Highlights
- •Limited information is available on shedding of pathogens outside patient rooms.
- •We examined shedding during appointments outside patient rooms.
- •38.5% of MRSA-colonized patients shed MRSA during appointments.
- •Presence of wounds with MRSA was a significant risk for environmental shedding.
- •No shedding of multidrug-resistant gram-negative bacilli was detected.
Background
Limited information is available on the frequency of and risk factors for shedding
of health care-associated pathogens in settings outside patient rooms.
Methods
We conducted a cohort study of hospitalized or recently discharged patients with methicillin-resistant
Staphylococcus aureus (MRSA) (N = 39) or multidrug-resistant gram-negative bacilli (MDR-GNB) (N = 11) colonization
to determine the frequency of environmental shedding during appointments outside hospital
rooms or during outpatient clinic visits. Chi-square tests were performed to identify
patient-level factors associated with environmental shedding. Spa typing was performed
for environmental and nasal MRSA isolates.
Results
Of 50 patients enrolled, 39 were colonized with MRSA and 11 with MDR-GNB. Shedding
during 1 or more appointments occurred more often for patients colonized with MRSA
versus MDR-GNB (15 of 39, 38.5% versus 0 of 11, 0%; P = .02). The presence of a wound with a positive culture for MRSA was associated with
shedding of MRSA during appointments (11 of 15, 73.3% with shedding versus 4 of 24,
16.7% with no shedding; P = .008). Eighty percent of environmental MRSA isolates were genetically related to
concurrent nasal isolates based on spa typing.
Conclusions
Environmental shedding of MRSA occurs frequently during appointments outside hospital
rooms or during outpatient clinic visits. Decontamination of surfaces and strategies
that reduce shedding of MRSA could reduce the risk for transmission in these settings.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Infection ControlAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Does improving surface cleaning and disinfection reduce health care-associated infections?.Am J Infect Control. 2013; 41: S12-S19
- Shedding of methicillin-resistant Staphylococcus aureus by colonized patients during procedures and patient care activities.Infect Control Hosp Epidemiol. 2019; 40: 328-332
- Shedding of multidrug-resistant gram-negative bacilli by colonized patients during procedures and patient care activities.Am J Infect Control. 2020; 48: 1336-1340
- Transmission of methicillin-resistant Staphylococcus aureus (MRSA) to healthcare worker gowns and gloves during care of nursing home residents.Infect Control Hosp Epidemiol. 2015; 36: 1050-1057
- 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
- Transmission of resistant gram-negative bacteria to health care worker gowns and gloves during care of nursing home residents in Veterans Affairs community living centers.Antimicrob Agents Chemother. 2017; 61 (e00790-17)
- Indwelling device use and antibiotic resistance in nursing homes: identifying a high-risk group.J Am Geriatr Soc. 2007; 55: 1921-1926
- Evaluation of patients' skin, environmental surfaces, and urinary catheters as sources for transmission of urinary pathogens.Am J Infect Control. 2014; 42: 810-812
- Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients.N Engl J Med. 2000; 343: 1925-1932
- Skin and environmental contamination with methicillin-resistant Staphylococcus aureus among carriers identified clinically versus through active surveillance.Clin Infect Dis. 2009; 48: 1423-1428
- 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
- Hospital outpatient clinics as a potential hazard for healthcare associated infections.J Infect Public Health. 2016; 9: 88-97
- Microbial transmission in an outpatient clinic and impact of an intervention with an ethanol-based disinfectant.Am J Infect Control. 2019; 47: 128-132
- Environmental contamination with vancomycin-resistant enterococci in an outpatient setting.Infect Control Hosp Epidemiol. 1998; 19: 515-518
- Outpatient healthcare settings and transmission of Clostridium difficile.PLoS One. 2013; 8: e70175
- Contamination of common area and rehabilitation gym environment with multidrug-resistant organisms.J Am Geriatr Soc. 2020; 68: 478-485
- Analysis of typing methods for epidemiological surveillance of both methicillin-resistant and methicillin-susceptible Staphylococcus aureus strains.J Clin Microbiol. 2008; 46: 136-144
- 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: e17-e21
- Chlorhexidine-based decolonization to reduce healthcare-associated infections and multidrug-resistant organisms (MDROs): who, what, where, when, and why?.J Hosp Infect. 2019; 103: 235-243
- Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci.Arch Intern Med. 2006; 166: 306-312
- A comparison of the efficacy of multiple ultraviolet light room decontamination devices in a radiology procedure room.Infect Control Hosp Epidemiol. 2019; 40: 158-163
- Contaminated clothing of methicillin-resistant Staphylococcus aureus carriers is a potential source of transmission.Am J Infect Control. 2018; 46: 1414-1416
Article info
Publication history
Published online: March 09, 2021
Footnotes
Funding: The authors acknowledge funding from the Centers for Disease Control and Prevention's investments to combat antibiotic resistance under award number 2019-06723 to CJD.
Conflicts of interest: C.J.D. has received research funding from Clorox, PDI, and Pfizer. All other authors report no conflicts of interest relevant to this article.
Identification
Copyright
Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.
