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Assessment of antibiotic-resistant organism transmission among rooms of hospitalized patients, healthcare personnel, and the hospital environment utilizing surrogate markers and selective bacterial cultures

Published online by Cambridge University Press:  23 January 2020

Jennie H. Kwon*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
Kimberly Reske
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
Caroline A. O’Neil
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
Candice Cass
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
Sondra Seiler
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
Meghan A. Wallace
Affiliation:
Department of Pathology & Immunology, Washington University School of Medicine, St Louis, Missouri
Tiffany Hink
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
Stephen Y. Liang
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri Division of Emergency Medicine, Washington University School of Medicine, St Louis, Missouri
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
Carey-Ann D. Burnham
Affiliation:
Department of Pathology & Immunology, Washington University School of Medicine, St Louis, Missouri
Erik R. Dubberke
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
*
Author for correspondence: Jennie H. Kwon, E-mail: J.Kwon@wustl.edu

Abstract

Objective:

To assess potential transmission of antibiotic-resistant organisms (AROs) using surrogate markers and bacterial cultures.

Design:

Pilot study.

Setting:

A 1,260-bed tertiary-care academic medical center.

Participants:

The study included 25 patients (17 of whom were on contact precautions for AROs) and 77 healthcare personnel (HCP).

Methods:

Fluorescent powder (FP) and MS2 bacteriophage were applied in patient rooms. HCP visits to each room were observed for 2–4 hours; hand hygiene (HH) compliance was recorded. Surfaces inside and outside the room and HCP skin and clothing were assessed for fluorescence, and swabs were collected for MS2 detection by polymerase chain reaction (PCR) and selective bacterial cultures.

Results:

Transfer of FP was observed for 20 rooms (80%) and 26 HCP (34%). Transfer of MS2 was detected for 10 rooms (40%) and 15 HCP (19%). Bacterial cultures were positive for 1 room and 8 HCP (10%). Interactions with patients on contact precautions resulted in fewer FP detections than interactions with patients not on precautions (P < .001); MS2 detections did not differ by patient isolation status. Fluorescent powder detections did not differ by HCP type, but MS2 was recovered more frequently from physicians than from nurses (P = .03). Overall, HH compliance was better among HCP caring for patients on contact precautions than among HCP caring for patients not on precautions (P = .003), among nurses than among other nonphysician HCP at room entry (P = .002), and among nurses than among physicians at room exit (P = .03). Moreover, HCP who performed HH prior to assessment had fewer fluorescence detections (P = .008).

Conclusions:

Contact precautions were associated with greater HCP HH compliance and reduced detection of FP and MS2.

Type
Original Article
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

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Footnotes

PREVIOUS PRESENTATION: Preliminary results of the study described in this manuscript were presented at ID Week 2016 on October 27, 2016, in New Orleans, Louisiana.

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