Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-16T17:35:29.470Z Has data issue: false hasContentIssue false
  • English
  • Français

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 Open the ORCID record for Jennie H. Kwon [Opens in a new window] ,
Kimberly Reske Open the ORCID record for Kimberly Reske [Opens in a new window] ,
Caroline A. O’Neil ,
Candice Cass ,
Sondra Seiler ,
Meghan A. Wallace ,
Tiffany Hink ,
Stephen Y. Liang ,
Victoria J. Fraser Open the ORCID record for Victoria J. Fraser [Opens in a new window]  and
Carey-Ann D. Burnham Open the ORCID record for Carey-Ann D. Burnham [Opens in a new window]
...Show all authors
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
Get access Rights & Permissions [Opens in a new window]

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
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 5 , May 2020 , pp. 539 - 546
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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.

References

Boyce, JM. Environmental contamination makes an important contribution to hospital infection. J Hosp Infect 2007;65 suppl 2:50–54.CrossRefGoogle ScholarPubMed
Otter, JA, Yezli, S, Salkeld, JA, French, GL. Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings. Am J Infect Control 2013;41:S6–S11.CrossRefGoogle Scholar
Suleyman, G, Alangaden, G, Bardossy, AC. The role of environmental contamination in the transmission of nosocomial pathogens and healthcare-associated infections. Curr Infect Dis Rep 2018;20:12.CrossRefGoogle ScholarPubMed
Weber, DJ, Anderson, D, Rutala, WA. The role of the surface environment in healthcare-associated infections. Curr Opin Infect Dis 2013;26:338–344.CrossRefGoogle ScholarPubMed
Mitchell, A, Spencer, M, Edmiston, C Jr. Role of healthcare apparel and other healthcare textiles in the transmission of pathogens: a review of the literature. J Hosp Infect 2015;90:285–292.CrossRefGoogle ScholarPubMed
Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus . Infect Control Hosp Epidemiol 2003;24:362–386.CrossRefGoogle ScholarPubMed
Morgan, DJ, Murthy, R, Munoz-Price, LS, et al. Reconsidering contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus . Infect Control Hosp Epidemiol 2015;36:1163–1172.CrossRefGoogle ScholarPubMed
Morgan, DJ, Wenzel, RP, Bearman, G. Contact precautions for endemic MRSA and VRE: time to retire legal mandates. JAMA 2017;318:329–330.CrossRefGoogle ScholarPubMed
Rubin, MA, Samore, MH, Harris, AD. The importance of contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. JAMA 2018;319:863–864.CrossRefGoogle ScholarPubMed
Chen, LF, Knelson, LP, Gergen, MF, et al. A prospective study of transmission of multidrug-resistant organisms (MDROs) between environmental sites and hospitalized patients—the TransFER study. Infect Control Hosp Epidemiol 2019;40:47–52.CrossRefGoogle ScholarPubMed
Drees, M, Snydman, DR, Schmid, CH, et al. Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci. Clin Infect Dis 2008;46:678–685.CrossRefGoogle ScholarPubMed
Huang, SS, Datta, R, Platt, R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006;166:1945–1951.CrossRefGoogle ScholarPubMed
Hayden, MK, Blom, DW, Lyle, EA, Moore, CG, Weinstein, RA. Risk of hand or glove contamination after contact with patients colonized with vancomycin-resistant enterococcus or the colonized patients’ environment. Infect Control Hosp Epidemiol 2008;29:149–154.CrossRefGoogle ScholarPubMed
Morgan, DJ, Rogawski, E, Thom, KA, et al. Transfer of multidrug-resistant bacteria to healthcare workers’ gloves and gowns after patient contact increases with environmental contamination. Crit Care Med 2012;40:1045–1051.CrossRefGoogle ScholarPubMed
Snyder, GM, Thom, KA, Furuno, JP, et al. Detection of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on the gowns and gloves of healthcare workers. Infect Control Hosp Epidemiol 2008;29:583–589.CrossRefGoogle ScholarPubMed
Tenorio, AR, Badri, SM, Sahgal, NB, et al. Effectiveness of gloves in the prevention of hand carriage of vancomycin-resistant Enterococcus species by healthcare workers after patient care. Clin Infect Dis 2001;32:826–829.CrossRefGoogle ScholarPubMed
Kwon, JH, Burnham, CD, Reske, KA, et al. Assessment of healthcare worker protocol deviations and self-contamination during personal protective equipment donning and doffing. Infect Control Hosp Epidemiol 2017;38:1077–1083.CrossRefGoogle ScholarPubMed
Duckro, AN, Blom, DW, Lyle, EA, Weinstein, RA, Hayden, MK. Transfer of vancomycin-resistant enterococci via healthcare-worker hands. Arch Intern Med 2005;165:302–307.CrossRefGoogle Scholar
Alhmidi, H, Koganti, S, Tomas, ME, Cadnum, JL, Jencson, A, Donskey, CJ. A pilot study to assess use of fluorescent lotion in patient care simulations to illustrate pathogen dissemination and train personnel in correct use of personal protective equipment. Antimicrob Resist Infect Control 2016;5:40.CrossRefGoogle ScholarPubMed
Koganti, S, Alhmidi, H, Tomas, ME, Cadnum, JL, Jencson, A, Donskey, CJ. Evaluation of hospital floors as a potential source of pathogen dissemination using a nonpathogenic virus as a surrogate marker. Infect Control Hosp Epidemiol 2016;37:1374–1377.CrossRefGoogle ScholarPubMed
Casanova, L, Alfano-Sobsey, E, Rutala, WA, Weber, DJ, Sobsey, M. Virus transfer from personal protective equipment to healthcare employees’ skin and clothing. Emerg Infect Dis 2008;14:1291–1293.CrossRefGoogle ScholarPubMed
Bell, T, Smoot, J, Patterson, J, Smalligan, R, Jordan, R. Ebola virus disease: the use of fluorescents as markers of contamination for personal protective equipment. IDCases 2015;2:27–30.CrossRefGoogle ScholarPubMed
Fattorini, M, Ceriale, E, Nante, N, et al. Use of a fluorescent marker for assessing hospital bathroom cleanliness. Am J Infect Control 2016;44:1066–1068.CrossRefGoogle ScholarPubMed
Boyce, JM, Havill, NL, Havill, HL, Mangione, E, Dumigan, DG, Moore, BA. Comparison of fluorescent marker systems with 2 quantitative methods of assessing terminal cleaning practices. Infect Control Hosp Epidemiol 2011;32:1187–1193.CrossRefGoogle ScholarPubMed
Hung, IC, Chang, HY, Cheng, A, et al. Application of a fluorescent marker with quantitative bioburden methods to assess cleanliness. Infect Control Hosp Epidemiol 2018;39:1296–1300.CrossRefGoogle ScholarPubMed
Manji, R, Bythrow, M, Branda, JA, et al. Multi-center evaluation of the VITEK(R) MS system for mass spectrometric identification of non-Enterobacteriaceae gram-negative bacilli. Eur J Clin Microbiol Infect Dis 2014;33:337–346.CrossRefGoogle ScholarPubMed
Richter, SS, Sercia, L, Branda, JA, et al. Identification of Enterobacteriaceae by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry using the VITEK MS system. Eur J Clin Microbiol Infect Dis 2013;32:1571–1578.CrossRefGoogle ScholarPubMed
McElvania TeKippe, E, Burnham, CA. Evaluation of the Bruker Biotyper and VITEK MS MALDI-TOF MS systems for the identification of unusual and/or difficult-to-identify microorganisms isolated from clinical specimens. Eur J Clin Microbiol Infect Dis 2014;33:2163–2171.CrossRefGoogle ScholarPubMed
El Feghaly, RE, Stamm, JE, Fritz, SA, Burnham, CA. Presence of the bla(Z) beta-lactamase gene in isolates of Staphylococcus aureus that appear penicillin susceptible by conventional phenotypic methods. Diagn Microbiol Infect Dis 2012;74:388–393.CrossRefGoogle Scholar
Fritz, SA, Hogan, PG, Singh, LN, et al. Contamination of environmental surfaces with Staphylococcus aureus in households with children infected with methicillin-resistant S aureus . JAMA Pediatr 2014;168:1030–1038.CrossRefGoogle ScholarPubMed
Casanova, LM, Erukunuakpor, K, Kraft, CS, et al. Assessing viral transfer during doffing of Ebola-level personal protective equipment in a biocontainment unit. Clin Infect Dis 2018;66:945–949.CrossRefGoogle Scholar
Tomas, ME, Kundrapu, S, Thota, P, et al. Contamination of healthcare personnel during removal of personal protective equipment. JAMA Intern Med 2015;175:1904–1910.CrossRefGoogle ScholarPubMed
Thomsen, IP, Kadari, P, Soper, NR, et al. Molecular epidemiology of invasive Staphylococcus aureus infections and concordance with colonization isolates. J Pediatr 2019;210:173–177.CrossRefGoogle ScholarPubMed
Hassoun, A, Linden, PK, Friedman, B. Incidence, prevalence, and management of MRSA bacteremia across patient populations—a review of recent developments in MRSA management and treatment. Crit Care 2017;21:211.CrossRefGoogle ScholarPubMed
Alhmidi, H, John, A, Mana, TC, et al. Evaluation of viral surrogate markers for study of pathogen dissemination during simulations of patient care. Open Forum Infect Dis 2017;4:ofx128.CrossRefGoogle ScholarPubMed
Bearman, GM, Marra, AR, Sessler, CN, et al. A controlled trial of universal gloving versus contact precautions for preventing the transmission of multidrug-resistant organisms. Am J Infect Control 2007;35:650–655.CrossRefGoogle ScholarPubMed
Harris, AD, Pineles, L, Belton, B, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 2013;310:1571–1580.Google ScholarPubMed
Sassi, HP, Sifuentes, LY, Koenig, DW, et al. Control of the spread of viruses in a long-term care facility using hygiene protocols. Am J Infect Control 2015;43:702–706.CrossRefGoogle Scholar
Julian, TR, Leckie, JO, Boehm, AB. Virus transfer between fingerpads and fomites. J Appl Microbiol 2010;109:1868–1874.CrossRefGoogle ScholarPubMed
Mastrandrea, R, Soto-Aladro, A, Brouqui, P, Barrat, A. Enhancing the evaluation of pathogen transmission risk in a hospital by merging hand-hygiene compliance and contact data: a proof-of-concept study. BMC Res Notes 2015;8:426.CrossRefGoogle Scholar