Methicillin‐Resistant Staphylococcus aureus Burden in Nursing Homes Associated with Environmental Contamination of Common Areas

Abstract

Background Variation in MRSA prevalence across nursing homes is poorly understood. Differences in environmental cleaning may be one source of variable MRSA burden. Design Prospective study of environmental contamination and cleaning quality. Setting/Participants 10 California nursing homes. Measurements We categorized nursing homes into two groups based upon high and low differences in MRSA point prevalence and admission prevalence (delta prevalence) from nares screenings of nursing home residents. We evaluated environmental cleaning and infection control practices by (a) culturing common area objects for MRSA, (b) assessing removal of intentionally-applied marks visible only under ultraviolet light (c) administering surveys on infection control and cleaning. Results Overall, 16% (78/500) of objects were MRSA-positive, and 22% (129/577) of UV-visible marks were removed. A higher proportion of MRSA-positive objects was found in the high vs. low nursing home groups (19% vs. 10%, p=0.005). Infection control and cleaning policies varied, including the frequency of common room cleaning (mean 2.5 times daily, range 1–3) and time spent cleaning per room (mean 18 min, range 7–45). In multivariate models, MRSA-positive objects were associated with high delta prevalence nursing homes (OR=2.8, p=0.005), facilities spending less time cleaning each room (OR = 2.9, p<0.001) and facilities where common rooms were cleaned less frequently (OR =1.5, p=0.01). Conclusions We found substantial variation in MRSA environmental contamination, infection control practices, and cleaning quality. MRSA environmental contamination was associated with larger differences between MRSA point and admission prevalence, less frequent common room cleaning, and less time spent cleaning per room. This suggests that modifying cleaning practices may reduce both MRSA environmental contamination and burden among nursing homes.

Healthcare-Associated Pathogens and Nursing Home Policies and Practices: Results From a National Survey

“…17 The survey (Appendix 1) was composed of 56 mostly close-ended questions about residents who are colonized or infected, admission policies for such residents, policies for routine screening on admission and for contact precautions, residents’ activity restrictions, decolonization practices, and the environmental cleaning practices for rooms of residents on contact precautions. Respondents were also asked about their title and the amount of time dedicated to infection control.…”

Current prevalence of multidrug-resistant organisms in long-term care facilities in the Rhine-Main district, Germany, 2013

“…Notably, residents of LTCFs may present various risk factors for MDRO carriage and/or transmission (e.g. older age, comorbidities, medical devices or recurrent antibiotic treatments) [30,31]. To issue recommendations for MDRO screening of LTCFs residents, e.g.…”

Evaluation of a Disinfectant Wipe Intervention on Fomite-to-Finger Microbial Transfer

“…Numerous studies have examined the efficacy of surface cleaners and disinfectants in reducing pathogen exposure in households (7,37,38), hospitals (14, 16, 18, 19, 23-25, 29, 30, 37, 58-60), and nursing homes (20). However, only few studies have quantitatively assessed the efficiency of microbial transfers to and from various surfaces or the ability of disinfectant wipe intervention to inhibit such transfers.…”

“…The occurrence and spread of pathogens throughout the home and health care settings have also been studied to better understand the role of fomites in pathogen exposure and acquired infections (5)(6)(7)(8)(9)(10)(11). The potential for pathogen transfer from contaminated fomites to fingers is a concern in health care environments; particularly those in close proximity to the patient that are frequently touched (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Health care-acquired infections caused by methicillin-resistant Staphylococcus aureus (MRSA), methicillin-susceptible S. aureus, and Clostridium difficile are associated with high morbidity and mortality (18,20,22,(26)(27)(28)(29)(30).…”

“…The potential for pathogen transfer from contaminated fomites to fingers is a concern in health care environments; particularly those in close proximity to the patient that are frequently touched (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Health care-acquired infections caused by methicillin-resistant Staphylococcus aureus (MRSA), methicillin-susceptible S. aureus, and Clostridium difficile are associated with high morbidity and mortality (18,20,22,(26)(27)(28)(29)(30). Most nosocomial and foodborne pathogens can persist on fomites for weeks or even months (18,19,31,32) and on fingers for up to several hours (33)(34)(35).…”