We assessed environmental contamination of inpatient rooms housing COVID-19 patients in a dedicated COVID-19 unit. Contamination with SARS-CoV-2 was found on 5.5% (19/347) of surfaces via RT-PCR and 0.3% (1/347) of surfaces via cell culture. Environmental contamination is uncommon in hospitals rooms; RNA presence is not a specific indicator of infectious virus.

ImportanceEnvironmental contamination is a source of transmission between patients, health care practitioners, and other stakeholders in the acute care setting.ObjectiveTo compare the efficacy of an enhanced daily disinfection strategy vs standard disinfection in acute care hospital rooms.Design, Setting, and ParticipantsThis randomized clinical trial (RCT) was conducted in acute care hospital rooms at Duke University Hospital in Durham, North Carolina, from November 2021 to March 2022. Rooms were occupied by patients with contact precautions. Room surfaces (bed rails, overbed table, and in-room sink) were divided into 2 sides (right vs left), allowing each room to serve as its own control. Each side was randomized 1:1 to the intervention group or control group.InterventionsThe intervention was a quaternary ammonium, salt-based, 24-hour continuously active germicidal wipe. It was applied in addition to routine disinfection for the intervention group. The control group received no intervention beyond routine disinfection.Main Outcomes and MeasuresThe primary outcome was the total contamination, measured in colony-forming units (CFUs) on the bed rails, overbed table, and sink on study day 1. The secondary outcomes were the proportion of sample areas with positive test results for clinically important pathogens, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and carbapenem-resistant Enterobacteriaceae; the similarity in baseline contamination between sample area sides on study day 0 before application of the intervention, and the proportion of sample areas with removed UV luminescent gel on study day 1.ResultsA total of 50 study rooms occupied by 50 unique patients (median [IQR] age, 61 [45-69] years; 26 men [52%]) with contact precautions were enrolled. Of these patients, 41 (82%) were actively receiving antibiotics, 39 (78%) were bedridden, and 28 (56%) had active infections with study-defined clinically important pathogens. On study day 1, the median (IQR) total CFUs for the intervention group was lower than that for the control group (3561 [1292-7602] CFUs vs 5219 [1540-12 364] CFUs; P = .002). On study day 1, the intervention side was less frequently contaminated with patient-associated clinically important pathogens compared with the control side of the room (4 [14%] vs 11 [39%]; P = .04).Conclusions and RelevanceResults of this RCT demonstrated that a quaternary ammonium, salt-based, 24-hour continuously active germicidal wipe decreased the environmental bioburden in acute care hospital rooms compared with routine disinfection. The findings warrant large-scale RCTs to determine whether enhanced daily disinfection strategies can decrease patient acquisition and adverse patient outcomes.Trial RegistrationClinicalTrials.gov Identifier: NCT05560321

Introduction Patients with Clostridioides difficile infections (CDI) contaminate the healthcare environment; however, the relative contribution of contamination by colonized individuals is unknown. Current guidelines do not recommend the use of contact precautions for asymptomatic C. difficile carriers. We evaluated C. difficile environmental contamination in rooms housing adult inpatients with diarrhea based on C. difficile status. Methods We performed a prospective cohort study of inpatient adults with diarrhea who underwent testing for CDI via PCR and enzyme immunoassay. Patients were stratified into cohorts based on test result: infected (PCR +/EIA +), colonized (PCR +/EIA -) or negative/control (PCR -). Environmental microbiological samples were taken within 24 hours of C. difficile testing and again for two successive days. Samples were obtained from the patient, bathroom, and care areas. Results We enrolled 94 patients between November 2019 and June 2021. C. difficile was recovered in 93 (38%) patient rooms: 44 (62%) infected patient rooms, 35 (43%) colonized patient rooms (p=0.08 vs. infected 38 patient rooms), and 14 (15%) negative patient rooms (p<0.01 vs. infected; p<0.01 vs. colonized). C. difficile was recovered in 40 (56%), 6 (9%) and 20 (28%) of bathrooms, care areas and patient areas in 40 infected patient rooms; 34 (41%), 1 (1%), and 4 (5%) samples in colonized patient rooms; and 12 (13%), 41 1 (1%), and 3 (3%) of samples in negative patient rooms, respectively. Conclusion Patients colonized with C. difficile frequently contaminated the hospital environment. Our data support the use of contact precautions when entering rooms of patients colonized with C. difficile, especially when entering the bathroom.

Background Time from opening of a new bed tower to CREcontamination of patient room hospital sinks is poorly understood. Methods A 26-bed patient care unit in a new bed tower was opened on 7/18/2020. Patients admitted to this unit underwent weekly rectal cultures to survey for carbapenemase-producing (CP) CRE. Additionally, infection preventionists performed routine surveillance of all clinical cultures for CP-CRE. In-room sinks were located opposite the patient headwall in each patient room and were cultured monthly beginning 9/14/2020 for 3 months. Samples were obtained from the drain cover, handles, and top of bowl using sponges soaked in neutralizing buffer and processed using the stomacher technique. The tailpipe was sampled using a flocked mini-tip swab soaked in neutralizing buffer; the p-trap water was sampled with sterile tubing attached to a 50mL syringe. All samples were plated on HARDYCHROM-ESBL and KPC Colorex medias and incubated at 37°C for 24 hours. Carbapenem resistance genes (NDM1, KPC, IMP, VIM and OXA48) were detected by multiplex PCR and species were confirmed using MALDI-TOF. Environmental pathogens with intrinsic carbapenem resistance and no detected carbapenem-resistance genes were excluded. Results Generally, patients admitted to study rooms were similar across samplings (Table 1). No CP-CRE-positive patients were identified from weekly screening or clinical cultures from the opening of the unit through the end of the study. On the first sampling we discovered KPC-positive Enterobacter cloacae complex on a drain cover (1,400 CFU) and two environmental pathogens housing IMP or KPC genes. On the second sampling we discovered five environmental pathogens housing IMP or KPC genes. On the third sampling we discovered two environmental pathogens housing the IMP gene in p-traps (Figure 1). Table 1. Patient Characteristics Figure 1. Bacterial species and carbapenem-resistance genes found over time Conclusion In a new bed tower open for 58 days with no evidence of CRE positive patients, CRE and CRE genes were discovered in in-room sinks in clinically important (KPC) and environmental pathogens (KPC, IMP). We observed transient colonization of sink drains with potentially important pathogens during a short observation period. Observation over longer time is required to determine transient versus persistent colonization and risk factors for persistent drain colonization. Disclosures All Authors: No reported disclosures

We assessed Oxivir Tb wipe disinfectant residue in a controlled laboratory setting to evaluate low environmental contamination of SARS-CoV-2. Frequency of viral RNA detection was not statistically different between intervention and control arms on day 3 (P=0.14). Environmental contamination viability is low; residual disinfectant did not significantly contribute to low contamination.