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A prospective study of transmission of Multidrug-Resistant Organisms (MDROs) between environmental sites and hospitalized patients—the TransFER study

  • Luke F. Chen (a1) (a2), Lauren P. Knelson (a1) (a2), Maria F. Gergen (a3), Olga M. Better (a4), Bradly P. Nicholson (a4), Christopher W. Woods (a1) (a4), William A. Rutala (a3), David J. Weber (a3), Daniel J. Sexton (a1) (a2), Deverick J. Anderson (a1) (a2) and for the CDC Prevention Epicenters Program (a1) (a2) (a4) (a3)...



Hospital environmental surfaces are frequently contaminated by microorganisms. However, the causal mechanism of bacterial contamination of the environment as a source of transmission is still debated. This prospective study was performed to characterize the nature of multidrug-resistant organism (MDRO) transmission between the environment and patients using standard microbiological and molecular techniques.


Prospective cohort study at 2 academic medical centers.


A prospective multicenter study to characterize the nature of bacterial transfer events between patients and environmental surfaces in rooms that previously housed patients with 1 of 4 ‘marker’ MDROs: methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Clostridium difficile, and MDR Acinetobacter baumannii. Environmental and patient microbiological samples were obtained on admission into a freshly disinfected inpatient room. Repeat samples from room surfaces and patients were taken on days 3 and 7 and each week the patient stayed in the same room. The bacterial identity, antibiotic susceptibility, and molecular sequences were compared between organisms found in the environment samples and patient sources.


We enrolled 80 patient–room admissions; 9 of these patients (11.3%) were asymptomatically colonized with MDROs at study entry. Hospital room surfaces were contaminated with MDROs despite terminal disinfection in 44 cases (55%). Microbiological Bacterial Transfer events either to the patient, the environment, or both occurred in 12 patient encounters (18.5%) from the microbiologically evaluable cohort.


Microbiological Bacterial Transfer events between patients and the environment were observed in 18.5% of patient encounters and occurred early in the admission. This study suggests that research on prevention methods beyond the standard practice of room disinfection at the end of a patient’s stay is needed to better prevent acquisition of MDROs through the environment.


Corresponding author

Author for correspondence: Luke F. Chen, Duke University Health System, Durham, North Carolina, 27710. E-mail:


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PREVIOUS PRESENTATION: This study was presented in part at the IDWeek 2015 Conference on October 9th, 2015, in San Diego, California.

Cite this article: Chen LF, et al. (2019). A prospective study of transmission of Multidrug-Resistant Organisms (MDROs) between environmental sites and hospitalized patients—the TransFER Study. Infection Control & Hospital Epidemiology 2019, 40, 47–52. doi: 10.1017/ice.2018.275



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