Contamination of Common Area and Rehabilitation Gym Environment with Multidrug‐Resistant Organisms

Abstract

OBJECTIVES To quantify the multidrug‐resistant organism (MDRO) burden of high‐touch common area and rehabilitation gym surfaces, and to assess microorganism transfer potential during rehabilitation sessions. DESIGN Prospective study of environmental contamination. SETTING Nursing home (NH). PARTICIPANTS Six Michigan NHs. MEASUREMENTS Monthly samples from common area surfaces (eg, living room), rehabilitation equipment, and rehabilitation personnel hands were screened for methicillin‐resistant Staphylococcus aureus (MRSA), vancomycin‐resistant enterococci (VRE), and resistant gram‐negative bacilli (R‐GNB). To assess microorganism transfer potential, we conducted an in‐depth assessment of microorganism transfer during 10 rehabilitation sessions. Microorganism transfer was defined as the identification of a microorganism on a destination surface that was uncontaminated before the rehabilitation session. Patient frequency of common area usage was also assessed qualitatively. RESULTS We obtained 1338 common area specimens from 180 monthly facility visits, of which 13.4% (179/1338) were MDRO positive: MRSA, 3.8%; VRE, 5.8%; and R‐GNB, 5.1%. A total of 64% (116/180) of sampling visits had at least one MDRO‐positive common area specimen. Within rehabilitation gyms, we obtained 521 equipment and 190 personnel hand specimens during 60 monthly visits. Of the equipment specimens collected, 7.7% (40/521) were MDRO positive: MRSA, 2.5%; VRE, 4.0%; and R‐GNB, 1.9%. Of the 190 rehabilitation personnel hand specimens collected, 3.7% (7/190) were MDRO positive. Overall, 55% (33/60) of rehabilitation gym visits had at least one MDRO‐positive specimen. Microorganism transfer assessment during 10 rehabilitation sessions revealed 35 opportunities for transfer during which microorganism transfer occurred in 17.1% (6/35) of opportunities. CONCLUSION NH common areas and rehabilitation gyms are MDRO reservoirs that may contribute to the transmission of healthcare‐associated pathogens. Because NHs accommodate the increasing short‐stay patient population, developing effective interventions that reduce MDRO transmission in the common area and rehabilitation gym environment should be considered an infection prevention priority. J Am Geriatr Soc 68:478–485, 2020

Return to training in the COVID‐19 era: The physiological effects of face masks during exercise

“…Several countries and some parts of the US have made this practice mandatory 6 . As sports clubs, gyms, and public spaces may serve an important source of viral transmission, masking may become an integral part of physical activity 19 . This measure might be even more important during aerobic activity, such as running or biking, as some preliminary studies show that small droplets can spread as far as 5 meters while walking at a pace of 4 km/h and 10 meters when running at 14.4 km/h 20…”

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“…The median (IQR) days from NH admission that patients were enrolled at was 6.0 (IQR, 3.0-7.0), plenty of time for shedding to the room environment. 39,53,54 Fifth, the determination of clinically relevant differences in hospital-and NH-antibiotic prescription practices requires further in-depth study. Sixth, facility variation in infection prevention and antibiotic stewardship efforts must be considered when evaluating the contribution of antibiotic exposures to MDRO epidemiology.…”

Do Clean Common Areas Save Lives?

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“…4,5 In this issue of the Journal of the American Geriatrics Society, Gontjes et al examine the burden of MDROs recovered in nursing homes from environments outside of resident rooms. 6 In doing so, they are also moving into new territory for infection prevention and control-that of common and rehabilitations areas in nursing homes.…”