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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

  • Jennie H. Kwon (a1), Kimberly Reske (a1), Caroline A. O’Neil (a1), Candice Cass (a1), Sondra Seiler (a1), Meghan A. Wallace (a2), Tiffany Hink (a1), Stephen Y. Liang (a1) (a3), Victoria J. Fraser (a1), Carey-Ann D. Burnham (a2), Erik R. Dubberke (a1) and for the CDC Prevention Epicenters Program...

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.

Copyright

Corresponding author

Author for correspondence: Jennie H. Kwon, E-mail: J.Kwon@wustl.edu

Footnotes

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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.

Footnotes

References

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1.Boyce, JM.Environmental contamination makes an important contribution to hospital infection. J Hosp Infect 2007;65 suppl 2:5054.
2.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:S6S11.
3.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.
4.Weber, DJ, Anderson, D, Rutala, WA.The role of the surface environment in healthcare-associated infections. Curr Opin Infect Dis 2013;26:338344.
5.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;90:285292.
6.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;24:362386.
7.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;36:11631172.
8.Morgan, DJ, Wenzel, RP, Bearman, G.Contact precautions for endemic MRSA and VRE: time to retire legal mandates. JAMA 2017;318:329330.
9.Rubin, MA, Samore, MH, Harris, AD.The importance of contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. JAMA 2018;319:863864.
10.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;40:4752.
11.Drees, M, Snydman, DR, Schmid, CH, et al.Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci. Clin Infect Dis 2008;46:678685.
12.Huang, SS, Datta, R, Platt, R.Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006;166:19451951.
13.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;29:149154.
14.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;40:10451051.
15.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;29:583589.
16.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;32:826829.
17.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;38:10771083.
18.Duckro, AN, Blom, DW, Lyle, EA, Weinstein, RA, Hayden, MK.Transfer of vancomycin-resistant enterococci via healthcare-worker hands. Arch Intern Med 2005;165:302307.
19.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.
20.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;37:13741377.
21.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;14:12911293.
22.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;2:2730.
23.Fattorini, M, Ceriale, E, Nante, N, et al.Use of a fluorescent marker for assessing hospital bathroom cleanliness. Am J Infect Control 2016;44:10661068.
24.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;32:11871193.
25.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;39:12961300.
26.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;33:337346.
27.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;32:15711578.
28.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;33:21632171.
29.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;74:388393.
30.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;168:10301038.
31.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;66:945949.
32.Tomas, ME, Kundrapu, S, Thota, P, et al.Contamination of healthcare personnel during removal of personal protective equipment. JAMA Intern Med 2015;175:19041910.
33.Thomsen, IP, Kadari, P, Soper, NR, et al.Molecular epidemiology of invasive Staphylococcus aureus infections and concordance with colonization isolates. J Pediatr 2019;210:173177.
34.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.
35.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.
36.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;35:650655.
37.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;310:15711580.
38.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;43:702706.
39.Julian, TR, Leckie, JO, Boehm, AB.Virus transfer between fingerpads and fomites. J Appl Microbiol 2010;109:18681874.
40.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.

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

  • Jennie H. Kwon (a1), Kimberly Reske (a1), Caroline A. O’Neil (a1), Candice Cass (a1), Sondra Seiler (a1), Meghan A. Wallace (a2), Tiffany Hink (a1), Stephen Y. Liang (a1) (a3), Victoria J. Fraser (a1), Carey-Ann D. Burnham (a2), Erik R. Dubberke (a1) and for the CDC Prevention Epicenters Program...

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