Environmental Contamination of Contact Precaution and Non-Contact Precaution Patient Rooms in Six Acute Care Facilities

Abstract

Background Environmental contamination is an important source of hospital multidrug-resistant organism (MDRO) transmission. Factors such as patient MDRO contact precautions (CP) status, patient proximity to surfaces, and unit type likely influence MDRO contamination and bacterial bioburden levels on patient room surfaces. Identifying factors associated with environmental contamination in patient rooms and on shared unit surfaces could help identify important environmental MDRO transmission routes. Methods Surfaces were sampled from MDRO CP and non-CP rooms, nursing stations, and mobile equipment in acute care, intensive care, and transplant units within 6 acute care hospitals using a convenience sampling approach blinded to cleaning events. Precaution rooms had patients with clinical or surveillance tests positive for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, carbapenem-resistant Enterobacteriaceae or Acinetobacter within the previous 6 months, or Clostridioides difficile toxin within the past 30 days. Rooms not meeting this definition were considered non-CP rooms. Samples were cultured for the above MDROs and total bioburden. Results Overall, an estimated 13% of rooms were contaminated with at least 1 MDRO. MDROs were detected more frequently in CP rooms (32% of 209 room-sample events) than non-CP rooms (12% of 234 room-sample events). Surface bioburden did not differ significantly between CP and non-CP rooms or MDRO-positive and MDRO-negative rooms. Conclusions CP room surfaces are contaminated more frequently than non-CP room surfaces; however, contamination of non-CP room surfaces is not uncommon and may be an important reservoir for ongoing MDRO transmission. MDRO contamination of non-CP rooms may indicate asymptomatic patient MDRO carriage, inadequate terminal cleaning, or cross-contamination of room surfaces via healthcare personnel hands.

Microbial burden on environmental surfaces in patient rooms before daily cleaning—Analysis of multiple confounding variables

“…5,14,[19][20][21] Surfaces near patients had higher mean ACCs than other surfaces, a finding similar to results of several previous surveys conducted at various times relative to cleaning procedures. 5,6,8,21 We also found that surfaces in patient bathrooms had high ACCs, which is consistent with the study by Moore et al 5 but differs from the study by Tanner et al, 8 which did not include toilet seats.…”

“…[4][5][6] Lack of agreement between earlier studies can be explained in part by differences in the types of surfaces and areas of the hospital sampled, culture methods, cleaning and disinfectant products used, timing of sampling relative to cleaning and disinfection procedures, and method of reporting results. [7][8][9][10][11][12] To further study the issue of the microbial burden on environmental surfaces in hospitals, we analyzed the level of contamination of selected surfaces by obtaining cultures before daily cleaning in patient rooms during a trial comparing 2 commercially available hospital disinfectants.…”

Microbial bioburden of inpatient and outpatient areas beyond patient hospital rooms

“…2 Then 200-μL aliquots of eluate were plated on CHROMagar Staph aureus with 6 μg/mL cefoxitin for methicillin-resistant Staphylococcus aureus (MRSA), Enterococcosel agar with 20 μg/mL vancomycin for vancomycinresistant enterococci (VRE), MacConkey agar for gram-negative bacilli, and Sabouraud dextrose agar for Candida spp. 2,11 Bacterial and Candida spp isolates were identified using matrixassisted laser desorption/ionization time-of-flight (MALDI-TOF; Bruker Biotyper CA System, Bellerica, MA). Isolates of Enterobacteriaciae were screened for ceftazidime by plating on MacConkey agar containing 10 μg/mL ceftazidime.…”

“…Many studies have demonstrated that environmental contamination with healthcare-associated pathogens is common in rooms of hospitalized patients and residents of long-term care facilities. [1][2][3][4] In contrast, relatively little information is available on contamination of surfaces outside patient rooms. [5][6][7][8] Care areas and equipment outside patient rooms in healthcare facilities and in outpatient settings may represent an underappreciated reservoir of pathogen transmission.…”

Evaluation of microbial contamination in a surgical department of a Romanian military emergency hospital - A case study

“…The present study aimed at assessing the risk of exposure of patients and health professionals through the quantitative and qualitative detection of possibly pathogenic aerobic micro-organisms which may accidentally contaminate the existing microclimate during intra-operative procedures [1][2][3][4][5][6]. Research into the microbial load of the operative environment during daily pre-, intra-, and post-operative procedures in a surgical department of a military emergency hospital in Bucharest were carried out in the specialized laboratory for microbiological diagnosis only.…”