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Relationships Among Cleaning, Environmental DNA, and Healthcare-Associated Infections in a New Evidence-Based Design Hospital

Published online by Cambridge University Press:  08 July 2015

Emil Lesho*
Affiliation:
Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland
Philip Carling
Affiliation:
Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
Eve Hosford
Affiliation:
Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland
Ana Ong
Affiliation:
Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland
Erik Snesrud
Affiliation:
Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland
Michael Sparks
Affiliation:
Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland
Fatma Onmus-Leone
Affiliation:
Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland
Nicole Dzialowy
Affiliation:
Navy and Marine Corps Public Health Center, Epidata Center Department, Portsmouth, Virginia
Susan Fraser
Affiliation:
Fort Belvoir Community Hospital, Fort Belvoir, Virginia
Yoon Kwak
Affiliation:
Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland
Sonia Miller
Affiliation:
Fort Belvoir Community Hospital, Fort Belvoir, Virginia
Uzo Chukwuma
Affiliation:
Navy and Marine Corps Public Health Center, Epidata Center Department, Portsmouth, Virginia
Michael Julius
Affiliation:
Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland
Patrick McGann
Affiliation:
Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland
Robert Clifford
Affiliation:
Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland
*
Address all correspondence to Emil Lesho, 503 Robert Grant Avenue, Silver Spring, MD 20910 (carolinelesho@yahoo.com).

Abstract

OBJECTIVE

Hospital environments influence healthcare-associated infection (HAI) patterns, but the role of evidenced-based design (EBD) and residual bacterial DNA (previously thought to be clinically inert) remain incompletely understood.

METHODS

In a newly built EBD hospital, we used culture-based and culture-free (molecular) assays, pulsed-field gel electrophoresis (PFGE), and whole-genome sequencing (WGS) to determine: (1) patterns of environmental contamination with target organisms (TOs) and multidrug-resistant (MDR) target organisms (MDR-TOs); (2) genetic relatedness between environmentally isolated MDR-TO and those from HAIs; and (3) correlation between surface contamination and HAIs.

RESULTS

A total of 1,273 high-touch surfaces were swabbed before and after terminal cleaning during 77 room visits. Of the 2,546 paired swabs, 47% had cultivable biomaterial and 42% had PCR-amplifiable DNA. The ratios of TOs detected to surfaces assayed were 85 per 1,273 for the culture-based method and 106 per 1,273 for the PCR-based method. Sinks, toilet rails, and bedside tables most frequently harbored biomaterial. Although cleaned surfaces were less likely to have cultivable TOs than precleaned surfaces, they were not less likely to harbor bacterial DNA. The rate of MDR-TOs to surfaces swabbed was 0.1% (3/2546). Although environmental MDR-TOs and MDR-TOs from HAIs were genetically related by PFGE, WGS revealed that they were unrelated. Environmental levels of cultivable Enterococcus spp. and E. coli DNA were positively correlated with infection incidences (P<.04 and P<.005, respectively).

CONCLUSION

MDR-TOs were rarely detected during surveillance and were not implicated in HAIs. The roles of environmental DNA and EBD, particularly with respect to water-associated fixtures or the potential suppression of cultivable environmental MDR-TOs, warrant multicenter investigations.

Infect Control Hosp Epidemiol 2015;36(10):1130–1138

Type
Original Articles
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

The views expressed herein are solely those of the authors and are not to be construed as official or to represent the US Army or the Department of Defense.

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