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

  • Heba Alhmidi (a1), Jennifer L. Cadnum (a1), Sreelatha Koganti (a1), Annette L. Jencson (a1), Joseph D. Rutter (a1), Robert A. Bonomo (a2) (a3), Brigid M. Wilson (a2), JeanMarie Mayer (a4), Matthew H. Samore (a5) and Curtis J. Donskey (a2) (a3)...

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.

Copyright

Corresponding author

Author for correspondence: Curtis J. Donskey, Email: Curtis. Donskey@va.gov.

References

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