Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-24T11:24:21.529Z Has data issue: false hasContentIssue false
  • English
  • Français

Shedding of methicillin-resistant Staphylococcus aureus by colonized patients during procedures and patient care activities

Published online by Cambridge University Press:  19 February 2019

Heba Alhmidi ,
Jennifer L. Cadnum ,
Sreelatha Koganti ,
Annette L. Jencson ,
Joseph D. Rutter ,
Robert A. Bonomo ,
Brigid M. Wilson ,
JeanMarie Mayer ,
Matthew H. Samore  and
Curtis J. Donskey
Heba Alhmidi
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Jennifer L. Cadnum
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Sreelatha Koganti
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Annette L. Jencson
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Joseph D. Rutter
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Robert A. Bonomo
Affiliation:
Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio Case Western Reserve University School of Medicine, Cleveland, Ohio
Brigid M. Wilson
Affiliation:
Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
JeanMarie Mayer
Affiliation:
University of Utah School of Medicine, Salt Lake City, Utah
Matthew H. Samore
Affiliation:
University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, Utah
Curtis J. Donskey*
Affiliation:
Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio Case Western Reserve University School of Medicine, Cleveland, Ohio
*
Author for correspondence: Curtis J. Donskey, Email: Curtis. Donskey@va.gov.
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Medical procedures and patient care activities may facilitate environmental dissemination of healthcare-associated pathogens such as methicillin-resistant Staphylococcus aureus (MRSA).

Design:

Observational cohort study of MRSA-colonized patients to determine the frequency of and risk factors for environmental shedding of MRSA during procedures and care activities in carriers with positive nares and/or wound cultures. Bivariate analyses were performed to identify factors associated with environmental shedding.

Setting:

A Veterans Affairs hospital.

Participants:

This study included 75 patients in contact precautions for MRSA colonization or infection.

Results:

Of 75 patients in contact precautions for MRSA, 55 (73%) had MRSA in nares and/or wounds and 25 (33%) had positive skin cultures. For the 52 patients with MRSA in nares and/or wounds and at least 1 observed procedure, environmental shedding of MRSA occurred more frequently during procedures and care activities than in the absence of a procedure (59 of 138, 43% vs 8 of 83, 10%; P < .001). During procedures, increased shedding occurred ≤0.9 m versus >0.9 m from the patient (52 of 138, 38% vs 25 of 138, 18%; P = .0004). Contamination occurred frequently on surfaces touched by personnel (12 of 38, 32%) and on portable equipment used for procedures (25 of 101, 25%). By bivariate analysis, the presence of a wound with MRSA was associated with shedding (17 of 29, 59% versus 6 of 23, 26%; P = .04).

Conclusions:

Environmental shedding of MRSA occurs frequently during medical procedures and patient care activities. There is a need for effective strategies to disinfect surfaces and equipment after procedures.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 3 , March 2019 , pp. 328 - 332
Copyright
© 2019 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.)

References

Donskey, CJ. Does improving surface cleaning and disinfection reduce health care-associated infections? Am J Infect Control 2013;41:S12–S19.CrossRefGoogle ScholarPubMed
Stiefel, U, Cadnum, JL, Eckstein, BC, Guerrero, DM, Tima, MA, Donskey, CJ. Contamination of hands with methicillin-resistant Staphylococcus aureus after contact with environmental surfaces and after contact with the skin of colonized patients. Infect Control Hosp Epidemiol 2011;32:185–187.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
Cheng, VC, Li, IW, Wu, AK, et al. Effect of antibiotics on the bacterial load of meticillin-resistant Staphylococcus aureus colonisation in anterior nares. J Hosp Infect 2008;70:27–34.CrossRefGoogle ScholarPubMed
Livorsi, DJ, Arif, S, Garry, P, et al. Methicillin-resistant Staphylococcus aureus (MRSA) nasal real-time PCR: a predictive tool for contamination of the hospital environment. Infect Control Hosp Epidemiol 2015;36:34–39.CrossRefGoogle ScholarPubMed
Chang, S, Sethi, AK, Eckstein, BC, Stiefel, U, Cadnum, JL, Donskey, CJ. Skin and environmental contamination with methicillin-resistant Staphylococcus aureus among carriers identified clinically versus through active surveillance. Clin Infect Dis 2009;48:1423–1428.10.1086/598505CrossRefGoogle ScholarPubMed
Bhalla, A, Pultz, NJ, Aron, DC, Donskey, CJ. Staphylococcus aureus intestinal colonization is associated with increased frequency of skin contamination in hospitalized patients. BioMed Central Infect Dis 2007;7:105.CrossRefGoogle ScholarPubMed
Mody, L, Maheshwari, S, Galecki, A, Kauffman, CA, Bradley, SF. Indwelling device use and antibiotic resistance in nursing homes: identifying a high-risk group. J Am Geriatr Soc 2007;55:1921–1926.CrossRefGoogle ScholarPubMed
Boyce, JM, Havill, NL, Otter, JA, Adams, NM. Widespread environmental contamination associated with patients with diarrhea and methicillin-resistant Staphylococcus aureus colonization of the gastrointestinal tract. Infect Control Hosp Epidemiol 2007;28:1142–1147.CrossRefGoogle ScholarPubMed
Pineles, L, Morgan, DJ, Lydecker, A, et al. Transmission of methicillin-resistant Staphylococcus aureus to health care worker gowns and gloves during care of residents in Veterans Affairs nursing homes. Am J Infect Control 2017;45:947–953.CrossRefGoogle ScholarPubMed
Kanwar, A, Cadnum, JL, Jencson, AL, Donskey, CJ. Impact of antibiotic treatment on the burden of nasal Staphylococcus aureus among hospitalized patients. Antimicrob Agents Chemother. 2018 Sep 24;62(10):e00609-18. doi: 10.1128/AAC.00609-18.CrossRefGoogle ScholarPubMed
Endimiani, A, Blackford, M, Dasenbrook, EC, et al. Emergence of linezolid-resistant Staphylococcus aureus after prolonged treatment of cystic fibrosis patients in Cleveland, Ohio. Antimicrob Agents Chemother 2011;55: 1684–1692.CrossRefGoogle ScholarPubMed
Faria, NA, Carrico, JA, Oliveira, DC, Ramirez, M, de Lencastre, H. Analysis of typing methods for epidemiological surveillance of both methicillin-resistant and methicillin-susceptible Staphylococcus aureus strains. J Clin Microbiol 2008;46:136–144.CrossRefGoogle ScholarPubMed
Carrel, M, Perencevich, EN, David, MZ. USA300 Methicillin-resistant Staphylococcus aureus, United States, 2000–2013. Emerg Infect Dis 2015;11:1973–1980.CrossRefGoogle Scholar
Donskey, CJ, Deshpande, A. Effect of chlorhexidine bathing in preventing infections and reducing skin burden and environmental contamination: a review of the literature. Am J Infect Control 2016;44(5 suppl):e17–e21.CrossRefGoogle ScholarPubMed
Kanwar, A, Cadnum, JL, Thakur, M, Jencson, AL, Donskey, CJ. Contaminated clothing of methicillin-resistant Staphylococcus aureus carriers is a potential source of transmission. Am J Infect Control 2018;46:1414–1416.CrossRefGoogle ScholarPubMed
Sunkesula, VCK, Kundrapu, S, Knighton, S, Cadnum, JL, Donskey, CJ. A randomized trial to determine the impact of an educational patient hand-hygiene intervention on contamination of hospitalized patient’s hands with healthcare-associated pathogens. Infect Control Hosp Epidemiol 2017;38:595–597.CrossRefGoogle ScholarPubMed
Sunkesula, V, Kundrapu, S, Macinga, DR, Donskey, CJ. Efficacy of alcohol gel for removal of methicillin-resistant Staphylococcus aureus from hands of colonized patients. Infect Control Hosp Epidemiol 2015;36:229–231.CrossRefGoogle ScholarPubMed
Rutala, WA, Weber, DJ and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for disinfection and sterilization in healthcare facilities, 2008. Centers for Disease Control and Preention website. https://www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf. Published 2008. Accessed February 10, 2017.Google Scholar
Havill, NL, Havill, HL, Mangione, E, Dumigan, DG, Boyce, JM. Cleanliness of portable medical equipment disinfected by nursing staff. Am J Infect Control 2011;39:602–604.CrossRefGoogle ScholarPubMed
John, A, Alhmidi, H, Cadnum, JL, Jencson, AL, Donskey, CJ. Contaminated portable equipment is a potential vector for dissemination of pathogens in the intensive care unit. Infect Control Hosp Epidemiol 2017;38:1247–1249.CrossRefGoogle ScholarPubMed
Kundrapu, S, Sunkesula, V, Jury, LA, Donskey, CJ. A randomized trial of daily disinfection of high-touch surfaces in isolation rooms to reduce contamination of healthcare workers’ hands. Infect Control Hosp Epidemiol 2012;33:1039–1042.CrossRefGoogle ScholarPubMed
Shen, Z, Ning, F, Zhou, W, et al. Superspreading SARS events, Beijing, 2003. Emerg Infect Dis 2004;10:256–260.CrossRefGoogle Scholar
James, A, Pitchford, JW, Plank, MJ. An event-based model of superspreading in epidemics. Proc Biol Sci 2007;274:741–747.CrossRefGoogle ScholarPubMed
Lloyd-Smith, JO, Schreiber, SJ, Kopp, PE, Getz, WM. Superspreading and the effect of individual variation on disease emergence. Nature 2005;438:355–359.CrossRefGoogle ScholarPubMed
Shiomori, T, Miyamoto, H, Makishima, K, et al. Evaluation of bedmaking-related airborne and surface methicillin-resistant Staphylococcus aureus contamination. J Hosp Infect 2002;50:30–35.CrossRefGoogle ScholarPubMed