleaning methods effective against hazardous drugs? 

J. Vasc. Access. 2020. NP49 - NP50. DOI: 10.1177/1129729820953.

Wrong type of publication (conference abstract)

DeJonge PM. Martin E, Hashikawa AN. Environmental Cleaning Strategies Used by Child Care Centers During Illness Outbreaks. Pediatrics, 2018; 142(1_MeetingAbstract), 784-784.

Wrong type of publication (conference abstract)

Lalla F, Dingle P, Cheong C. The antibacterial action of cloths and sanitizers and the use of environmental alternatives in food industries. J Environ Health. 2005 Dec;68(5):31-5. PMID: 16392629.

Wrong setting (the food industry)

Egert M, Späth K, Weik K, Kunzelmann H, Horn C, Kohl M, Blessing F. Bacteria on smartphone touchscreens in a German university setting and evaluation of two popular cleaning methods using commercially available cleaning products. Folia Microbiol (Praha). 2015 Mar;60(2):159-64. doi: 10.1007/s12223-014-0350-2. Epub 2014 Oct 11. PMID: 25305112.

About cleaning smartphones, not cleaning of surfaces/areas

Berendt AE, Turnbull L, Spady D, Rennie R, Forgie SE. Three swipes and you're out: how many swipes are needed to decontaminate plastic with disposable wipes? Am J Infect Control. 2011 Jun;39(5):442-443. doi: 10.1016/j.ajic.2010.08.014. Epub 2011 Feb 9. PMID: 21306797.

About cleaning plastics, not cleaning surfaces/areas

Bergen LK, Meyer M, Høg M, Rubenhagen B, Andersen LP. Spread of bacteria on surfaces when cleaning with microfibre cloths. J Hosp Infect. 2009 Feb;71(2):132-7. doi: 10.1016/j.jhin.2008.10.025. Epub 2008 Dec 23. PMID: 19108933.

No comparison

Dramowski A, Aucamp M, Bekker A, Pillay S, Moloto K, Whitelaw AC, Cotton MF, Coffin S. NeoCLEAN: a multimodal strategy to enhance environmental cleaning in a resource-limited neonatal unit. Antimicrob Resist Infect Control. 2021 Feb 12;10(1):35. doi: 10.1186/s13756-021-00905-y. PMID: 33579364; PMCID: PMC7881651.

About cleaning routines

Isiyel E, Soydan S. Comparison Of Two Cleaning Methods Intaking Urine Culture Samples In Children. Flora. 2019, 107 - 112 DOI: 10.5578/flora.67606

Article in Turkish

Robertson A, Barrell M, Maillard JY. Combining detergent/disinfectant with microfibre material provides a better control of microbial contaminants on surfaces than the use of water alone. J Hosp Infect. 2019 Sep;103(1):e101-e104. doi: 10.1016/j.jhin.2019.05.005. Epub 2019 May 18. PMID: 31112729.

Wrong comparison

Soubieux A, Palamini M, Tanguay C, Bussières JF. Evaluation of decontamination strategies for cyclophosphamide. J Oncol Pharm Pract. 2020 Mar;26(2):413-422. doi: 10.1177/1078155219865931. Epub 2019 Aug 1. PMID: 31370747.

About effectivity of wipes for cyclophosphamide removal

Tojo K, Nakamura K, Sato E, Hayami S, Fujii M, Miyaji K. Effectiveness of microfiber cleaning cloth used for medical equipment. Ther. Res. 2013; 399-407.

Article in Japanese

Moore G, Griffith C. A laboratory evaluation of the decontamination properties of microfibre cloths. J Hosp Infect. 2006 Dec;64(4):379-85. doi: 10.1016/j.jhin.2006.08.006. Epub 2006 Oct 19. PMID: 17055112.

Unclear which cloths were compared

 

Risk of bias-tabel

Author, year

Selection of participants

 

Was selection of exposed and non-exposed cohorts drawn from the same population?

 

 

 

Exposure

 

 

Can we be confident in the assessment of exposure?

 

 

 

Outcome of interest

 

Can we be confident that the outcome of interest was not present at start of study?

 

 

 

 

Confounding-assessment

 

Can we be confident in the assessment of confounding factors? 

Confounding-analysis

 

Did the study match exposed and unexposed for all variables that are associated with the outcome of interest or did the statistical analysis adjust for these confounding variables?

Assessment of outcome

 

Can we be confident in the assessment of outcome?

 

 

Follow up

 

 

Was the follow up of cohorts adequate? In particular, was outcome data complete or imputed?

 

Co-interventions

 

Were co-interventions similar between groups?

 

 

 

 

Overall Risk of bias

 

 

 

 

 

Definitely yes, probably yes, probably no, definitely no

Definitely yes, probably yes, probably no, definitely no

Definitely yes, probably yes, probably no, definitely no

Definitely yes, probably yes, probably no, definitely no

Definitely yes, probably yes, probably no, definitely no

Definitely yes, probably yes, probably no, definitely no

Definitely yes, probably yes, probably no, definitely no

Definitely yes, probably yes, probably no, definitely no

Low, Some concerns, High

Diab-Elschahawi (2010)

Definitely yes

 

Reason: similar test areas were used for intervention and control.

Definitely yes 

 

Reason: Microorganisms were applied similar on all test areas.

Definitely yes

 

Reason: similar quantities of microorganism were applied on test areas.

Definitely yes

 

Reason: wiping was performed similar in all experiments. 

Not applicable

 

Definitely yes 

 

Reason:

quantative outcome measures were used.

Not applicable

 

Not applicable

 

Low 

 

Hron (2019)

Definitely yes

 

Reason: similar test areas were used for intervention and control.

Definitely yes 

 

Reason: Microorganisms and hydrophobic residue were applied similar on all test areas.

Definitely yes

 

Reason: similar quantities of microorganism and hydrophobic residue were applied on test areas.

Definitely yes

 

Reason: wiping was performed similar in all experiments. 

Not applicable

 

Definitely yes 

 

Reason:

quantative outcome measures were used.

Not applicable

 

Not applicable

 

Low 

 

Trajtman (2015)

Definitely yes

 

Reason: similar test areas were used for intervention and control.

Definitely yes 

 

Reason: Microorganisms were applied similar on all test areas.

Definitely yes

 

Reason: similar quantities of microorganism were applied on test areas.

Definitely yes

 

Reason: wiping was performed similar in all experiments. 

Not applicable

 

Definitely yes 

 

Reason:

quantative outcome measures were used.

Not applicable

 

Not applicable

 

Low

 

Wiemken (2014)

Definitely yes

 

Reason: similar test areas were used for intervention and control.

Definitely yes 

 

Reason: Microorganisms were applied similar on all test areas.

Definitely yes

 

Reason: similar quantities of microorganism were applied on test areas.

Definitely yes

 

Reason: wiping was performed similar in all experiments.

Not applicable

 

Definitely yes 

 

Reason:

quantative outcome measures were used.

Not applicable

 

Not applicable

 

Low 

 

Wren (2008)

Definitely yes

 

Reason: similar test areas were used for intervention and control.

Definitely yes 

 

Reason: Microorganisms were applied similar on all test areas.

Definitely yes

 

Reason: similar quantities of microorganism were applied on test areas.

Definitely yes

 

Reason: wiping was performed similar in all experiments. 

Not applicable

 

Definitely yes 

 

Reason:

quantative outcome measures were used.

Not applicable

 

Not applicable

 

Low 

 

 

Beoordelingsdatum en geldigheid

Laatst beoordeeld  : 01-01-2024

Initiatief en autorisatie

Initiatief:
  • Samenwerkingsverband Richtlijnen Infectiepreventie
Geautoriseerd door:
  • Nederlands Oogheelkundig Gezelschap
  • Nederlandse Vereniging van Artsen voor Longziekten en Tuberculose
  • Nederlandse Vereniging voor Anesthesiologie
  • Nederlandse Vereniging voor Heelkunde
  • Nederlandse Vereniging voor Medische Microbiologie
  • Verpleegkundigen en Verzorgenden Nederland
  • Nederlandse Vereniging van Ziekenhuisapothekers
  • Vereniging voor Hygiëne en Infectiepreventie in de Gezondheidszorg
  • Patiëntenfederatie Nederland
  • Nederlandse Vereniging voor Arbeidshygiëne

Algemene gegevens

De ontwikkeling/herziening van deze richtlijnmodule is ondersteund door het Kennisinstituut van de Federatie Medisch Specialisten  en is gefinancierd door het ministerie van VWS (Ministerie van Volksgezondheid, Welzijn en Sport). De financier heeft geen enkele invloed gehad op de inhoud van de richtlijnmodule.

Samenstelling werkgroep

Voor het ontwikkelen van de richtlijnmodule is in 2021 een multidisciplinaire werkgroep samengesteld, bestaande uit vertegenwoordigers van alle relevante specialismen.

 

De werkgroep bestaat uit:

  • Dr. E.J.M. Verkade (voorzitter), arts-microbioloog, Nederlandse Vereniging voor Medische Microbiologie (NVMM)
  • Drs. E. Bowles, arts-microbioloog, Nederlandse Vereniging voor Medische Microbiologie (NVMM)
  • Dr. M.H. Nabuurs-Franssen, arts-microbioloog, Nederlandse Vereniging voor Medische Microbiologie (NVMM)
  • Drs. Y. Chahid, ziekenhuisapotheker, Nederlandse Vereniging van Ziekenhuisapothekers (NVZA)
  • Dr. S.S. Gisbertz, chirurg, Nederlandse Vereniging voor Heelkunde (NVvH)
  • Drs. ing. I.V. Hoogendijk, deskundige infectiepreventie, Vereniging voor Hygiëne & Infectiepreventie in de Gezondheidszorg (VHIG)
  • Ing. W. van Vianen, deskundige infectiepreventie, Vereniging voor Hygiëne & Infectiepreventie in de Gezondheidszorg (VHIG)
  • N. Kiefte-van Grol, deskundige infectiepreventie, Rijksinstituut voor Volksgezondheid en Milieu (RIVM)
  • Drs. A.A. Bartels, Beleidsadviseur infectiepreventie, Rijksinstituut voor Volksgezondheid en Milieu (RIVM) 
  • J. Pattipeilohy-van Ommen, verpleegkundige, Verpleegkundigen & Verzorgenden Nederland (V&VN)
  • Dr. ing. M. van Bergen, biorisk-professional, Nederlandse vereniging voor Arbeidshygiëne (NVvA)

Met ondersteuning van:

  • I. van Dusseldorp, literatuurspecialist, Kennisinstituut van de Federatie Medisch Specialisten
  • Dr. A.J Versteeg, adviseur, Kennisinstituut van de Federatie Medisch Specialisten
  • Dr. M.F.Q. Kluijtmans-van den Bergh, senior-adviseur, Kennisinstituut van de Federatie Medisch Specialisten
  • Dr. H. Graveland, senior-adviseur, Kennisinstituut van de Federatie Medisch Specialisten

Belangenverklaringen

De Code ter voorkoming van oneigenlijke beïnvloeding door belangenverstrengeling is gevolgd. Alle werkgroepleden hebben schriftelijk verklaard of zij in de laatste drie jaar directe financiële belangen (betrekking bij een commercieel bedrijf, persoonlijke financiële belangen, onderzoeksfinanciering) of indirecte belangen (persoonlijke relaties, reputatiemanagement) hebben gehad. Gedurende de ontwikkeling of herziening van een module worden wijzigingen in belangen aan de voorzitter doorgegeven. De belangenverklaring wordt opnieuw bevestigd tijdens de commentaarfase. 

 

Een overzicht van de belangen van werkgroepleden en het oordeel over het omgaan met eventuele belangen vindt u in onderstaande tabel. De ondertekende belangenverklaringen zijn op te vragen bij het secretariaat van het Kennisinstituut van de Federatie Medisch Specialisten.

Werkgroeplid

Functie

Nevenfuncties

Gemelde belangen 

Ondernomen actie

Dr. E.J.M. Verkade

Arts-microbioloog bij CERTE MDA te Groningen

Geen

Geen

Geen

Drs. E. Bowles

Arts-microbioloog, Radboud UMC

Geen

Geen

Geen

Dr M.H. Nabuurs-Franssen

Arts-microbioloog, CWZ Nijmegen

Geen

Financier ZonMw: Inhoud onderzoek: Control of Covid-19 in hospitals: sero-epidemiologie in healthcare workers. Rol projectleider: nee

Geen

Drs. Y. Chahid

Ziekenhuisapotheker, Amsterdam UMC

Geen

Geen

Geen

Dr. S.S. Gisbertz

Chirurg

Geen

Geen

Geen

Drs. ing. I.V. Hoogendijk

Deskundige infectiepreventie, LUMC

Geen

Geen

Geen

Ing. W. van Vianen

 

Deskundige infectiepreventie, Erasmus MC

Geen

Geen

Geen

N. Kiefte-van Grol

ZZP-deskundige infectiepreventie. Afgevaardigd namens het RIVM vanwege ervaring in publieke gezondheidszorg

Geen

Geen

Geen

Drs. A.A. Bartels

Beleidsadviseur infectiepreventie bij RIVM (centrum LCI/LCHV)

Geen

Geen

Geen

J. Pattipeilohy-van Ommen

Verpleegkundige

Geen

Geen

Geen

Dr. ing. M. van Bergen

Biorisk-professional/manager bij Radboud UMC en Radboud Universiteit

Incidenteel adviseur op het gebied van biorisk prevention (op basis van inhuur via Radboud UMC)

Geen

Geen

 

Inbreng patiëntenperspectief

Er werd aandacht besteed aan het patiëntenperspectief door uitnodigen van Patiëntfederatie Nederland (PFNL) voor de invitational conference. De verkregen input is meegenomen bij het opstellen van de uitgangsvragen, de keuze voor de uitkomstmaten en bij het opstellen van de overwegingen. De conceptrichtlijn is tevens voor commentaar voorgelegd aan PFNL en de eventueel aangeleverde commentaren zijn bekeken en verwerkt.

 

Wkkgz & Kwalitatieve raming van mogelijke substantiële financiële gevolgen

Bij de richtlijn is conform de Wet kwaliteit, klachten en geschillen zorg (Wkkgz) een kwalitatieve raming uitgevoerd of de aanbevelingen mogelijk leiden tot substantiële financiële gevolgen. Bij het uitvoeren van deze beoordeling zijn richtlijnmodules op verschillende domeinen getoetst (zie het stroomschema op de Richtlijnendatabase). 

 

Uit de kwalitatieve raming blijkt dat er waarschijnlijk geen substantiële financiële gevolgen zijn. Zie onderstaande tabel.

Module

Uitkomst raming

Toelichting

Module Reinigingsdoeken

Geen substantiële financiële gevolgen

Hoewel uit de toetsing volgt dat de aanbeveling(en) breed toepasbaar zijn (5.000-40.000 patiënten), volgt ook uit de toetsing dat het geen nieuwe manier van zorgverlening of andere organisatie van zorgverlening betreft. Er wordt geen toename in voltijdsequivalenten dan wel opleidingsniveau verwacht. Er worden daarom geen substantiële financiële gevolgen verwacht.

Werkwijze

Deze richtlijnmodule is opgesteld conform de eisen vermeld in het rapport Medisch Specialistische Richtlijnen 2.0 van de adviescommissie Richtlijnen van de Raad Kwaliteit. Dit rapport is gebaseerd op het AGREE II instrument (Appraisal of Guidelines for Research & Evaluation II; Brouwers, 2010). 

 

Knelpuntenanalyse en uitgangsvragen

Tijdens de voorbereidende fase inventariseerde de werkgroep de knelpunten in de zorg voor het reinigen en desinfecteren van ruimten. De werkgroep beoordeelde de aanbeveling(en) uit de eerdere richtlijnen ‘Reiniging en Desinfectie van ruimten’, ‘Beleid reiniging desinfectie en sterilisatie’, WIP-richtlijn ‘Reiniging, Desinfectie & Sterilisatie [VWT]/[REV]’ en ‘Reiniging en desinfectie: validatie’ op noodzaak tot revisie. Tevens zijn er knelpunten aangedragen door RIVM, SVN, VDSMH, ZorgThuisnl, NVA en NFU via de invitational conference. Een verslag hiervan is opgenomen onder Rapportage knelpunteninventarisatie.

 

Op basis van de uitkomsten van de knelpuntenanalyse zijn door de werkgroep concept-uitgangsvragen opgesteld en definitief vastgesteld. 

 

Uitkomstmaten

Na het opstellen van de zoekvraag behorende bij de uitgangsvraag inventariseerde de werkgroep welke uitkomstmaten voor de patiënt/zorgmedewerker relevant zijn, waarbij zowel naar gewenste als ongewenste effecten werd gekeken. Hierbij werd een maximum van acht uitkomstmaten gehanteerd. De werkgroep waardeerde deze uitkomstmaten volgens hun relatieve belang bij de besluitvorming rondom aanbevelingen, als cruciaal (kritiek voor de besluitvorming), belangrijk (maar niet cruciaal) en onbelangrijk. Tevens definieerde de werkgroep tenminste voor de cruciale uitkomstmaten welke verschillen zij klinisch (patiënt) relevant vonden. 

 

Methode literatuursamenvatting

Een uitgebreide beschrijving van de strategie voor zoeken en selecteren van literatuur is te vinden onder Zoeken en selecteren onder Onderbouwing. Indien mogelijk werd de data uit verschillende studies gepoold in een random-effects-model. De beoordeling van de kracht van het wetenschappelijke bewijs wordt hieronder toegelicht.

 

Beoordelen van de kracht van het wetenschappelijke bewijs 

De kracht van het wetenschappelijke bewijs werd bepaald volgens de GRADE-methode. GRADE staat voor ‘Grading Recommendations Assessment, Development and Evaluation’ (zie https://www.gradeworkinggroup.org/). De basisprincipes van de GRADE-methodiek zijn: het benoemen en prioriteren van de klinisch (patiënt) relevante uitkomstmaten, een systematische review per uitkomstmaat, en een beoordeling van de bewijskracht per uitkomstmaat op basis van de acht GRADE-domeinen (domeinen voor downgraden: risk of bias, inconsistentie, indirectheid, imprecisie, en publicatiebias; domeinen voor upgraden: dosis-effect relatie, groot effect, en residuele plausibele confounding).

 

GRADE onderscheidt vier gradaties voor de kwaliteit van het wetenschappelijk bewijs: hoog, redelijk, laag en zeer laag. Deze gradaties verwijzen naar de mate van zekerheid die er bestaat over de literatuurconclusie, in het bijzonder de mate van zekerheid dat de literatuurconclusie de aanbeveling adequaat ondersteunt (Schünemann, 2013; Hultcrantz, 2017). 

GRADE

Definitie

Hoog

Er is hoge zekerheid dat het ware effect van behandeling dichtbij het geschatte effect van behandeling ligt;

het is zeer onwaarschijnlijk dat de literatuurconclusie klinisch relevant verandert wanneer er resultaten van nieuw grootschalig onderzoek aan de literatuuranalyse worden toegevoegd.

Redelijk

Er is redelijke zekerheid dat het ware effect van behandeling dichtbij het geschatte effect van behandeling ligt;

het is mogelijk dat de conclusie klinisch relevant verandert wanneer er resultaten van nieuw grootschalig onderzoek aan de literatuuranalyse worden toegevoegd.

Laag

Er is lage zekerheid dat het ware effect van behandeling dichtbij het geschatte effect van behandeling ligt;

er is een reële kans dat de conclusie klinisch relevant verandert wanneer er resultaten van nieuw grootschalig onderzoek aan de literatuuranalyse worden toegevoegd.

Zeer laag

Er is zeer lage zekerheid dat het ware effect van behandeling dichtbij het geschatte effect van behandeling ligt;

de literatuurconclusie is zeer onzeker.

 

Bij het beoordelen (graderen) van de kracht van het wetenschappelijk bewijs in richtlijnen volgens de GRADE-methodiek spelen grenzen voor klinische besluitvorming een belangrijke rol (Hultcrantz, 2017). Dit zijn de grenzen die bij overschrijding aanleiding zouden geven tot een aanpassing van de aanbeveling. Om de grenzen voor klinische besluitvorming te bepalen moeten alle relevante uitkomstmaten en overwegingen worden meegewogen. De grenzen voor klinische besluitvorming zijn daarmee niet één op één vergelijkbaar met het minimaal klinisch relevant verschil (Minimal Clinically Important Difference (MCID)). Met name in situaties waarin een interventie geen belangrijke nadelen heeft en de kosten relatief laag zijn, kan de grens voor klinische besluitvorming met betrekking tot de effectiviteit van de interventie bij een lagere waarde (dichter bij het nuleffect) liggen dan de MCID (Hultcrantz, 2017).

 

Overwegingen (van bewijs naar aanbeveling)

Om te komen tot een aanbeveling zijn naast (de kwaliteit van) het wetenschappelijke bewijs ook andere aspecten belangrijk en worden meegewogen, zoals aanvullende argumenten uit bijvoorbeeld de biomechanica of fysiologie, waarden en voorkeuren van patiënten, kosten (middelenbeslag), aanvaardbaarheid, haalbaarheid en implementatie. Deze aspecten zijn systematisch vermeld en beoordeeld (gewogen) onder het kopje Overwegingen en kunnen (mede) gebaseerd zijn op expert opinion. Hierbij is gebruik gemaakt van een gestructureerd format gebaseerd op het evidence-to-decision-framework van de internationale GRADE Working Group (Alonso-Coello, 2016a; Alonso-Coello 2016b). Dit evidence-to-decision-framework is een integraal onderdeel van de GRADE methodiek.

 

Formuleren van aanbevelingen

De aanbevelingen geven antwoord op de uitgangsvraag en zijn gebaseerd op het beschikbare wetenschappelijke bewijs en de belangrijkste overwegingen, en een weging van de gunstige en ongunstige effecten van de relevante interventies. De kracht van het wetenschappelijk bewijs en het gewicht dat door de werkgroep wordt toegekend aan de overwegingen, bepalen samen de sterkte van de aanbeveling. Conform de GRADE-methodiek sluit een lage bewijskracht van conclusies in de systematische literatuuranalyse een sterke aanbeveling niet a priori uit, en zijn bij een hoge bewijskracht ook zwakke aanbevelingen mogelijk (Agoritsas, 2017; Neumann, 2016). De sterkte van de aanbeveling wordt altijd bepaald door weging van alle relevante argumenten tezamen. De werkgroep heeft bij elke aanbeveling opgenomen hoe zij tot de richting en sterkte van de aanbeveling zijn gekomen. 

 

In de GRADE-methodiek wordt onderscheid gemaakt tussen sterke en zwakke (of conditionele) aanbevelingen. De sterkte van een aanbeveling verwijst naar de mate van zekerheid dat de voordelen van de interventie opwegen tegen de nadelen (of vice versa), gezien over het hele spectrum van patiënten waarvoor de aanbeveling is bedoeld. De sterkte van een aanbeveling heeft duidelijke implicaties voor patiënten, behandelaars en beleidsmakers (zie onderstaande tabel). Een aanbeveling is geen dictaat, zelfs een sterke aanbeveling gebaseerd op bewijs van hoge kwaliteit (GRADE gradering HOOG) zal niet altijd van toepassing zijn, onder alle mogelijke omstandigheden en voor elke individuele patiënt.

Implicaties van sterke en zwakke aanbevelingen voor verschillende richtlijngebruikers 

 

 

Sterke aanbeveling

Zwakke (conditionele) aanbeveling

Voor patiënten/

zorgmedewerkers

De meeste patiënten zouden de aanbevolen interventie of aanpak kiezen en slechts een klein aantal niet.

Een aanzienlijk deel van de patiënten zouden de aanbevolen interventie of aanpak kiezen, maar veel patiënten ook niet. 

Voor beleidsmakers

De aanbevolen interventie of aanpak kan worden gezien als standaardbeleid.

Beleidsbepaling vereist uitvoerige discussie met betrokkenheid van veel stakeholders. Er is een grotere kans op lokale beleidsverschillen. 

Organisatie van zorg

In de knelpuntenanalyse en bij de ontwikkeling van de richtlijnmodule is expliciet aandacht geweest voor de organisatie van zorg: alle aspecten die randvoorwaardelijk zijn voor het verlenen van zorg (zoals coördinatie, communicatie, (financiële) middelen, mankracht en infrastructuur). Randvoorwaarden die relevant zijn voor het beantwoorden van deze specifieke uitgangsvraag zijn genoemd bij de overwegingen. 

 

Commentaar- en autorisatiefase

De conceptrichtlijn werd aan de betrokken (wetenschappelijke) verenigingen en (patiënt) organisaties voorgelegd ter commentaar. De commentaren werden verzameld en besproken met de werkgroep. Naar aanleiding van de commentaren werd de conceptrichtlijn aangepast en definitief vastgesteld door de werkgroep. De definitieve richtlijn werd aan de deelnemende (wetenschappelijke) verenigingen en (patiënt) organisaties voorgelegd voor autorisatie en door hen geautoriseerd dan wel geaccordeerd.

 

Literatuur

Agoritsas T, Merglen A, Heen AF, Kristiansen A, Neumann I, Brito JP, Brignardello-Petersen R, Alexander PE, Rind DM, Vandvik PO, Guyatt GH. UpToDate adherence to GRADE criteria for strong recommendations: an analytical survey. BMJ Open. 2017 Nov 16;7(11):e018593. doi: 10.1136/bmjopen-2017-18593. PubMed PMID: 29150475; PubMed Central PMCID: PMC5701989.

 

Alonso-Coello P, Schünemann HJ, Moberg J, Brignardello-Petersen R, Akl EA, Davoli M, Treweek S, Mustafa RA, Rada G, Rosenbaum S, Morelli A, Guyatt GH, Oxman AD; GRADE Working Group. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction. BMJ. 2016 Jun 28;353:i2016. doi: 10.1136/bmj.i2016. PubMed PMID: 27353417.

 

Alonso-Coello P, Oxman AD, Moberg J, Brignardello-Petersen R, Akl EA, Davoli M, Treweek S,Mustafa RA, Vandvik PO, Meerpohl J, Guyatt GH, Schünemann HJ; GRADE Working Group. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines. BMJ. 2016 Jun 30;353:i2089. doi: 10.1136/bmj.i2089. PubMed PMID: 27365494.

 

Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, Fervers B, Graham ID, Grimshaw J, Hanna SE, Littlejohns P, Makarski J, Zitzelsberger L; AGREE Next Steps Consortium. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ. 2010 Dec 14;182(18):E839-42. doi: 10.1503/cmaj.090449. Epub 2010 Jul 5. Review. PubMed PMID: 20603348; PubMed Central PMCID: PMC3001530.

 

Hultcrantz M, Rind D, Akl EA, Treweek S, Mustafa RA, Iorio A, Alper BS, Meerpohl JJ, Murad MH, Ansari MT, Katikireddi SV, Östlund P, Tranæus S, Christensen R, Gartlehner G, Brozek J, Izcovich A, Schünemann H, Guyatt G. The GRADE Working Group clarifies the construct of certainty of evidence. J Clin Epidemiol. 2017 Jul;87:4-13. doi: 10.1016/j.jclinepi.2017.05.006. Epub 2017 May 18. PubMed PMID: 28529184; PubMed Central PMCID: PMC6542664.

 

Medisch Specialistische Richtlijnen 2.0 (2012). Adviescommissie Richtlijnen van de Raad Kwaliteit.

 

Neumann I, Santesso N, Akl EA, Rind DM, Vandvik PO, Alonso-Coello P, Agoritsas T, Mustafa RA, Alexander PE, Schünemann H, Guyatt GH. A guide for health professionals to interpret and use recommendations in guidelines developed with the GRADE approach. J Clin Epidemiol. 2016 Apr;72:45-55. doi: 10.1016/j.jclinepi.2015.11.017. Epub 2016 Jan 6. Review. PubMed PMID: 26772609.

 

Schünemann H, Brożek J, Guyatt G, et al. GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. The GRADE Working Group, 2013. 

Zoekverantwoording

Zoekverantwoording

Algemene informatie

Richtlijn: SRI Reiniging en desinfectie ruimtes

Uitgangsvraag: 

Wat is het verschil in effectiviteit tussen microvezeldoeken en kant en klare reinigingsdoekjes? 

Database(s): Ovid/Medline, Embase, Cinahl, Web of Science

Datum: 15-2-2022, 21-3-2022

Periode: 2000-

Talen: nvt

Literatuurspecialist: Ingeborg van Dusseldorp

BMI zoekblokken: voor verschillende opdrachten wordt (deels) gebruik gemaakt van de zoekblokken van BMI-Online https://blocks.bmi-online.nl/ Bij gebruikmaking van een volledig zoekblok zal naar de betreffende link op de website worden verwezen.

Toelichting:

 

21-3-2022

In overleg met de adviseur is vastgesteld dat de terminologie en de vraagstelling correct is. Er wordt in 4 verschillende databases gezocht. Met uitzondering van de database Web of Science, die vanwege multidisciplinair karakter moeilijk in te delen is op studiedesign, is gezocht naar SR, RCT en observationele studies. De overzichtsartikelen en guidelines gevonden in de oriënterende strategie zijn toegevoegd.

 

 

23-2-2022

Er is een concept zoekstrategie opgezet, waarin is gezocht naar microvezeldoekjes of wegwerpdoekjes in combinatie met reiniging en desinfectie. De resultaten zijn ter oriëntatie aangeboden in Rayyan om te bepalen of de juiste terminologie is gebruikt en de vraagstelling correct is.

 

15-2-2022

Er is geen trefwoord voor microvezeldoekjes. Er wordt verwezen naar Fiber, maar dat is te breed en veroorzaakt veel ruis, vandaar dat alleen met title/abstract/keyword is gezocht.

(((microfiber OR microfibre) NEAR/3 (cloth OR cloths OR material*)):ti,ab,kw) OR 'cleaning cloth':ti,ab,kw OR 'cleaning cloths':ti,ab,kw

Is de I en C omgekeerd en gaat de vraag meer over wegwerp doekjes? De strategie wordt dan: 

('disposable equipment'/exp OR disposab*:ti,ab,kw) AND (wipe*:ti,ab,kw OR cloth:ti,ab,kw OR cloths:ti,ab,kw)

(Uit deze strategie zijn een drietal artikelen geselecteerd waarvan ik dacht dat ze mogelijk relevant zouden kunnen zijn.) 

Wordt de juiste terminologie gebruikt en/of wordt het antwoord ook al gevonden in de vraag: Bij welke reinigingsfrequentie van patiëntgebonden ruimten , vloeren, meubilair en bepaalde objecten*, wordt voldaan aan meetbare en valide kwaliteitseisen?  (In deze vraag is tot nu toe alleen gezocht op: reiniging van patiëntgebonden ruimtes)

Te gebruiken voor richtlijnen tekst:

In de databases Embase en Ovid/Medline, Cinah en Web of Science is op 21-3-2022 met relevante zoektermen gezocht naar systematische reviews en RCTs en observationele studies. De literatuurzoekactie leverde 304 unieke treffers op.

 

 

Zoekopbrengst

21-3-2022

Embase

Ovid/Medline

Cinahl

Web of Science

Ontdubbeld

SRs

8

5

3

 

14

RCTs

22

16

47

 

61

Observationele studies

117

55

25

 

130

Overig

 

 

 

123

81

Overzichtsartikelen, guidelines

 

 

 

 

24

Totaal

 

 

 

 

304

23-2-2022

EMBASE microvezeldoekjes

Embase disposables

 

 

Ontdubbeld

SRs

1

8

 

 

 

RCTs

2

19

 

 

 

Observationele studies

19

61

 

 

 

Overig

 

 

 

 

 

Totaal

21

 

 

 

 

 

Zoekstrategie

Embase

21-3-2022

No.

Query

Results

#13 

#11 NOT #10 NOT #9 OBS

117

#12 

#10 NOT #9 RCT

22

#11 

#4 AND (#7 OR #8)

140

#10 

#4 AND #6

22

#9 

#4 AND #5 SR

8

#8 

'case control study'/de OR 'comparative study'/exp OR 'control group'/de OR 'controlled study'/de OR 'controlled clinical trial'/de OR 'crossover procedure'/de OR 'double blind procedure'/de OR 'phase 2 clinical trial'/de OR 'phase 3 clinical trial'/de OR 'phase 4 clinical trial'/de OR 'pretest posttest design'/de OR 'pretest posttest control group design'/de OR 'quasi experimental study'/de OR 'single blind procedure'/de OR 'triple blind procedure'/de OR (((control OR controlled) NEAR/6 trial):ti,ab,kw) OR (((control OR controlled) NEAR/6 (study OR studies)):ti,ab,kw) OR (((control OR controlled) NEAR/1 active):ti,ab,kw) OR 'open label*':ti,ab,kw OR (((double OR two OR three OR multi OR trial) NEAR/1 (arm OR arms)):ti,ab,kw) OR ((allocat* NEAR/10 (arm OR arms)):ti,ab,kw) OR placebo*:ti,ab,kw OR 'sham-control*':ti,ab,kw OR (((single OR double OR triple OR assessor) NEAR/1 (blind* OR masked)):ti,ab,kw) OR nonrandom*:ti,ab,kw OR 'non-random*':ti,ab,kw OR 'quasi-experiment*':ti,ab,kw OR crossover:ti,ab,kw OR 'cross over':ti,ab,kw OR 'parallel group*':ti,ab,kw OR 'factorial trial':ti,ab,kw OR ((phase NEAR/5 (study OR trial)):ti,ab,kw) OR ((case* NEAR/6 (matched OR control*)):ti,ab,kw) OR ((match* NEAR/6 (pair OR pairs OR cohort* OR control* OR group* OR healthy OR age OR sex OR gender OR patient* OR subject* OR participant*)):ti,ab,kw) OR ((propensity NEAR/6 (scor* OR match*)):ti,ab,kw) OR versus:ti OR vs:ti OR compar*:ti OR ((compar* NEAR/1 study):ti,ab,kw) OR (('major clinical study'/de OR 'clinical study'/de OR 'cohort analysis'/de OR 'observational study'/de OR 'cross-sectional study'/de OR 'multicenter study'/de OR 'correlational study'/de OR 'follow up'/de OR cohort*:ti,ab,kw OR 'follow up':ti,ab,kw OR followup:ti,ab,kw OR longitudinal*:ti,ab,kw OR prospective*:ti,ab,kw OR retrospective*:ti,ab,kw OR observational*:ti,ab,kw OR 'cross sectional*':ti,ab,kw OR cross?ectional*:ti,ab,kw OR multicent*:ti,ab,kw OR 'multi-cent*':ti,ab,kw OR consecutive*:ti,ab,kw) AND (group:ti,ab,kw OR groups:ti,ab,kw OR subgroup*:ti,ab,kw OR versus:ti,ab,kw OR vs:ti,ab,kw OR compar*:ti,ab,kw OR 'odds ratio*':ab OR 'relative odds':ab OR 'risk ratio*':ab OR 'relative risk*':ab OR 'rate ratio':ab OR aor:ab OR arr:ab OR rrr:ab OR ((('or' OR 'rr') NEAR/6 ci):ab)))

12912012

#7 

'major clinical study'/de OR 'clinical study'/de OR 'case control study'/de OR 'family study'/de OR 'longitudinal study'/de OR 'retrospective study'/de OR 'prospective study'/de OR 'comparative study'/de OR 'cohort analysis'/de OR ((cohort NEAR/1 (study OR studies)):ab,ti) OR (('case control' NEAR/1 (study OR studies)):ab,ti) OR (('follow up' NEAR/1 (study OR studies)):ab,ti) OR (observational NEAR/1 (study OR studies)) OR ((epidemiologic NEAR/1 (study OR studies)):ab,ti) OR (('cross sectional' NEAR/1 (study OR studies)):ab,ti)

6928224

#6 

'randomized controlled trial'/exp OR random*:ti,ab OR (((pragmatic OR practical) NEAR/1 'clinical trial*'):ti,ab) OR ((('non inferiority' OR noninferiority OR superiority OR equivalence) NEAR/3 trial*):ti,ab) OR rct:ti,ab,kw

1879065

#5 

'meta analysis'/exp OR 'meta analysis (topic)'/exp OR metaanaly*:ti,ab OR 'meta analy*':ti,ab OR metanaly*:ti,ab OR 'systematic review'/de OR 'cochrane database of systematic reviews'/jt OR prisma:ti,ab OR prospero:ti,ab OR (((systemati* OR scoping OR umbrella OR 'structured literature') NEAR/3 (review* OR overview*)):ti,ab) OR ((systemic* NEAR/1 review*):ti,ab) OR (((systemati* OR literature OR database* OR 'data base*') NEAR/10 search*):ti,ab) OR (((structured OR comprehensive* OR systemic*) NEAR/3 search*):ti,ab) OR (((literature NEAR/3 review*):ti,ab) AND (search*:ti,ab OR database*:ti,ab OR 'data base*':ti,ab)) OR (('data extraction':ti,ab OR 'data source*':ti,ab) AND 'study selection':ti,ab) OR ('search strategy':ti,ab AND 'selection criteria':ti,ab) OR ('data source*':ti,ab AND 'data synthesis':ti,ab) OR medline:ab OR pubmed:ab OR embase:ab OR cochrane:ab OR (((critical OR rapid) NEAR/2 (review* OR overview* OR synthes*)):ti) OR ((((critical* OR rapid*) NEAR/3 (review* OR overview* OR synthes*)):ab) AND (search*:ab OR database*:ab OR 'data base*':ab)) OR metasynthes*:ti,ab OR 'meta synthes*':ti,ab

802829

#4 

#3 AND [1-1-2000]/sd NOT ('conference abstract'/it OR 'orial'/it OR 'letter'/it OR 'note'/it) NOT (('animal'/exp OR 'animal experiment'/exp OR 'animal model'/exp) NOT 'human'/exp)

285

#3 

#1 AND #2

1044

#2 

'hospital service'/exp OR 'disinfection'/mj OR 'microbial contamination'/exp OR 'infection control'/exp OR 'disinfectant agent'/exp OR 'detergent'/exp OR 'decontamination'/exp OR 'cleaning'/exp OR 'hospital housekeeping'/exp OR housekeeping:ti,ab,kw OR 'house keeping':ti,ab,kw OR hygien*:ti,ab,kw OR 'sanitary engineering':ti,ab,kw OR sanitation:ti,ab,kw OR bundling:ti,ab,kw OR antiseptic*:ti,ab,kw OR asepsis:ti,ab,kw OR biocid*:ti,ab,kw OR germicid*:ti,ab,kw OR microbicid*:ti,ab,kw OR bactericid*:ti,ab,kw OR fungicid*:ti,ab,kw OR tuberculocid*:ti,ab,kw OR virucid*:ti,ab,kw OR sanitiz*:ti,ab,kw OR sanitis*:ti,ab,kw OR decontaminat*:ti,ab,kw OR ((surface NEAR/2 active NEAR/2 agent*):ti,ab,kw) OR cleaner*:ti,ab,kw OR mop:ti,ab,kw OR mops:ti,ab,kw OR vacuum*:ti,ab,kw OR cleaning:ti,ab,kw OR 'domestic services':ti,ab,kw OR soap:ti,ab,kw OR soaps:ti,ab,kw OR detergent*:ti,ab,kw OR surfactant*:ti,ab,kw OR ((steam NEAR/2 clean*):ti,ab,kw) OR ((spray NEAR/2 clean*):ti,ab,kw) OR ((wet NEAR/2 scrub*):ti,ab,kw) OR ((mechanical NEAR/2 scrub*):ti,ab,kw) OR ((dry NEAR/2 wip*):ti,ab,kw) OR ((damp NEAR/2 wash*):ti,ab,kw) OR disinfect*:ti,ab,kw OR inactivation:ti,ab,kw OR alcohol*:ti,ab,kw OR chlorine*:ti,ab,kw OR hypochlorite*:ti,ab,kw OR aldehyde*:ti,ab,kw OR formaldehyde:ti,ab,kw OR glutaraldehyde:ti,ab,kw OR peroxide*:ti,ab,kw OR ((peroxygen NEAR/1 compound*):ti,ab,kw) OR 'benzalkonium chloride':ti,ab,kw OR iodophor*:ti,ab,kw OR ortho‐phthalaldehyde:ti,ab,kw OR 'peracetic acid':ti,ab,kw OR phenolic*:ti,ab,kw OR ((quaternary NEAR/1 ammonium NEAR/1 compound*):ti,ab,kw) OR quat:ti,ab,kw OR 'orthobenzyl parachlorophenol':ti,ab,kw OR 'ortho‐benzyl para‐chlorophenol':ti,ab,kw OR ((active NEAR/1 oxygen‐based NEAR/1 compound*):ti,ab,kw) OR (glycol:ti,ab,kw AND next:ti,ab,kw AND derivative*:ti,ab,kw) OR alkylamine*:ti,ab,kw

1877138

#1 

'disposable equipment'/exp AND (cloth:ti,ab,kw OR cloths:ti,ab,kw OR wipe*:ti,ab,kw) OR (((fibre OR fiber OR microfiber OR microfibre OR disposable* OR cleaning OR disinfectant* OR decontamination) NEAR/3 (cloth OR cloths OR wipe*)):ti,ab,kw) OR vermop:ti,ab,kw

694

 

OVID/Medline

21-3-2022

 

#

Searches

Results

12

(5 or 6) and 9 OBS

55

11

4 and 9 RCT

16

10

3 and 9 SR

5

9

8 not ((exp animals/ or exp models, animal/) not humans/) not (letter/ or comment/ or orial/)

211

8

limit 7 to yr="2000 -Current"

220

7

1 and 2 

239

6

Case-control Studies/ or clinical trial, phase ii/ or clinical trial, phase iii/ or clinical trial, phase iv/ or comparative study/ or control groups/ or controlled before-after studies/ or controlled clinical trial/ or double-blind method/ or historically controlled study/ or matched-pair analysis/ or single-blind method/ or (((control or controlled) adj6 (study or studies or trial)) or (compar* adj (study or studies)) or ((control or controlled) adj1 active) or "open label*" or ((double or two or three or multi or trial) adj (arm or arms)) or (allocat* adj10 (arm or arms)) or placebo* or "sham-control*" or ((single or double or triple or assessor) adj1 (blind* or masked)) or nonrandom* or "non-random*" or "quasi-experiment*" or "parallel group*" or "factorial trial" or "pretest posttest" or (phase adj5 (study or trial)) or (case* adj6 (matched or control*)) or (match* adj6 (pair or pairs or cohort* or control* or group* or healthy or age or sex or gender or patient* or subject* or participant*)) or (propensity adj6 (scor* or match*))).ti,ab,kf. or (confounding adj6 adjust*).ti,ab. or (versus or vs or compar*).ti. or ((exp cohort studies/ or epidemiologic studies/ or multicenter study/ or observational study/ or seroepidemiologic studies/ or (cohort* or 'follow up' or followup or longitudinal* or prospective* or retrospective* or observational* or multicent* or 'multi-cent*' or consecutive*).ti,ab,kf.) and ((group or groups or subgroup* or versus or vs or compar*).ti,ab,kf. or ('odds ratio*' or 'relative odds' or 'risk ratio*' or 'relative risk*' or aor or arr or rrr).ab. or (("OR" or "RR") adj6 CI).ab.))

5110085

5

Epidemiologic studies/ or case control studies/ or exp cohort studies/ or Controlled Before-After Studies/ or Case control.tw. or cohort.tw. or Cohort analy$.tw. or (Follow up adj (study or studies)).tw. or (observational adj (study or studies)).tw. or Longitudinal.tw. or Retrospective*.tw. or prospective*.tw. or consecutive*.tw. or Cross sectional.tw. or Cross-sectional studies/ or historically controlled study/ or interrupted time series analysis/ [Onder exp cohort studies vallen ook longitudinale, prospectieve en retrospectieve studies]

4097774

4

(exp randomized controlled trial/ or randomized controlled trials as topic/ or random*.ti,ab. or rct?.ti,ab. or ((pragmatic or practical) adj "clinical trial*").ti,ab,kf. or ((non-inferiority or noninferiority or superiority or equivalence) adj3 trial*).ti,ab,kf.) not (animals/ not humans/)

1360221

3

(meta-analysis/ or meta-analysis as topic/ or (metaanaly* or meta-analy* or metanaly*).ti,ab,kf. or systematic review/ or cochrane.jw. or (prisma or prospero).ti,ab,kf. or ((systemati* or scoping or umbrella or "structured literature") adj3 (review* or overview*)).ti,ab,kf. or (systemic* adj1 review*).ti,ab,kf. or ((systemati* or literature or database* or data-base*) adj10 search*).ti,ab,kf. or ((structured or comprehensive* or systemic*) adj3 search*).ti,ab,kf. or ((literature adj3 review*) and (search* or database* or data-base*)).ti,ab,kf. or (("data extraction" or "data source*") and "study selection").ti,ab,kf. or ("search strategy" and "selection criteria").ti,ab,kf. or ("data source*" and "data synthesis").ti,ab,kf. or (medline or pubmed or embase or cochrane).ab. or ((critical or rapid) adj2 (review* or overview* or synthes*)).ti. or (((critical* or rapid*) adj3 (review* or overview* or synthes*)) and (search* or database* or data-base*)).ab. or (metasynthes* or meta-synthes*).ti,ab,kf.) not (comment/ or orial/ or letter/ or ((exp animals/ or exp models, animal/) not humans/))

553691

2

Housekeeping, Hospital/ or exp Disinfection/ or exp Infection Control/ or exp Anti-Infective Agents/ or Household Products/ or Detergents/ or Soaps/ or Decontamination/ or housekeeping.ti,ab,kf. or house keeping.ti,ab,kf. or hygien*.ti,ab,kf. or sanitary engineering.ti,ab,kf. or sanitation.ti,ab,kf. or bundling.ti,ab,kf. or antiseptic*.ti,ab,kf. or asepsis.ti,ab,kf. or biocid*.ti,ab,kf. or germicid*.ti,ab,kf. or microbicid*.ti,ab,kf. or bactericid*.ti,ab,kf. or fungicid*.ti,ab,kf. or tuberculocid*.ti,ab,kf. or virucid*.ti,ab,kf. or sanitiz*.ti,ab,kf. or sanitis*.ti,ab,kf. or decontaminat*.ti,ab,kf. or (surface adj2 active adj2 agent*).ti,ab,kf. or cleaner*.ti,ab,kf. or mop.ti,ab,kf. or mops.ti,ab,kf. or vacuum*.ti,ab,kf. or cleaning.ti,ab,kf. or domestic services.ti,ab,kf. or soap.ti,ab,kf. or soaps.ti,ab,kf. or detergent*.ti,ab,kf. or surfactant*.ti,ab,kf. or (steam adj2 clean*).ti,ab,kf. or (spray adj2 clean*).ti,ab,kf. or (wet adj2 scrub*).ti,ab,kf. or (mechanical adj2 scrub*).ti,ab,kf. or (dry adj2 wip*).ti,ab,kf. or (damp adj2 wash*).ti,ab,kf. or disinfect*.ti,ab,kf. or inactivation.ti,ab,kf. or alcohol*.ti,ab,kf. or chlorine*.ti,ab,kf. or hypochlorite*.ti,ab,kf. or aldehyde*.ti,ab,kf. or formaldehyde.ti,ab,kf. or glutaraldehyde.ti,ab,kf. or peroxide*.ti,ab,kf. or (peroxygen adj1 compound*).ti,ab,kf. or benzalkonium chloride.ti,ab,kf. or iodophor*.ti,ab,kf. or ortho phthalaldehyde.ti,ab,kf. or peracetic acid.ti,ab,kf. or phenolic*.ti,ab,kf. or (quaternary adj1 ammonium adj1 compound*).ti,ab,kf. or quat.ti,ab,kf. or orthobenzyl parachlorophenol.ti,ab,kf. or (active adj1 oxygen based adj1 compound*).ti,ab,kf. or (glycol adj1 derivative*).ti,ab,kf. or alkylamine*.ti,ab,kf.

2714611

1

(exp disposable equipment/ and (cloth or cloths or wipe*).ti,ab,kf.) or ((fibre or fiber or microfiber or microfibre or disposable* or cleaning) adj3 (cloth or cloths or wipe*)).ti,ab,kf. or vermop.ti,ab,kf.

426

 

 

Cinahl

21-3-2022

 

 

Search Terms

Search Options

Actions

S10

S4 AND S7 OBS

Limiters - Publication Year: 2000-2022

Expanders - Apply equivalent subjects

Search modes - Boolean/Phrase

 (25)

 

 

 

S9

S4 AND S6  RCT

Limiters - Publication Year: 2000-2022

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 (47)

 

 

 

S8

S4 AND S5  SR

Limiters - Publication Year: 2000-2022

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 (3)

 

 

 

S7

(MH "Case Control Studies+") OR (MH "Case Studies") OR (MH "Cross Sectional Studies") OR (MH "Prospective Studies+") OR (MH "Retrospective Panel Studies") OR (MH "Correlational Studies") OR TI "case control" OR TI “case referent” OR AB “case referent*” OR TI “case stud*” OR AB “case stud*” OR TI “case series” OR AB “case series” OR TI cohort* OR AB cohort* OR TI “cross sectional” OR AB “cross sectional” OR TI “follow up” OR AB “follow up” OR TI longitudinal OR AB longitudinal OR TI retrospective ...

Limiters - Publication Year: 2000-2022

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 (1,356,020)

 

 

 

S6

(MH "Clinical Trials+") OR (PT (Clinical trial)) OR (MH "Random Assignment") OR (MH "Quantitative Studies") OR (TX ((clini* N1 trial*) OR (singl* N1 blind*) OR (singl* N1 mask*) OR (doubl* N1 blind*) OR (doubl* N1 mask*) OR (tripl* N1 blind*) OR (tripl* N1 mask*) OR (random* N1 allocat*) OR placebo* OR ((waitlist* OR (wait* and list*)) and (control* OR group)) OR "treatment as usual" OR tau OR (control* N3 (trial* OR study OR studies OR group*)) OR randomized OR randomised)) 

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 (1,665,272)

 

 

 

S5

(MH "Meta Analysis") or TX (meta-analy* or metanaly* or metaanaly* or meta analy*) or TX (systematic* N5 review*) or (evidence* N5 review*) or (methodol* N5 review*) or (quantitativ* N5 review*) or TX (systematic* N5 overview*) or (evidence* N5 overview*) or (methodol* N5 overview*) or (quantitativ* N5 overview*) or TX (systematic* N5 survey*) or (evidence* N5 survey*) or (methodol* N5 survey*) or (quantitativ* N5 survey*) or TX (systematic* N5 overview*) or (evidence* N5 overview*) or (methodol ...

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 (269,721)

 

 

 

S4

S1 AND S2 

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 (167)

 

 

 

S3

S1 AND S2 

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 (172)

 

 

 

S2

(MM "Home Maintenance") OR (MH "Health Facilities+" OR Household Products" OR "Microbial Contamination+" OR "Infection Control+") OR (TI "infection control" OR decontaminat* OR contaminat* OR cleaning) OR (AB "infection control" OR decontaminat* OR contaminat* OR cleaning) 

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 (538,479)

 

 

 

S1

(MH "Disposable Equipment") AND ((TI (cloth OR cloths OR wipe*)) OR (AB (cloth OR cloths OR wipe*))) OR (TI ((fibre OR fiber OR microfiber OR microfibre OR disposable* OR cleaning OR disinfectant* OR decontamination) N3 (cloth OR cloths OR wipe*))) OR (AB ((fibre OR fiber OR microfiber OR microfibre OR disposable* OR cleaning OR disinfectant* OR decontamination) N3 (cloth OR cloths OR wipe*))) 

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 (232)

 

 

 

 

Web of Science (WOS)

21-3-2022

(ALL=("microfiber cloth" OR "microfiber cloths"OR "disposable cloth" OR "disposable cloths" OR "cleaning cloth" OR "cleaning cloths" OR "microfiber wipe*" OR "disposable wipe*" OR "cleaning wipe*")) AND (PY==("2000" OR "2001" OR "2002" OR "2003" OR "2004" OR "2005" OR "2006" OR "2007" OR "2009" OR "2010" OR "2011" OR "2022" OR "2021" OR "2020" OR "2019" OR "2018" OR "2017" OR "2016" OR "2015" OR "2014" OR "2013" OR "2012"))

Embase

23-2-2022

No.

Query

Results

#52 

#51 NOT #43 NOT #44 NOT #45

24

#51 

#37 AND #50

32

#50 

#48 OR #49

3451526

#49 

'practice guideline'/exp

631124

#48 

'review'/exp

2948312

#47 

#45 NOT #44 NOT #43

78

#46 

#44 NOT #43

15

#45 

#38 AND (#41 OR #42)

93

#44 

#38 AND #40

16

#43 

#38 AND #39

3

#42 

'case control study'/de OR 'comparative study'/exp OR 'control group'/de OR 'controlled study'/de OR 'controlled clinical trial'/de OR 'crossover procedure'/de OR 'double blind procedure'/de OR 'phase 2 clinical trial'/de OR 'phase 3 clinical trial'/de OR 'phase 4 clinical trial'/de OR 'pretest posttest design'/de OR 'pretest posttest control group design'/de OR 'quasi experimental study'/de OR 'single blind procedure'/de OR 'triple blind procedure'/de OR (((control OR controlled) NEAR/6 trial):ti,ab,kw) OR (((control OR controlled) NEAR/6 (study OR studies)):ti,ab,kw) OR (((control OR controlled) NEAR/1 active):ti,ab,kw) OR 'open label*':ti,ab,kw OR (((double OR two OR three OR multi OR trial) NEAR/1 (arm OR arms)):ti,ab,kw) OR ((allocat* NEAR/10 (arm OR arms)):ti,ab,kw) OR placebo*:ti,ab,kw OR 'sham-control*':ti,ab,kw OR (((single OR double OR triple OR assessor) NEAR/1 (blind* OR masked)):ti,ab,kw) OR nonrandom*:ti,ab,kw OR 'non-random*':ti,ab,kw OR 'quasi-experiment*':ti,ab,kw OR crossover:ti,ab,kw OR 'cross over':ti,ab,kw OR 'parallel group*':ti,ab,kw OR 'factorial trial':ti,ab,kw OR ((phase NEAR/5 (study OR trial)):ti,ab,kw) OR ((case* NEAR/6 (matched OR control*)):ti,ab,kw) OR ((match* NEAR/6 (pair OR pairs OR cohort* OR control* OR group* OR healthy OR age OR sex OR gender OR patient* OR subject* OR participant*)):ti,ab,kw) OR ((propensity NEAR/6 (scor* OR match*)):ti,ab,kw) OR versus:ti OR vs:ti OR compar*:ti OR ((compar* NEAR/1 study):ti,ab,kw) OR (('major clinical study'/de OR 'clinical study'/de OR 'cohort analysis'/de OR 'observational study'/de OR 'cross-sectional study'/de OR 'multicenter study'/de OR 'correlational study'/de OR 'follow up'/de OR cohort*:ti,ab,kw OR 'follow up':ti,ab,kw OR followup:ti,ab,kw OR longitudinal*:ti,ab,kw OR prospective*:ti,ab,kw OR retrospective*:ti,ab,kw OR observational*:ti,ab,kw OR 'cross sectional*':ti,ab,kw OR cross?ectional*:ti,ab,kw OR multicent*:ti,ab,kw OR 'multi-cent*':ti,ab,kw OR consecutive*:ti,ab,kw) AND (group:ti,ab,kw OR groups:ti,ab,kw OR subgroup*:ti,ab,kw OR versus:ti,ab,kw OR vs:ti,ab,kw OR compar*:ti,ab,kw OR 'odds ratio*':ab OR 'relative odds':ab OR 'risk ratio*':ab OR 'relative risk*':ab OR 'rate ratio':ab OR aor:ab OR arr:ab OR rrr:ab OR ((('or' OR 'rr') NEAR/6 ci):ab)))

12912012

#41 

'major clinical study'/de OR 'clinical study'/de OR 'case control study'/de OR 'family study'/de OR 'longitudinal study'/de OR 'retrospective study'/de OR 'prospective study'/de OR 'comparative study'/de OR 'cohort analysis'/de OR ((cohort NEAR/1 (study OR studies)):ab,ti) OR (('case control' NEAR/1 (study OR studies)):ab,ti) OR (('follow up' NEAR/1 (study OR studies)):ab,ti) OR (observational NEAR/1 (study OR studies)) OR ((epidemiologic NEAR/1 (study OR studies)):ab,ti) OR (('cross sectional' NEAR/1 (study OR studies)):ab,ti)

6928224

#40 

'randomized controlled trial'/exp OR random*:ti,ab OR (((pragmatic OR practical) NEAR/1 'clinical trial*'):ti,ab) OR ((('non inferiority' OR noninferiority OR superiority OR equivalence) NEAR/3 trial*):ti,ab) OR rct:ti,ab,kw

1879065

#39 

'meta analysis'/exp OR 'meta analysis (topic)'/exp OR metaanaly*:ti,ab OR 'meta analy*':ti,ab OR metanaly*:ti,ab OR 'systematic review'/de OR 'cochrane database of systematic reviews'/jt OR prisma:ti,ab OR prospero:ti,ab OR (((systemati* OR scoping OR umbrella OR 'structured literature') NEAR/3 (review* OR overview*)):ti,ab) OR ((systemic* NEAR/1 review*):ti,ab) OR (((systemati* OR literature OR database* OR 'data base*') NEAR/10 search*):ti,ab) OR (((structured OR comprehensive* OR systemic*) NEAR/3 search*):ti,ab) OR (((literature NEAR/3 review*):ti,ab) AND (search*:ti,ab OR database*:ti,ab OR 'data base*':ti,ab)) OR (('data extraction':ti,ab OR 'data source*':ti,ab) AND 'study selection':ti,ab) OR ('search strategy':ti,ab AND 'selection criteria':ti,ab) OR ('data source*':ti,ab AND 'data synthesis':ti,ab) OR medline:ab OR pubmed:ab OR embase:ab OR cochrane:ab OR (((critical OR rapid) NEAR/2 (review* OR overview* OR synthes*)):ti) OR ((((critical* OR rapid*) NEAR/3 (review* OR overview* OR synthes*)):ab) AND (search*:ab OR database*:ab OR 'data base*':ab)) OR metasynthes*:ti,ab OR 'meta synthes*':ti,ab

802829

#38 

#37 AND [1-1-2000]/sd NOT ('conference abstract'/it OR 'orial'/it OR 'letter'/it OR 'note'/it) NOT (('animal'/exp OR 'animal experiment'/exp OR 'animal model'/exp OR 'nonhuman'/exp) NOT 'human'/exp)

230

#37 

#35 AND #36

437

#36 

'hospital service'/exp OR 'disinfection'/mj OR 'infection control'/exp OR 'disinfectant agent'/exp OR 'detergent'/exp OR 'decontamination'/exp OR 'cleaning'/exp OR 'hospital housekeeping'/exp OR housekeeping:ti,ab,kw OR 'house keeping':ti,ab,kw OR hygien*:ti,ab,kw OR 'sanitary engineering':ti,ab,kw OR sanitation:ti,ab,kw OR bundling:ti,ab,kw OR antiseptic*:ti,ab,kw OR asepsis:ti,ab,kw OR biocid*:ti,ab,kw OR germicid*:ti,ab,kw OR microbicid*:ti,ab,kw OR bactericid*:ti,ab,kw OR fungicid*:ti,ab,kw OR tuberculocid*:ti,ab,kw OR virucid*:ti,ab,kw OR sanitiz*:ti,ab,kw OR sanitis*:ti,ab,kw OR decontaminat*:ti,ab,kw OR ((surface NEAR/2 active NEAR/2 agent*):ti,ab,kw) OR cleaner*:ti,ab,kw OR mop:ti,ab,kw OR mops:ti,ab,kw OR vacuum*:ti,ab,kw OR cleaning:ti,ab,kw OR 'domestic services':ti,ab,kw OR soap:ti,ab,kw OR soaps:ti,ab,kw OR detergent*:ti,ab,kw OR surfactant*:ti,ab,kw OR ((steam NEAR/2 clean*):ti,ab,kw) OR ((spray NEAR/2 clean*):ti,ab,kw) OR ((wet NEAR/2 scrub*):ti,ab,kw) OR ((mechanical NEAR/2 scrub*):ti,ab,kw) OR ((dry NEAR/2 wip*):ti,ab,kw) OR ((damp NEAR/2 wash*):ti,ab,kw) OR disinfect*:ti,ab,kw OR inactivation:ti,ab,kw OR alcohol*:ti,ab,kw OR chlorine*:ti,ab,kw OR hypochlorite*:ti,ab,kw OR aldehyde*:ti,ab,kw OR formaldehyde:ti,ab,kw OR glutaraldehyde:ti,ab,kw OR peroxide*:ti,ab,kw OR ((peroxygen NEAR/1 compound*):ti,ab,kw) OR 'benzalkonium chloride':ti,ab,kw OR iodophor*:ti,ab,kw OR ortho‐phthalaldehyde:ti,ab,kw OR 'peracetic acid':ti,ab,kw OR phenolic*:ti,ab,kw OR ((quaternary NEAR/1 ammonium NEAR/1 compound*):ti,ab,kw) OR quat:ti,ab,kw OR 'orthobenzyl parachlorophenol':ti,ab,kw OR 'ortho‐benzyl para‐chlorophenol':ti,ab,kw OR ((active NEAR/1 oxygen‐based NEAR/1 compound*):ti,ab,kw) OR (glycol:ti,ab,kw AND next:ti,ab,kw AND derivative*:ti,ab,kw) OR alkylamine*:ti,ab,kw

1849609

#35 

'disposable equipment'/exp AND (cloth:ti,ab,kw OR cloths:ti,ab,kw OR wipe*:ti,ab,kw) OR (((fibre OR fiber OR microfiber OR microfibre OR disposable*) NEAR/3 (cloth OR cloths OR material* OR wipe*)):ti,ab,kw) OR vermop:ti,ab,kw

2677

 


Embase Session Results (15 Feb 2022)

No.

Query

Results

#38 

#35 OR #36 OR #37

21

#37 

#30 AND (#33 OR #34)

19

#36 

#30 AND #32

2

#35 

#30 AND #31

1

#34 

'case control study'/de OR 'comparative study'/exp OR 'control group'/de OR 'controlled study'/de OR 'controlled clinical trial'/de OR 'crossover procedure'/de OR 'double blind procedure'/de OR 'phase 2 clinical trial'/de OR 'phase 3 clinical trial'/de OR 'phase 4 clinical trial'/de OR 'pretest posttest design'/de OR 'pretest posttest control group design'/de OR 'quasi experimental study'/de OR 'single blind procedure'/de OR 'triple blind procedure'/de OR (((control OR controlled) NEAR/6 trial):ti,ab,kw) OR (((control OR controlled) NEAR/6 (study OR studies)):ti,ab,kw) OR (((control OR controlled) NEAR/1 active):ti,ab,kw) OR 'open label*':ti,ab,kw OR (((double OR two OR three OR multi OR trial) NEAR/1 (arm OR arms)):ti,ab,kw) OR ((allocat* NEAR/10 (arm OR arms)):ti,ab,kw) OR placebo*:ti,ab,kw OR 'sham-control*':ti,ab,kw OR (((single OR double OR triple OR assessor) NEAR/1 (blind* OR masked)):ti,ab,kw) OR nonrandom*:ti,ab,kw OR 'non-random*':ti,ab,kw OR 'quasi-experiment*':ti,ab,kw OR crossover:ti,ab,kw OR 'cross over':ti,ab,kw OR 'parallel group*':ti,ab,kw OR 'factorial trial':ti,ab,kw OR ((phase NEAR/5 (study OR trial)):ti,ab,kw) OR ((case* NEAR/6 (matched OR control*)):ti,ab,kw) OR ((match* NEAR/6 (pair OR pairs OR cohort* OR control* OR group* OR healthy OR age OR sex OR gender OR patient* OR subject* OR participant*)):ti,ab,kw) OR ((propensity NEAR/6 (scor* OR match*)):ti,ab,kw) OR versus:ti OR vs:ti OR compar*:ti OR ((compar* NEAR/1 study):ti,ab,kw) OR (('major clinical study'/de OR 'clinical study'/de OR 'cohort analysis'/de OR 'observational study'/de OR 'cross-sectional study'/de OR 'multicenter study'/de OR 'correlational study'/de OR 'follow up'/de OR cohort*:ti,ab,kw OR 'follow up':ti,ab,kw OR followup:ti,ab,kw OR longitudinal*:ti,ab,kw OR prospective*:ti,ab,kw OR retrospective*:ti,ab,kw OR observational*:ti,ab,kw OR 'cross sectional*':ti,ab,kw OR cross?ectional*:ti,ab,kw OR multicent*:ti,ab,kw OR 'multi-cent*':ti,ab,kw OR consecutive*:ti,ab,kw) AND (group:ti,ab,kw OR groups:ti,ab,kw OR subgroup*:ti,ab,kw OR versus:ti,ab,kw OR vs:ti,ab,kw OR compar*:ti,ab,kw OR 'odds ratio*':ab OR 'relative odds':ab OR 'risk ratio*':ab OR 'relative risk*':ab OR 'rate ratio':ab OR aor:ab OR arr:ab OR rrr:ab OR ((('or' OR 'rr') NEAR/6 ci):ab)))

12886408

#33 

'major clinical study'/de OR 'clinical study'/de OR 'case control study'/de OR 'family study'/de OR 'longitudinal study'/de OR 'retrospective study'/de OR 'prospective study'/de OR 'comparative study'/de OR 'cohort analysis'/de OR ((cohort NEAR/1 (study OR studies)):ab,ti) OR (('case control' NEAR/1 (study OR studies)):ab,ti) OR (('follow up' NEAR/1 (study OR studies)):ab,ti) OR (observational NEAR/1 (study OR studies)) OR ((epidemiologic NEAR/1 (study OR studies)):ab,ti) OR (('cross sectional' NEAR/1 (study OR studies)):ab,ti)

6913054

#32 

'randomized controlled trial'/exp OR random*:ti,ab OR (((pragmatic OR practical) NEAR/1 'clinical trial*'):ti,ab) OR ((('non inferiority' OR noninferiority OR superiority OR equivalence) NEAR/3 trial*):ti,ab) OR rct:ti,ab,kw

1875495

#31 

'meta analysis'/exp OR 'meta analysis (topic)'/exp OR metaanaly*:ti,ab OR 'meta analy*':ti,ab OR metanaly*:ti,ab OR 'systematic review'/de OR 'cochrane database of systematic reviews'/jt OR prisma:ti,ab OR prospero:ti,ab OR (((systemati* OR scoping OR umbrella OR 'structured literature') NEAR/3 (review* OR overview*)):ti,ab) OR ((systemic* NEAR/1 review*):ti,ab) OR (((systemati* OR literature OR database* OR 'data base*') NEAR/10 search*):ti,ab) OR (((structured OR comprehensive* OR systemic*) NEAR/3 search*):ti,ab) OR (((literature NEAR/3 review*):ti,ab) AND (search*:ti,ab OR database*:ti,ab OR 'data base*':ti,ab)) OR (('data extraction':ti,ab OR 'data source*':ti,ab) AND 'study selection':ti,ab) OR ('search strategy':ti,ab AND 'selection criteria':ti,ab) OR ('data source*':ti,ab AND 'data synthesis':ti,ab) OR medline:ab OR pubmed:ab OR embase:ab OR cochrane:ab OR (((critical OR rapid) NEAR/2 (review* OR overview* OR synthes*)):ti) OR ((((critical* OR rapid*) NEAR/3 (review* OR overview* OR synthes*)):ab) AND (search*:ab OR database*:ab OR 'data base*':ab)) OR metasynthes*:ti,ab OR 'meta synthes*':ti,ab

800203

#30 

#29 AND [1-1-2000]/sd NOT ('conference abstract'/it OR 'orial'/it OR 'letter'/it OR 'note'/it) NOT (('animal'/exp OR 'animal experiment'/exp OR 'animal model'/exp OR 'nonhuman'/exp) NOT 'human'/exp)

55

#29 

(((microfiber OR microfibre) NEAR/3 (cloth OR cloths OR material*)):ti,ab,kw) OR 'cleaning cloth':ti,ab,kw OR 'cleaning cloths':ti,ab,kw

115

       

 

Microvezeldoekjes

RECORD 1
TITLE
  Impact of Porous Matrices and Concentration by Lyophilization on Cell-Free Expression
AUTHOR NAMES
  Blum S.M.;  Lee M.S.;  Mgboji G.E.;  Funk V.L.;  Beabout K.;  Harbaugh S.V.;  Roth P.A.;  Liem A.T.;  Miklos A.E.;  Emanuel P.A.;  Walper S.A.;  Chávez J.L.;  Lux M.W.
SOURCE
  ACS Synthetic Biology (2021) 10:5 (1116-1131). Date of Publication: 21 May 2021
ABSTRACT
  Cell-free expression systems have drawn increasing attention as a tool to achieve complex biological functions outside of the cell. Several applications of the technology involve the delivery of functionality to challenging environments, such as field-forward diagnostics or point-of-need manufacturing of pharmaceuticals. To achieve these goals, cell-free reaction components are preserved using encapsulation or lyophilization methods, both of which often involve an embedding of components in porous matrices like paper or hydrogels. Previous work has shown a range of impacts of porous materials on cell-free expression reactions. Here, we explored a panel of 32 paperlike materials and 5 hydrogel materials for the impact on reaction performance. The screen included a tolerance to lyophilization for reaction systems based on both cell lysates and purified expression components. For paperlike materials, we found that (1) materials based on synthetic polymers were mostly incompatible with cell-free expression, (2) lysate-based reactions were largely insensitive to the matrix for cellulosic and microfiber materials, and (3) purified systems had an improved performance when lyophilized in cellulosic but not microfiber matrices. The impact of hydrogel materials ranged from completely inhibitory to a slight enhancement. The exploration of modulating the rehydration volume of lyophilized reactions yielded reaction speed increases using an enzymatic colorimetric reporter of up to twofold with an optimal ratio of 2:1 lyophilized reaction to rehydration volume for the lysate system and 1.5:1 for the purified system. The effect was independent of the matrices assessed. Testing with a fluorescent nonenzymatic reporter and no matrix showed similar improvements in both yields and reaction speeds for the lysate system and yields but not reaction speeds for the purified system. We finally used these observations to show an improved performance of two sensors that span reaction types, matrix, and reporters. In total, these results should enhance efforts to develop field-forward applications of cell-free expression systems.

RECORD 2
TITLE
  Environmental cleaning and disinfection of hospital rooms: A nationwide survey
AUTHOR NAMES
  Han Z.;  Pappas E.;  Simmons A.;  Fox J.;  Donskey C.J.;  Deshpande A.
SOURCE
  American Journal of Infection Control (2021) 49:1 (34-39). Date of Publication: 1 Jan 2021
ABSTRACT
  Background: As an important reservoir for hospital-acquired infections, environmental surfaces have long been targeted by interventions to improve cleaning and disinfection. Differences in disinfection practices across US hospitals, however, are still unclear. Methods: We conducted a nationwide survey of environmental services (EVS) personnel in the United States regarding their environmental surface disinfection practices from January 2019 to June 2019. We developed and pilot tested the survey in conjunction with EVS specialists. Survey questions inquired about choices of disinfectants and cleaning equipment during daily and terminal disinfection of both contact isolation and non-contact isolation rooms. We contacted 273 EVS personnel by phone and email to participate in the survey. Results: Fourty-seven EVS personnel representing different hospitals from 26 US states were included in the analysis. Hypochlorite (bleach) and quaternary ammonium compounds were the most frequently used disinfectants. Most respondents reported using microfiber-based cloths and mops to carry out disinfection. High-touch surfaces in contact isolation rooms were frequently disinfected using bleach (81%, n = 38); floors, however, were not disinfected as frequently in patient rooms. The vast majority of respondents reported use of sporicidal disinfectants for contact isolation rooms but not regular rooms. Conclusions: While frequently used to disinfectant contact isolation rooms, sporicidal agents are rarely used to disinfect regular rooms. Patient room floors are inconsistently disinfected compared to high-touch surfaces.

RECORD 3
TITLE
  Inward and outward effectiveness of cloth masks, a surgical mask, and a face shield
AUTHOR NAMES
  Pan J.;  Harb C.;  Leng W.;  Marr L.C.
SOURCE
  Aerosol Science and Technology (2021) 55:6 (718-733). Date of Publication: 2021
ABSTRACT
  We evaluated the effectiveness of 11 face coverings for material filtration efficiency, inward protection efficiency on a manikin, and outward protection efficiency on a manikin. At the most penetrating particle size, the vacuum bag, microfiber cloth, and single-layer surgical-type mask had material filtration efficiencies >50%, while the other materials had much lower filtration efficiencies. However, these efficiencies increased rapidly with particle size, and many materials had efficiencies >50% at 2 μm and >75% at 5 μm. The vacuum bag performed best, with efficiencies of 54–96% for all three metrics, depending on particle size. The thin acrylic and face shield performed worst. Inward protection efficiency and outward protection efficiency, defined for close-range, face-to-face interactions, were similar for many masks; the two efficiencies diverged for stiffer materials and those worn more loosely (e.g., bandana) or more tightly (e.g., wrapped around the head) compared to an earloop mask. Discrepancies between material filtration efficiency and inward/outward protection efficiency indicated that the fit of the mask was important. We calculated that the particle size most likely to deposit in the respiratory tract when wearing a mask is ∼2 μm. Based on these findings, we recommend a three-layer mask consisting of outer layers of a flexible, tightly woven fabric and an inner layer consisting of a material designed to filter out particles. This combination should produce an overall efficiency of >70% at the most penetrating particle size and >90% for particles 1 μm and larger if the mask fits well. Copyright © 2021 American Association for Aerosol Research.

RECORD 4
TITLE
  Forgotten Technology in the COVID-19 Pandemic: Filtration Properties of Cloth and Cloth Masks—A Narrative Review
AUTHOR NAMES
  Clase C.M.;  Fu E.L.;  Ashur A.;  Beale R.C.L.;  Clase I.A.;  Dolovich M.B.;  Jardine M.J.;  Joseph M.;  Kansiime G.;  Mann J.F.E.;  Pecoits-Filho R.;  Winkelmayer W.C.;  Carrero J.J.
SOURCE
  Mayo Clinic Proceedings (2020) 95:10 (2204-2224). Date of Publication: 1 Oct 2020
ABSTRACT
  Management of the global crisis of the coronavirus disease 2019 pandemic requires detailed appraisal of evidence to support clear, actionable, and consistent public health messaging. The use of cloth masks for general public use is being debated, and is in flux. We searched the MEDLINE and EMBASE databases and Google for articles reporting the filtration properties of flat cloth or cloth masks. We reviewed the reference lists of relevant articles to identify further articles and identified articles through social and conventional news media. We found 25 articles. Study of protection for the wearer used healthy volunteers, or used a manikin wearing a mask, with airflow to simulate different breathing rates. Studies of protection of the environment, also known as source control, used convenience samples of healthy volunteers. The design and execution of the studies was generally rigorously described. Many descriptions of cloth lacked the detail required for reproducibility; no study provided all the expected details of material, thread count, weave, and weight. Some of the homemade mask designs were reproducible. Successful masks were made of muslin at 100 threads per inch (TPI) in 3 to 4 layers (4-layer muslin or a muslin-flannel-muslin sandwich), tea towels (also known as dish towels), made using 1 layer (2 layers would be expected to be better), and good-quality cotton T-shirts in 2 layers (with a stitched edge to prevent stretching). In flat-cloth experiments, linen tea towels, 600-TPI cotton in 2 layers, and 600-TPI cotton with 90-TPI flannel performed well but 80-TPI cotton in 2 layers did not. We therefore recommend cotton or flannel at least 100 TPI, at least 2 layers. More layers, 3 or 4, will provide increased filtration but there is a trade-off in that more layers increases the resistance to breathing. Although this is not a systematic review, we included all the articles that we identified in an unbiased way. We did not include gray literature or preprints. A plain language summary of these data and recommendations, as well as information on making, wearing and cleaning cloth masks is available at www.clothmasks.ca.

RECORD 5
TITLE
  Cellulose-Derived Carbon Microfiber Mesh for Binder-Free Lithium-Sulfur Batteries
AUTHOR NAMES
  Li S.;  Cheng Z.;  Xie T.;  Dong Z.;  Liu G.
SOURCE
  Journal of nanoscience and nanotechnology (2020) 20:9 (5629-5635). Date of Publication: 1 Sep 2020
ABSTRACT
  The practical application of lithium-sulfur batteries (LSBs) has been impeded by several chronic problems related to the insulating nature of sulfur and lithium sulfide, in addition to the dissolution and diffusion of lithium polysulfides. In view of these problems, a large variety of carbonaceous materials have been employed to enhance the electronic conductivity of the cathode and/or sequester lithium polysulfides within conductive matrixes. Although they may exhibit impressive electrochemical performance, the fabrication of most carbon materials involves costly precursors and complicated procedures. Waste paper-the main constituent of municipal waste-is composed of carbohydrates, and can be an ideal precursor for carbon materials. Herein, carbon microfiber meshes (CMFMs) obtained by the pyrolysis of common filter paper in argon (A-CMFM) or ammonia (N-CMFM) were used to form sulfur cathodes. Compared with LSBs based on A-CMFM, those based on N-CMFM demonstrated higher specific capacity and better rate capability, with a capacity of 650 mA h g-1 at 0.2 C and 550 mA h g-1 at 0.5 C. This was owing to the strong immobilization of lithium polysulfides resulting from the heteroatom doping and hydrophilicity of N-CMFM. The results indicate that cellulose paper-derived carbon is a promising candidate for application in high-performance LSBs.

RECORD 6
TITLE
  Poly(ϵ-caprolactone) Scaffolds Doped with c-Jun N-terminal Kinase Inhibitors Modulate Phagocyte Activation
AUTHOR NAMES
  Stankevich K.S.;  Schepetkin I.A.;  Goreninskii S.I.;  Lavrinenko A.K.;  Bolbasov E.N.;  Kovrizhina A.R.;  Kirpotina L.N.;  Filimonov V.D.;  Khlebnikov A.I.;  Tverdokhlebov S.I.;  Quinn M.T.
SOURCE
  ACS Biomaterials Science and Engineering (2019) 5:11 (5990-5999). Date of Publication: 11 Nov 2019
ABSTRACT
  The modulation of phagocyte responses is essential for successful performance of biomaterials in order to prevent negative outcomes associated with inflammation. Herein, we developed electrospun poly(ϵ-caprolactone) (PCL) scaffolds doped with the novel potent c-Jun N-terminal kinase (JNK) inhibitors 11H-indeno[1,2-b]quinoxalin-11-one oxime (IQ-1) and 11H-indeno[1,2-b]quinoxalin-11-one O-(O-ethylcarboxymethyl) oxime(IQ-1E) as a promising approach for modulating phagocyte activation. Optimized electrospinning parameters allowed us to produce microfiber composite materials with suitable mechanical properties. We found that embedded compounds were bound to the polymer matrix via hydrophobic interactions and released in two steps, with release mostly controlled by Fickian diffusion. The fabricated scaffolds doped with active compounds IQ-1 and IQ-1E effectively inhibited phagocyte inflammatory responses. For example, they suppressed human neutrophil activation by the biomaterials, as indicated by decreased neutrophil reactive oxygen species (ROS) production and Ca2+ mobilization. In addition, they inhibited lipopolysaccharide (LPS)-induced NF-κB/AP-1 reporter activity in THP-1Blue cells and interleukin (IL)-6 production in MonoMac-6 cells without affecting cell viability. These effects were attributed to the released compounds rather than cell-surface interactions. Therefore, our study demonstrates that doping tissue engineering scaffolds with novel JNK inhibitors represents a powerful tool for preventing adverse immune responses to biomaterials as well as serves as a platform for drug delivery.

RECORD 7
TITLE
  Microfluidic Generation of Bioinspired Spindle-knotted Graphene Microfibers for Oil Absorption
AUTHOR NAMES
  Wu Z.;  Wang J.;  Zhao Z.;  Yu Y.;  Shang L.;  Zhao Y.
SOURCE
  Chemphyschem : a European journal of chemical physics and physical chemistry (2018) 19:16 (1990-1994). Date of Publication: 17 Aug 2018
ABSTRACT
  Graphene materials have a demonstrated value in water treatment. Efforts to promote these materials are focused on the generation of functional graphene adsorbents for effectively removing contaminants from water. Here, inspired by the conformation of spider silks, we present a novel graphene microfiber material with spindle-knotted microstructures by using a microfluidic emulsification and spinning collaborative technology. The size and spacing of the spindle-knots were highly controllable by adjusting the flow rates of microfluidics during the generation process of the microfibers. The generated microfibers could adsorb oil from a water-oil mixed environment due to their hydrophobic surface chemistry. Because of the surface energy curvature gradient and the difference in Laplace pressure, the collected oil tended to form droplets and move from joints between the spindle-knots to the knots. In addition, by encapsulating additional functional elements, such as magnetic nanoparticles, the graphene microfiber with the ability to control and facilitate the collection of oily contaminants can also be achieved. These features greatly prove the promising values of the spindle-knotted graphene microfibers in the protection of the environment.

RECORD 8
TITLE
  Quantitative characterization of TiO2 nanoparticle release from textiles by conventional and single particle ICP-MS
AUTHOR NAMES
  Mackevica A.;  Olsson M.E.;  Hansen S.F.
SOURCE
  Journal of Nanoparticle Research (2018) 20:1 Article Number: 6. Date of Publication: 1 Jan 2018
ABSTRACT
  TiO2 is ubiquitously present in a wide range of everyday items, both as an intentionally incorporated additive and naturally occurring constituent. It can be found in a wide range of consumer products, including personal care products, food contact materials, and textiles. Normal use of these products may lead to consumer and/or environmental exposure to TiO2, possibly in form of nanoparticles. The aim of this study is to perform a leaching test and apply state-of-the-art methods to investigate nano-TiO2 and total Ti release from five types of commercially available conventional textiles: table placemats, wet wipes, microfiber cloths, and two types of baby bodysuits, with Ti contents ranging from 2.63 to 1448 μg/g. Released particle analysis was performed using conventional and single particle inductively coupled plasma mass spectrometry (ICP-MS and spICP-MS), in conjunction with transmission electron microscopy (TEM), to measure total and particulate TiO2 release by mass and particle number, as well as size distribution. Less than 1% of the initial Ti content was released over 24 h of leaching, with the highest releases reaching 3.13 μg/g. The fraction of nano-TiO2 released varied among fabric types and represented 0–80% of total TiO2 release. Particle mode sizes were 50–75 nm, and TEM imaging revealed particles in sizes of 80–200 nm. This study highlights the importance of using a multi-method approach to obtain quantitative release data that is able to provide an indication regarding particle number, size distribution, and mass concentration, all of which can help in understanding the fate and exposure of nanoparticles.

RECORD 9
TITLE
  Sequential enhanced cleaning eliminates multidrug-resistant organisms in general intensive care unit of a traditional Chinese medicine hospital
AUTHOR NAMES
  Gan T.;  Xu H.;  Wu J.;  Zhu Y.;  Wang L.;  Jin H.;  Wei L.;  Shen L.;  Ni X.;  Cao J.;  Zhang Y.
SOURCE
  Journal of Critical Care (2017) 41 (216-221). Date of Publication: 1 Oct 2017
ABSTRACT
  Purpose Effective cleaning of surfaces within hospital wards is necessary to reduce pathogen transmission. We investigated the roles of sequential enhanced cleaning by culturing pathogens from high-touch surfaces in a general intensive care unit. Methods A before-after controlled study was conducted during a 17-month period in the 25-bed general intensive care unit. The study comprised a baseline period (period 1) and 4 sequential tiered interventions: each patient zone was wiped with a single clean microfiber cloth daily (period 2), fluorescent markers and adenosine triphosphate assay were used to monitor and provide feedback on the effectiveness of cleaning (period 3), wiping a single patient zone with 3 clean microfiber cloths daily (period 4), and withdrawal of the feedback (period 5). Results Compared with period 1, the cultures of multidrug-resistant organisms from high-touch surfaces were reduced by 41.0% (prevalence ratio [OR] = 0.59, P <.001), 70.8% (OR = 0.29, P <.001), 82.6% (OR = 0.17, P <.001), and 70.8% (OR = 0.29, P <.0001) in the subsequent sequential interventions, respectively. Conclusion Adoption of fluorescent markers and adenosine triphosphate bioluminescence reduced environmental contamination. Use of 3 cleaning cloths for 1 patient zone was more effective compared with a single cloth.

RECORD 10
TITLE
  Bacteria on smartphone touchscreens in a German university setting and evaluation of two popular cleaning methods using commercially available cleaning products
AUTHOR NAMES
  Egert M.;  Späth K.;  Weik K.;  Kunzelmann H.;  Horn C.;  Kohl M.;  Blessing F.
SOURCE
  Folia microbiologica (2015) 60:2 (159-164). Date of Publication: 1 Mar 2015
ABSTRACT
  Smartphone touchscreens are known as pathogen carriers in clinical environments. However, despite a rapidly growing number of smartphone users worldwide, little is known about bacterial contamination of smartphone touchscreens in non-clinical settings. Such data are needed to better understand the hygienic relevance of these increasingly popular items. Here, 60 touchscreens of smartphones provided by randomly chosen students of a German university were sampled by directly touching them with contact agar plates. The average bacterial load of uncleaned touchscreens was 1.37 ± 0.33 CFU/cm(2). Touchscreens wiped with commercially available microfiber cloths or alcohol-impregnated lens wipes contained significantly less bacteria than uncleaned touchscreens, i.e., 0.22 ± 0.10 CFU/cm(2) and 0.06 ± 0.02 CFU/cm(2), respectively. Bacteria isolated from cleaned and uncleaned touchscreens were identified by means of MALDI Biotyping. Out of 111 bacterial isolates, 56 isolates (50 %) were identified to genus level and 27 (24 %) to species level. The vast majority of the identified bacteria were typical human skin, mouth, lung, and intestinal commensals, mostly affiliated with the genera Staphylococcus and Micrococcus. Five out of 10 identified species were opportunistic pathogens. In conclusion, the touchscreens investigated here showed low bacterial loads and a species spectrum that is typical for frequently touched surfaces in domestic and public environments, the general health risk of which is still under debate.

RECORD 11
TITLE
  A follow-up study of hygiene in catering premises at large-scale events in the United Kingdom
AUTHOR NAMES
  Willis C.;  Elviss N.;  Mclauchlin J.
SOURCE
  Journal of Applied Microbiology (2015) 118:1 (222-232). Date of Publication: 1 Jan 2015
ABSTRACT
  Aims: To investigate food hygiene practices at large events by assessing the microbiological quality of ready-to-eat food, drinking water, food preparation surfaces, cleaning cloths and wristbands worn by food handlers for event security purposes. Methods and Results: Over a 7-month period, 1662 samples were collected at 153 events and examined for microbiological contamination. Eight per cent of food samples were of an unsatisfactory quality. A further one per cent contained potentially hazardous levels of human pathogenic bacteria. 27% of water samples, 32% of swabs and 56% of cloths were also unsatisfactory. These results represented an improvement in hygiene compared to a previous study carried out 12 months previously. A fifth of food handler wristbands were contaminated with Enterobacteriaceae, Escherichia coli and/or coagulase-positive staphylococci, with those bands made from fabric being more frequently contaminated than those made from plastic or other materials. Conclusions: This study provides evidence that the food hygiene at large-scale events may have improved. However, there is still a need for continued efforts to maintain an ongoing improvement in cleaning regimes and food hygiene management. Significance and Impact of the Study: This study was part of an ongoing focus on large events in the lead-up to the London 2012 Olympics. Lessons learnt here will be important in the planning of future large events.

RECORD 12
TITLE
  Clinical and cost effectiveness of eight disinfection methods for terminal disinfection of hospital isolation rooms contaminated with Clostridium difficile 027
AUTHOR NAMES
  Doan L.;  Forrest H.;  Fakis A.;  Craig J.;  Claxton L.;  Khare M.
SOURCE
  Journal of Hospital Infection (2012) 82:2 (114-121). Date of Publication: October 2012
ABSTRACT
  Background: Clostridium difficile spores can survive in the environment for months or years, and contaminated environmental surfaces are important sources of nosocomial C. difficile transmission. Aim: To compare the clinical and cost effectiveness of eight C. difficile environmental disinfection methods for the terminal cleaning of hospital rooms contaminated with C. difficile spores. Methods: This was a novel randomized prospective study undertaken in three phases. Each empty hospital room was disinfected, then contaminated with C. difficile spores and disinfected with one of eight disinfection products: hydrogen peroxide vapour (HPV; Bioquell Q10) 350-700 parts per million (ppm); dry ozone at 25 ppm (Mrox); 1000 ppm chlorine-releasing agent (Actichlor Plus); microfibre cloths (Vermop) used in combination with and without a chlorine-releasing agent; high temperature over heated dry atomized steam cleaning (Polti steam) in combination with a sanitizing solution (HPMed); steam cleaning (Osprey steam); and peracetic acid wipes (Clinell). Swabs were inoculated on to C. difficile-selective agar and colony counts were performed pre and post disinfection for each method. A cost-effectiveness analysis was also undertaken comparing all methods to the current method of 1000 ppm chlorine-releasing agent (Actichlor Plus). Findings: Products were ranked according to the log10reduction in colony count from contamination phase to disinfection. The three statistically significant most effective products were hydrogen peroxide (2.303); 1000 ppm chlorine-releasing agent (2.223) and peracetic acid wipes (2.134). Conclusion: The cheaper traditional method of using a chlorine-releasing agent for disinfection was as effective as modern methods. © 2012 The Healthcare Infection Society.

RECORD 13
TITLE
  Effect of surface coating and finish upon the cleanability of bed rails and the spread of Staphylococcus aureus
AUTHOR NAMES
  Ali S.;  Moore G.;  Wilson A.P.R.
SOURCE
  Journal of Hospital Infection (2012) 80:3 (192-198). Date of Publication: March 2012
ABSTRACT
  Background: Bacterial reservoirs in the near-patient environment are likely vectors of healthcare-acquired infection. Aim: To conduct a laboratory-based study to confirm a previous clinical finding of higher numbers of bacteria on plastic than on painted steel bed rails. Methods: Six different surfaces were inoculated with Staphylococcus aureus suspended in a range of synthetic soils. Aerobic colony counts and ATP bioluminescence were used to assess the efficacy of cleaning with microfibre cloths and antibacterial wipes. The ease with which S. aureus was transferred between fingertips and each bed rail was also investigated. Findings: Antibacterial wipes reduced bacterial numbers to below detectable levels on all rails but were less effective than microfibre cloths in removing organic debris. Surfaces that were comparatively easy to clean were more likely to transfer S. aureus on contact. If inadequately disinfected these rails could pose the greatest risk in terms of cross-transmission. In the absence of contaminating soil, bacterial transfer from fingertips to rail ranged from 38% to 64%. Transfer from rail to fingertip ranged from 22% to 38%. Surface material and rugosity were important factors in determining cleanability and transfer rate. However, the presence of organic soils affected bacterial transfer from all bed rails regardless of material or finish. Conclusion: Bed rails can become heavily contaminated. Regular wiping with antibacterial wipes could be a cost-effective means of maintaining low numbers of bacteria near to the patient. To minimize the risk of cross-transmission, cleaning protocols should be validated to ensure effective removal of microbial and non-microbial surface contamination. © 2012 The Healthcare Infection Society.

RECORD 14
TITLE
  Cellular compatibility of a gamma-irradiated modified siloxane-poly(lactic acid)-calcium carbonate hybrid membrane for guided bone regeneration.
AUTHOR NAMES
  Takeuchi N.;  Machigashira M.;  Yamashita D.;  Shirakata Y.;  Kasuga T.;  Noguchi K.;  Ban S.
SOURCE
  Dental materials journal (2011) 30:5 (730-738). Date of Publication: 2011
ABSTRACT
  A bi-layered silicon-releasable membrane consisting of a siloxane-poly(lactic acid) (PLA)-vaterite hybrid material (Si-PVH) microfiber mesh and a PLA microfiber mesh has been developed by an electrospinning method for guided bone regeneration (GBR) application. The bi-layered membrane was modified to a three-laminar structure by sandwiching an additional PLA microfiber mesh between the Si-PVH and PLA microfiber meshes (Si-PVH/PLA membrane). In this study, the influence of gamma irradiation, used for sterilization, on biological properties of the Si-PVH/PLA membrane was evaluated with osteoblasts and fibroblasts. After gamma irradiation, while the average molecular weight of the Si-PVH/PLA membrane decreased, the Si-PVH/PLA membrane promoted cell proliferation and differentiation (alkaline phosphatase activity and calcification) of osteoblasts, compared with the poly(lactide-co-glycolide) membrane. These results suggest that the gamma-irradiated Si-PVH/PLA membrane is biocompatible with both fibroblasts and osteoblasts, and may have an application for GBR.

RECORD 15
TITLE
  Direct fabrication of all -cellulose nanocomposite from cellulose microfibers using ionic liquid-based nanowelding
AUTHOR NAMES
  Yousefi H.;  Nishino T.;  Faezipour M.;  Ebrahimi G.;  Shakeri A.
SOURCE
  Biomacromolecules (2011) 12:11 (4080-4085). Date of Publication: 14 Nov 2011
ABSTRACT
  All-cellulose nanocomposite was directly fabricated using nanowelding of cellulose microfibers as a starting material, in 1-butyl-3-methylimidazolium chloride (BMIMCl) as a solvent, for the first time. The average diameter of the reinforcing component (undissolved nanofibrils) in the nanocomposite made directly from cellulose microfibers (NC-microfiber) was 53 ± 16 nm. Owing to its high mechanical properties (tensile strength of 208 MPa and Young's modulus of 20 GPa), high transparency (76% at a wavelength of 800 nm), and complete barrier to air and biodegradability, the NC-microfiber is regarded as a high multiperformance material. The NC-microfiber made directly from cellulose microfibers showed similar macro-, micro-, and nanostructures and the same properties as those made from solvent-based welding of ground cellulose nanofibers (NC-nanofiber). Omitting the step of cellulose nanofiber production makes the direct production of all-cellulose nanocomposite from cellulose microfibers easier, shorter, and cheaper than using cellulose nanofibers as starting material. The direct nanowelding of macro/micrometer-sized materials is theorized to be a fundamental approach for making nanocomposites. © 2011 American Chemical Society.

RECORD 16
TITLE
  Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
AUTHOR NAMES
  Datta R.;  Platt R.;  Yokoe D.S.;  Huang S.S.
SOURCE
  Archives of Internal Medicine (2011) 171:6 (491-494). Date of Publication: 28 Mar 2011
ABSTRACT
  Background: Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40% increased risk of acquisition, presumably through environmental contamination. Subsequently, a cleaning intervention was shown to reduce MRSA and VRE room contamination. We now evaluate the effect of this intervention on the risk of acquiring MRSA and VRE from prior room occupants. Methods: We conducted a retrospective cohort study of patients admitted to 10 intensive care units at a 750-bed academic medical center during the enhanced cleaning intervention (from September 1, 2006, through April 30, 2008; n=9449) vs baseline (from September 1, 2003, through April 30, 2005; n=8203) periods. The intervention consisted of targeted feedback using a black-light marker, cleaning cloths saturated with disinfectant via bucket immersion, and increased education regarding the importance of repeated bucket immersion during cleaning. Intensive care units included medical, cardiac, burn/trauma, general surgery, cardiac surgery, thoracic surgery and neurosurgery units. We calculated the number of room stays involving the potential for MRSA and VRE acquisition and then assessed the frequency at which eligible patients were exposed to rooms in which the prior occupants had MRSA-positive or VRE-positive status. Results: Acquisition of MRSA and VRE was lowered from 3.0% to 1.5% for MRSA and from 3.0% to 2.2% for VRE (P<.001 for both). Patients in rooms previously occupied by MRSA carriers had an increased risk of acquisition during the baseline (3.9% vs 2.9%, P=.03) but not the intervention (1.5% vs 1.5%, P=.79) period. In contrast, patients in rooms previously occupied by VRE carriers had an increased risk of acquisition during the baseline (4.5% vs 2.8%, P=.001) and intervention (3.5% vs 2.0%, P<.001) periods. Conclusions: Enhanced intensive care unit cleaning using the intervention methods may reduce MRSA and VRE transmission. It may also eliminate the risk of MRSA acquisition due to an MRSA-positive prior room occupant. ©2011 American Medical Association. All rights reserved.

RECORD 17
TITLE
  Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intensive care unit rooms
AUTHOR NAMES
  Goodman E.R.;  Platt R.;  Bass R.;  Onderdonk A.B.;  Yokoe D.S.;  Huang S.S.
SOURCE
  Infection Control and Hospital Epidemiology (2008) 29:7 (593-599). Date of Publication: July 2008
ABSTRACT
  OBJECTIVES. To evaluate the adequacy of discharge room cleaning and the impact of a cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) on environmental surfaces in intensive care unit (ICU) rooms. DESIGN. Prospective environmental study. SETTING AND SAMPLE. Convenience sample of ICU rooms in an academic hospital. METHODS AND INTERVENTION. The intervention consisted of (1) a change from the use of pour bottles to bucket immersion for applying disinfectant to cleaning cloths, (2) an educational campaign, and (3) feedback regarding adequacy of discharge cleaning. Cleaning of 15 surfaces was evaluated by inspecting for removal of a preapplied mark, visible only with an ultraviolet lamp ("black light"). Six surfaces were cultured for MRSA or VRE contamination. Outcomes of mark removal and culture positivity were evaluated by χ2 testing and generalized linear mixed models, clustering by room. RESULTS. The black-light mark was removed from 44% of surfaces at baseline, compared with 71% during the intervention (P < .001). The intervention increased the likelihood of removal of black-light marks after discharge cleaning (odds ratio, 4.4; P < .001), controlling for ICU type (medical vs surgical) and type of surface. The intervention reduced the likelihood of an environmental culture positive for MRSA or VRE (proportion of cultures positive, 45% at baseline vs 27% during the intervention; adjusted odds ratio, 0.4; P = .02). Broad, flat surfaces were more likely to be cleaned than were doorknobs and sink or toilet handles. CONCLUSIONS. Increasing the volume of disinfectant applied to environmental surfaces, providing education for Environmental Services staff, and instituting feedback with a black-light marker improved cleaning and reduced the frequency of MRSA and VRE contamination. © 2008 by The Society for Healthcare Epidemiology of America. All rights reserved.

RECORD 18
TITLE
  Bidirectional-barbed sutured knotless running anastomosis v classic van Velthoven suturing in a model system
AUTHOR NAMES
  Moran M.E.;  Marsh C.;  Perrotti M.
SOURCE
  Journal of Endourology (2007) 21:10 (1175-1177). Date of Publication: 1 Oct 2007
ABSTRACT
  Background and Purpose: Robotic prostatectomy is exploding into popular utilization throughout much of the United States. It is expected that the rise in the number of these cases into 2006 will continue exponentially. A significant amount of research has begun to focus on the anastomosis, because the robot allows unprecedented illumination and dexterous control to make the quality of this repair equal to that of a microscopic approach. Here, we report our results with a circular anastomosis technique using an innovative bidirectional-barbed suture material for knotless, tension-free repair and compare it with a standard polyglecaprone single-knot technique. Materials and Methods: Using a previously described in-vitro model of microfiber synthetic material, a running anastomosis was performed using the da Vinci Surgical System® by one surgeon. Two pre-tied 3-0 polyglecaprone sutures on a tapered Rb-1 needle were compared with a bidirectional-barbed suture (3-0 PDO) designed specifically for our use (Quill Sutures, Research Triangle Park, NC). The times needed to perform the anastomosis, the accuracy in idealized phantoms, and the surgeon's security in the quality of his work (linear scale) were all recorded for 10 consecutive anastomoses. Results: The PDO suture was faster to deploy (17.3 minutes v 19.2 minutes), and the security score by the surgeon was greater. The accuracy was equivalent for both types of running closure comparing the classic van Velthoven with the PDO-sutured anastomosis. Conclusions: It appears from our preliminary work that a bidirectional-barbed suture might improve the vesicourethral anastomosis during a robotic radical prostatectomy. Further investigations should be done to measure the disruptive force necessary to distract these sutures, whether the applied forces of the barbs are adequate for maintaining a watertight seal, and the reproducibility of our results by other surgeons. All of these investigations are in progress in our laboratory. © 2007 Mary Ann Liebert, Inc.

RECORD 19
TITLE
  A laboratory evaluation of the decontamination properties of microfibre cloths
AUTHOR NAMES
  Moore G.;  Griffith C.
SOURCE
  Journal of Hospital Infection (2006) 64:4 (379-385). Date of Publication: December 2006
ABSTRACT
  Standards of cleanliness in health care continue to attract attention. Effective cleaning requires the input of energy, and microfibre cloths may help in the physical removal of soil. The ability of these cloths to remove organic soil (measured by ATP) and bacteria was compared with paper towel and a conventional cloth in controlled wet and dry conditions. When used wet on a dry surface, the cleaning ability of six different microfibre cloths was variable, and in most cases, not significantly better than paper towel or a conventional cloth. One type of microfibre cloth did perform significantly better than the others and paper towel in reducing both organic soil and microbial load. When used dry on a dry surface, there was no significant difference between the cloths, and none of the cloths reduced microbial and organic bioburden effectively. The ability of the cloths to recontaminate the surface was also tested, and some of the microfibre cloths transferred significantly less organic debris and micro-organisms back to the surface than other cloths. Different makes of microfibre cloths have different characteristics, and the name 'microfibre' should not imply superior cleaning efficacy. © 2006 The Hospital Infection Society.

RECORD 20
TITLE
  Effects of cleaning and disinfection in reducing the spread of Norovirus contamination via environmental surfaces
AUTHOR NAMES
  Barker J.;  Vipond I.B.;  Bloomfield S.F.
SOURCE
  Journal of Hospital Infection (2004) 58:1 (42-49). Date of Publication: September 2004
ABSTRACT
  A reverse transcriptase polymerase chain reaction assay was used to study the transfer of Norovirus (NV) from contaminated faecal material via fingers and cloths to other hand-contact surfaces. The results showed that, where fingers come into contact with virus-contaminated material, NV is consistently transferred via the fingers to melamine surfaces and from there to other typical hand-contact surfaces, such as taps, door handles and telephone receivers. It was found that contaminated fingers could sequentially transfer virus to up to seven clean surfaces. The effectiveness of detergent- and disinfectant-based cleaning regimes typical of those that might be used to decontaminate faecally contaminated surfaces and reduce spread of NV was also compared. It was found that detergent-based cleaning with a cloth to produce a visibly clean surface consistently failed to eliminate NV contamination. Where there was faecal soiling, although a combined hypochlorite/detergent formulation at 5000 ppm of available chlorine produced a significant risk reduction, NV contamination could still be detected on up to 28% of surfaces. In order consistently to achieve good hygiene, it was necessary to wipe the surface clean using a cloth soaked in detergent before applying the combined hypochlorite/detergent. When detergent cleaning alone or combined hypochlorite/detergent treatment failed to eliminate NV contamination from the surface and the cleaning cloth was then used to wipe another surface, the virus was transferred to that surface and to the hands of the person handling the cloth. In contrast, were surfaces where contaminated with NV-infected faecal suspension diluted to 1 in 10 and 1 in 80, intended to simulate surfaces that have become contaminated after secondary transfer, treatment with a combined bleach/detergent formulation, without prior cleaning, was sufficient to decontaminate surfaces and prevent transfer. © 2004 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

RECORD 21
TITLE
  Monitoring of low level arsenic exposure during maintenance of ion implanters
AUTHOR NAMES
  Hwang Y.-H.;  Chen S.-C.
SOURCE
  Archives of Environmental Health (2000) 55:5 (347-354). Date of Publication: 2000
ABSTRACT
  To delineate potential exposure in ion implanter maintenance, the authors recruited 21 maintenance engineers (exposed group) and 10 computer programmers (controls) at three semiconductor manufacturing facilities. Samples of air, wipes, and urine; used cleaning cloths; and used gloves were collected for the characterization of arsenic exposure. Arsenic levels were very low in environmental samples, but high arsenic levels were found in some wipe samples, used cleaning cloths, and gloves. The average baseline content of urinary arsenic measured for maintenance engineers was 3.6 μg/g creatinine. Maintenance engineers experienced an increase of 1.0-7.8 μg/g creatinine in urinary arsenic levels during ion implanter maintenance. Results of a mixed-model analysis indicated that urinary arsenic levels were associated significantly with time series (p = .0001), and the extent of association was different among the three facilities (p = .0226). The results of this study indicate that arsenic intake via ingestion, rather than through inhalation, might play a significant role in the elevation of urinary arsenic levels. However, a series of urine samples with self-reference continue to be a good approach for the monitoring of low-level arsenic exposure.

 

 

Wegwerpdoekjes

 

 

RECORD 1
TITLE
  Disposable chlorine dioxide wipes for high-level disinfection in the ENT department: A systematic review
AUTHOR NAMES
  Tofanelli M.;  Capriotti V.;  Saraniti C.;  Marcuzzo A.V.;  Boscolo-Rizzo P.;  Tirelli G.
SOURCE
  American Journal of Otolaryngology - Head and Neck Medicine and Surgery (2020) 41:3 Article Number: 102415. Date of Publication: 1 May 2020
ABSTRACT
  Background: Nasopharyngoscope reprocessing methods should be effective, rapid and reproducible with moderate cost. Tristel Trio Wipes system (TTWS) is a manual reprocessing method based on chlorine dioxide that has lately emerged in ENT department. This review aims to collect evidence on this system. Methods: The PubMed, Web of Science and Cochrane Library databases were searched for all the studies on TTWS or one of its components. Data were grouped according to the study type. Results: Ten articles were included in the review. TTWS ensured high-level disinfection in laboratory and clinical setting. Although the limitations of the manual systems, TTWS proved to be faster than automated endoscope reprocessing (AER) and safe for patients and health-care workers. TTWS represented cheaper system than AER or sheaths in low- and medium-volume centers. Conclusion: TTWS could be a valid, safe and fast HLD method for nasopharyngoscopes, with reasonable costs for medium-low reprocessing volumes.

RECORD 2
TITLE
  Reducing health care-associated infections by implementing separated environmental cleaning management measures by using disposable wipes of four colors
AUTHOR NAMES
  Wong S.S.;  Huang C.H.;  Yang C.C.;  Hsieh Y.P.;  Kuo C.N.;  Chen Y.R.;  Chen L.C.
SOURCE
  Antimicrobial Resistance and Infection Control (2018) 7:1 Article Number: 34. Date of Publication: 7 Mar 2018
ABSTRACT
  Background: Environmental cleaning is a fundamental principle of infection control in health care settings. We determined whether implementing separated environmental cleaning management measures in MICU reduced the density of HAI. Methods: We performed a 4-month prospective cohort intervention study between August and December 2013, at the MICU of Cathay General hospital. We arranged a training program for all the cleaning staff regarding separated environmental cleaning management measures by using disposable wipes of four colors to clean the patients' bedside areas, areas at a high risk of contamination, paperwork areas, and public areas. Fifteen high-touch surfaces were selected for cleanliness evaluation by using the adenosine triphosphate (ATP) bioluminescence test. Then data regarding HAI densities in the MICU were collected during the baseline, intervention, and late periods. Results: A total of 120 ATP readings were obtained. The total number of clean high-touch surfaces increased from 13% to 53%, whereas that of unclean high-touch surface decreased from 47% to 20%. The densities of HAI were 14.32‰ and 14.90‰ during the baseline and intervention periods, respectively. The HAI density did not decrease after the intervention period, but it decreased to 9.07‰ during the late period. Conclusion: Implementing separated environmental cleaning management measures by using disposable wipes of four colors effectively improves cleanliness in MICU environments. However, no decrease in HAI density was observed within the study period. Considering that achieving high levels of hand-hygiene adherence is difficult, improving environmental cleaning is a crucial adjunctive measure for reducing the incidence of HAIs.

RECORD 3
TITLE
  Surface sampling for endotoxin assessment using electrostatic wiping cloths
AUTHOR NAMES
  Thorne P.S.;  Metwali N.;  Avol E.;  McConnell R.S.
SOURCE
  Annals of Occupational Hygiene (2005) 49:5 (401-406). Date of Publication: July 2005
ABSTRACT
  Objectives: Much of the cost of exposure assessment for studies of residential cohorts is in scheduling and travel time for field staff. One way to reduce costs is to simplify methods such that subjects can sample their own residence. Analysis of settled dust is being widely used for assessment of exposures to allergens, lead and pesticides and can also be used for endotoxins. While vacuum sampling is the most common surface sampling method, wipe sampling has the advantage that it can be readily performed by the resident when convenient and samples can then be mailed to researchers. Thus, we evaluated the feasibility of wipe sampling for endotoxin environmental assessment using electrostatic wipes with or without the use of disposable examination gloves. Methods: Multiple lots of six types of commercial wipes and eight types of gloves were extracted and analyzed for endotoxin content using the kinetic chromogenic Limulus amebocyte lysate assay. Wipes were compared across brands, between lots, within lots, between pairs depending on proximity to cardboard packaging, and in wipe tests with or without gloves. Collected dust samples of known concentration were also tested in spiking assays for endotoxin recovery. Results: The most striking finding was the high variability of endotoxin contamination of both wipes and gloves across brands and between various lots. The content of endotoxin in unused gloves ranged from <1.5 to 5810 endotoxin units (EU). The range for unused wipes was 3.6-87.8 EU. Surfaces of equal loading and area were sampled using three types of cloths that had low initial endotoxin contamination. The cloths were very good at collecting dust and endotoxin could be assayed from aqueous extracts of the wipes. Samples collected using cloths with bare washed hands yielded higher endotoxin loading per mass of collected dust versus samples collected wearing endotoxin-free gloves. This demonstrated additional endotoxin loading from the subject's hand. Conclusion: This study shows that wipe sampling while wearing medical gloves can be an effective method for collecting and assessing endotoxin on surfaces, so long as each lot of wipes and gloves have been tested and determined to be low in endotoxin. © 2005 British Occupational Hygiene Society Published by Oxford University Press.

 

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