Michelle M Nerandzic

STERIS Corp., Mentor, Ohio, United States · Advanced Sterilization

Background Alcohol is perceived to aid flexible endoscope channel drying, however we previously showed alcohol increased the time required to dry some channels with forced air versus water alone. Yet, alcohol may prevent microorganism outgrowth during storage. Drying endoscope channels has been shown to prevent outgrowth, but it is unknown if incom...

Background Endoscopic designs are more ergonomic and technically sophisticated than ever. Endoscope transmitted infections continues despite scrutiny and optimization of disinfection processes. Effective endoscopic dryness has been largely overlooked, even though it is paramount for prevention of water-borne pathogens accumulating after high level...

Background: Thorough drying of flexible endoscope channels has been identified as an essential reprocessing step. Yet, instructions are not specific on how to dry endoscopes. There is lack of data supporting efficacy of current drying practices, due to limitations in determining channel dryness. Methods: Novel endoscope test articles were used t...

Background Despite antiretroviral therapy (ART), some patients do not achieve IR. Moreover, GI bacterial translocation may lead to a decrease in CD4 counts with an increase in IL-6 in blood. However, the effect of OI prophylaxis on the GIM, bacterial translocation and IR has not been studied in HIV+ veterans. Here we studied the gut microbiome and...

Vancomycin taper regimens are commonly used for the treatment of recurrent Clostridium difficile infections. One rationale for tapering and pulsing of the dose at the end of therapy is to reduce the selective pressure of vancomycin on the indigenous intestinal microbiota. Here, we used a mouse model to test the hypothesis that the indigenous microb...

Background: Clostridium difficile is a leading cause of healthcare-associated infections worldwide. Prevention of C. difficile transmission is challenging because spores are not killed by alcohol-based hand sanitizers or many commonly used disinfectants. One strategy to control spores is to induce germination, thereby rendering the spores more susc...

BACKGROUND Clostridium difficile infection (CDI) and asymptomatic carriage of toxigenic C. difficile are common in long-term care facilities (LTCFs). However, whether C. difficile is frequently acquired in the LTCF versus during acute-care admissions remains unknown. OBJECTIVE To test the hypothesis that LTCF residents often acquire C. difficile c...

BACKGROUND We investigated an increase in the incidence of healthcare-associated Clostridium difficile infection (CDI) that occurred following a change from a bleach disinfectant to a peracetic acid–based disinfectant. OBJECTIVE To evaluate the efficacy of the peracetic acid–based disinfectant. DESIGN Laboratory-based product evaluation. METHODS...

Exposing Clostridium difficile spores to germinants in a quaternary ammonium matrix was an effective method to reduce environmental contamination by sensitizing the spores, leaving them susceptible to ambient conditions and enhancing killing by acid, high-intensity visible light, and radiation.

Response to Cowan on Need for UV-C Antimicrobial Device Standards - Volume 37 Issue 8 - Michelle M. Nerandzic, Curtis J. Donskey

Background Systemic antibiotics vary widely in in vitro activity against Clostridium difficile. Some agents with activity against C. difficile (e.g., piperacillin/tazobactam) inhibit establishment of colonization in mice. We tested the hypothesis that piperacillin/tazobactam and other agents with activity against C. difficile achieve sufficient con...

Background. Alcohol-based hand sanitizers are the primary method of hand hygiene in healthcare settings, but they lack activity against bacterial spores produced by pathogens such as Clostridium difficile and Bacillus anthracis. We previously demonstrated that acidification of ethanol induced rapid sporicidal activity, resulting in ethanol formulat...

Decontamination of gloves before removal could reduce the risk for contamination of hands of personnel caring for patients with Clostridium difficile infection. We demonstrated that a novel sporicidal formulation of ethanol rapidly reduced C. difficile spores on gloved hands without adverse odor, respiratory irritation, or staining of clothing. In...

Background: Due to their efficacy and convenience, alcohol-based hand sanitizers have been widely adopted as the primary method of hand hygiene in healthcare settings. However, alcohols lack activity against bacterial spores produced by pathogens such as Clostridium difficile and Bacillus anthracis. We hypothesized that sporicidal activity could b...

We used a colorimetric assay to determine the presence of chlorhexidine on skin, and we identified deficiencies in preoperative bathing and daily bathing in the intensive care unit. Both types of bathing improved with an intervention that included feedback to nursing staff. The assay provides a simple and rapid method of monitoring the performance...

OBJECTIVE To determine the effectiveness of a pulsed xenon ultraviolet (PX-UV) disinfection device for reduction in recovery of healthcare-associated pathogens. SETTING Two acute-care hospitals. METHODS We examined the effectiveness of PX-UV for killing of Clostridium difficile spores, methicillin-resistant Staphylococcus aureus (MRSA), and vanco...

Background: Chlorhexidine is a broad-spectrum antimicrobial commonly used to disinfect the skin of patients to reduce the risk of healthcare-associated infections. Because chlorhexidine is not sporicidal, it is not anticipated that it would have an impact on skin contamination with Clostridium difficile, the most important cause of healthcare-asso...

The emergence of antibiotic-resistant strains in facultative anaerobic Gram-positive coccal bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), is a global health issue. Typically, MRSA strains are found associated with institutions like hospitals but recent data suggest that they are becoming more prevalent in community-acquired...

Background: Current practice guidelines for management of Clostridium difficile infection (CDI) recommend that contact precautions can be discontinued after diarrhea resolves. However, it is known that patients with CDI often continue to shed spores for several weeks after successful treatment. We hypothesized that healthcare workers frequently con...

Antibiotics disrupt the intestinal microbiota, rendering patients vulnerable to colonization by exogenous pathogens. Intermicrobial interactions may attenuate this effect. Incubation with ceftriaxone-resistant, ccrA-positive, β-lactamase-producing Bacteroides strains raised the minimum bactericidal concentration of ceftriaxone required to kill a su...

Background Environmental surfaces play an important role in the transmission of healthcare-associated pathogens. Because environmental cleaning is often suboptimal, there is a growing demand for safe, rapid, and automated disinfection technologies, which has lead to a wealth of novel disinfection options available on the market. Specifically, autom...

Background The intestinal microbiota protect the host against enteric pathogens through a defense mechanism termed colonization resistance. Antibiotics excreted into the intestinal tract may disrupt colonization resistance and alter normal metabolic functions of the microbiota. We used a mouse model to test the hypothesis that alterations in levels...

Effective and easy-to-use methods for detecting Clostridium difficile spore contamination would be useful for identifying environmental reservoirs and monitoring the effectiveness of room disinfection. Culture-based detection methods are sensitive for detecting C. difficile, but their utility is limited due to the requirement of anaerobic culture c...

Antibiotics that are excreted into the intestinal tract may disrupt the indigenous intestinal microbiota and promote colonization by healthcare-associated pathogens. ß-lactam, or penicillin-type antibiotics, are among the most widely utilized antibiotics worldwide, and may also adversely affect the microbiota. Many bacteria are capable, however, of...

Recurrent skin and soft-tissue infections (SSTIs) due to Staphylococcus aureus are a common problem in children and adults. Many of these SSTIs are caused by a community-associated methicillin-resistant S. aureus (MRSA) strain designated USA300. Dilute bleach baths are commonly used as part of decolonization regimens for recurrent SSTI, particularl...

An organic load of 5%-10% fetal calf serum significantly reduced hypochlorite and UV radiation killing of Clostridium difficile spores, but organic material collected from hospital surfaces did not affect hypochlorite and only modestly affected UV killing of spores. Hypochlorite reduced aerobic microorganisms on unclean surfaces with no wiping.

Removing spores of Clostridium difficile and Bacillus anthracis from skin is challenging because they are resistant to commonly used antimicrobials and soap and water washing provides only modest efficacy. We hypothesized that hygiene interventions incorporating a sporicidal electrochemically generated hypochlorous acid solution (Vashe(®)) would re...

Education and passive observation resulted in a significant improvement in housekeeper disinfection of nontoxigenic Clostridium difficile spores artificially inoculated onto surfaces in C. difficile infection rooms. A further significant reduction occurred with direct supervision and real-time feedback, suggesting that optimal disinfection is achie...

Background: Germination is the irreversible loss of spore-specific properties prior to outgrowth. Because germinating spores become more susceptible to killing by stressors, induction of germination has been proposed as a spore control strategy. However, this strategy is limited by superdormant spores that remain unaffected by germinants. Harsh ch...

Background: Dilute bleach baths are commonly used as part of Staphylococcus aureus decolonization regimens in children, but limited data are available on the microbiological efficacy and optimal concentrations of bleach solutions on skin. We used a pigskin model to examine the effectiveness of various concentrations of dilute bleach solution for di...

Fidaxomicin causes less disruption of anaerobic microbiota during treatment of Clostridium difficile infection (CDI) than vancomycin and has activity against many vancomycin-resistant enterococci (VRE). In conjunction with a multicenter randomized trial of fidaxomicin versus vancomycin for CDI treatment, we tested the hypothesis that fidaxomicin pr...

Environmental surfaces play an important role in transmission of healthcare-associated pathogens. There is a need for new disinfection methods that are effective against Clostridium difficile spores, but also safe and rapid. The Sterilray™ Disinfection Wand device is a hand-held room decontamination technology that utilizes far-ultraviolet radiatio...

To determine the frequency of false-positive Clostridium difficile toxin enzyme immunoassay (EIA) results in hospitalized children and to examine potential reasons for this false positivity. Nested case-control. Two tertiary care pediatric hospitals. As part of a natural history study, prospectively collected EIA-positive stools were cultured for t...

Background: The incidence and severity of Clostridium difficile infection (CDI) is increasing among adults; however, little is known about the epidemiology of CDI among children. Methods: We conducted a nested case-control study to identify the risk factors for and a prospective cohort study to determine the outcomes associated with severe CDI at 2...

The incidence and severity of Clostridium difficile infection (CDI) is increasing among adults; however, little is known about the epidemiology of CDI among children. We conducted a nested case-control study to identify the risk factors for and a prospective cohort study to determine the outcomes associated with severe CDI at 2 children's hospitals...

In a prospective study of 30 patients with Clostridium difficile infection, we found that acquisition of spores on gloved hands was as likely after contact with commonly touched environmental surfaces (ie, bed rail, bedside table, telephone, call button) as after contact with commonly examined skin sites (ie, chest, abdomen, arm, hand).

In a prospective study of 132 patients with a diagnosis of Clostridium difficile infection (CDI) by polymerase chain reaction, 43 (32%) had enzyme immunoassay (EIA) results negative for toxin. EIA-negative patients with CDI did not differ in clinical presentation from EIA-positive patients and presented a similar risk for transmission of spores.

In a Veterans Affairs medical center, 39% of healthcare facility-onset, healthcare facility-associated Clostridium difficile infections had their onset in the affiliated long-term care facility (LTCF). Eighty-five percent of LTCF-onset patients had been transferred from the hospital within the past month. Delays in diagnosis and treatment were comm...

Ceftobiprole and ceftobiprole medocaril did not promote growth of or toxin production by Clostridium difficile in mouse cecal contents, whereas ceftazidime, cefoxitin, ceftriaxone, cefotaxime, and ertapenem did. The relatively low propensity of ceftobiprole to promote C. difficile was attributable to inhibitory activity against C. difficile and spa...

Patients with spinal cord injury (SCI) are at risk of acquiring colonization with Clostridium difficile and vancomycin-resistant Enterococcus (VRE) due to prolonged hospitalization and frequent antimicrobial use. We examined the frequency of stool, skin, and environmental contamination with C. difficile and VRE in hospitalized patients with SCl. We...

Clostridium difficile is an anaerobic, spore-forming bacterium that is the most common cause of healthcare-associated diarrhea in developed countries. Control of C. difficile is challenging because the spores are resistant to killing by alcohol-based hand hygiene products, antimicrobial soaps, and most disinfectants. Although initiation of germinat...

Environmental surfaces play an important role in transmission of healthcare-associated pathogens. There is a need for new disinfection methods that are effective against Clostridium difficile spores, but also safe, rapid, and automated. The Tru-D Rapid Room Disinfection device is a mobile, fully-automated room decontamination technology that utiliz...

Background: Environmental surfaces may play an important role in transmission of healthcare-associated pathogens, including Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE). Because colonized patients may continually shed pathogenic organisms, an ideal environmental cleaning prod...

Background: In 2006, data from the Ohio Department of Health demonstrated that more than half of all cases of C. difficile infection (CDI) in Ohio had their onset in long-term care facilities. However, it is not known these patients acquired C. difficile in the long-term care facilities or in the hospital prior to transfer to the long-term care fac...

Background: Environmental surfaces play an important role in transmission of healthcare-associated pathogens. Several studies have demonstrated that cleaning of surfaces in healthcare facilities is often suboptimal. There is a need for new disinfection methods that are effective but also safe, rapid, and automated. The Tru-DTM Rapid Room Disinfecti...

Background: Environmental surfaces play an important role in transmission of healthcare-associated pathogens. There is a need for new disinfection methods that are effective against Clostridium difficile spores, but also safe and rapid. The SterilrayTM Disinfection Wand device is a hand-held room decontamination technology that utilizes far-ultravi...

Background: Healthcare facilities and other institutions are potential clients for companies that market environmental decontamination products. However, many of the claims made regarding these products have not been subjected to rigorous testing. The FOGMASTER JR. is a hand-held fogging device that delivers a mist of a quaternary ammonium compound...

Background: In many cases of Clostridium difficile infection (CDI), the onset of symptoms occurs in the outpatient setting (i.e., community-onset CDI). Recent reports suggest that a significant proportion of patients with community-onset CDI have no recent inpatient healthcare exposures and no recent antibiotic exposure. Objective: To determine t...

Background: A 1:10 dilution of household bleach (sodium hypochlorite) is commonly used in hospitals for decontamination of surfaces in rooms of patients with Clostridium difficile infection (CDI). However, bleach has several limitations, including corrosive effects on various materials, irritation of eyes and respiratory tracts of cleaning staff an...

Background: Use of oral VAN or metronidazole for treatment of Clostridium difficile infection (CDI) promotes VAN-resistant enterococci (VRE) and may also promote colonization by yeast and antibiotic-resistant bacterial pathogens due to disruption of the intestinal microflora. Objective: We tested the hypothesis that FDX, a novel macrocyclic antib...

Background: In a prospective study of CD infection in hospitalized children conducted at 2 referral pediatric centers, nearly one-third of subjects whose stool was ELISA-positive for CD toxin A and B were negative for CD by culture. While asymptomatic excretion of CD is a known phenomenon in children, poor specificity of the ELISA toxin assay in...

Current guidelines for control of Clostridium difficile infection (CDI) suggest that contact precautions be discontinued after diarrhea resolves. However, limited information is available regarding the frequency of skin contamination and environmental shedding of C. difficile during and after treatment. We conducted a 9-month prospective, observati...

Proton pump inhibitors (PPIs) have been associated with Clostridium difficile infection (CDI) in several recent studies. However, other studies have not shown this association, and the mechanism by which PPIs might promote CDI has not been elucidated. We hypothesized two possible mechanisms of causation: first, by raising pH, PPIs may prevent gastr...

Numerous studies have demonstrated that environmental surfaces in the rooms of patients with Clostridium difficile infection (CDI) are often contaminated with spores. However, less information is available regarding the frequency of contamination of environmental surfaces outside of CDI isolation rooms. We performed a point-prevalence culture surve...

Both for epidemiologic studies and for diagnostic testing, there is a need for effective, economical, and readily available selective media for the culture of Clostridium difficile. We have developed a reduced-cost substitute for cycloserine-cefoxitin-fructose agar (CCFA), which is an effective but expensive selective medium for C. difficile. The m...

Oral metronidazole has been recommended for treatment of mild-to-moderate Clostridium difficile-associated disease (CDAD), in part because of concern that use of vancomycin may be more likely to promote colonization and transmission of vancomycin-resistant enterococci (VRE). The objective of our study was to compare the frequency of skin and enviro...

After mice received orogastric administration of a fluoroquinolone-resistant Klebsiella pneumoniae strain, subcutaneous treatment with ciprofloxacin, levofloxacin, and moxifloxacin promoted persistent low-density colonization in 10% to 40% of the mice, whereas treatment with clindamycin consistently promoted high-density colonization. No emergence...

There have been recent reports of frequent treatment failure associated with the use of metronidazole for treatment of Clostridium difficile-associated disease. We tested the hypothesis that treatment failure with metronidazole is associated with a suboptimal microbiological response in comparison with that of vancomycin. We conducted a 9-month pro...