Environmental Panels as a Proxy for Nursing Facility Patients With Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus Colonization

Cassone, Marco; Mantey, Julia; Perri, Mary Beth; Gibson, Kristen E.; Lansing, Bonnie; McNamara, Sara; Patel, Payal; Cheng, Vincent Chi-Chung; Stone, Nimalie D.; Zervos, Marcus J.; Mody, Lona

doi:10.1093/cid/ciy115

Cited by 23 publications

(24 citation statements)

References 29 publications

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“…The use of indwelling devices are a well-known risk factor for MDRO colonization as they compromise host defenses and mandate more contact-intense care placing patients at increased risk for the acquisition of new bacteria as well as transmitting bacteria to healthcare workers and the environment. 14,22,32,33 Antibiotics use and open wounds have been shown in other studies to be predictors of co-colonization, and diabetes has been demonstrated to increase the risk for MRSA and VRE colonization in other healthcare settings. 3, 11-12, 24, 34-37 Further studies are needed to investigate the benefits of identifying these high risk individuals and implementing specific infection prevention measures such as collecting surveillance cultures, utilizing proper contact and isolation precautions, and hand hygiene on patient co-colonization rates.…”

Section: Discussionmentioning

confidence: 95%

Predictors of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci co-colonization among nursing facility patients

Heinze

Kabeto

Martin

et al. 2019

American Journal of Infection Control

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Background: The emergence of vancomycin-resistant Staphylococcus aureus (VRSA) poses significant challenges for antibiotic therapy. We characterized the epidemiology of methicillinresistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) cocolonization that may facilitate resistance transfer and VRSA emergence among nursing facility (NF) patients. Methods: We cultured newly admitted patient hands, nares, oropharynx, groin, perianal region, plus wounds and device insertion sites if applicable upon enrollment, at day 14, day 30, and monthly thereafter for up to 6 months. Demographic, comorbidity, and antimicrobial use data was collected. Functional status was assessed at each visit using the Lawton & Brody Physical Self Maintenance Scale. Multinomial logistic regression was performed using a generalized linear mixed effect model to determine factors predictive of co-colonization. Results: 508 patients were enrolled with an average follow-up time of 28.5 days. Prevalence of MRSA/VRE cocolonization, MRSA alone, and VRE alone were 8.7%, 8.9%, and 23.4% respectively. Independent predictors of co-colonization included indwelling device use [OR=5.5

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Section: Discussionmentioning

confidence: 95%

Predictors of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci co-colonization among nursing facility patients

Heinze

Kabeto

Martin

et al. 2019

American Journal of Infection Control

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“…Environmental cultures were obtained during the same visit from the following sites in the patient's room: bed controls, bedside table (top and bottom), nurse call button, bed curtain, toilet seat, door knob, TV remote control, bedrail, and wheelchair handles. 10 We sampled the dominant hands of HCP, including the palm, fingers, and around nails with premoistened swabs, using techniques previously described, before and after completion of observed patient care activity, but prior to hand hygiene. 11 When HCP wore gloves, samples were collected immediately after glove removal but before hand hygiene.…”

Section: Specimen Collection and Microbiologymentioning

confidence: 99%

The devil is in the details: Factors influencing hand hygiene adherence and contamination with antibiotic-resistant organisms among healthcare providers in nursing facilities

Mills

Zhu

Mantey

et al. 2019

Infect. Control Hosp. Epidemiol.

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Background:Antibiotic-resistant organism (ARO) colonization rates in skilled nursing facilities (NFs) are high; hand hygiene is crucial to interrupt transmission. We aimed to determine factors associated with hand hygiene adherence in NFs and to assess rates of ARO acquisition among healthcare personnel (HCP).Methods:HCP were observed during routine care at 6 NFs. We recorded hand hygiene adherence, glove use, activities, and time in room. HCP hands were cultured before and after patient care; patients and high-touch surfaces were cultured. HCP activities were categorized as high-versus low-risk for self-contamination. Multivariable regression was performed to identify predictors of hand hygiene adherence.Results:We recorded 385 HCP observations and paired them with cultures performed before and after patient care. Hand hygiene adherence occurred in 96 of 352 observations (27.3%) before patient care and 165 of 358 observations (46.1%) after patient care. Gloves were worn in 169 of 376 observations (44.9%). Higher adherence was associated with glove use before patient care (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.44–4.54) and after patient care (OR, 3.11; 95% CI, 1.77–5.48). Compared with nurses, certified nurse assistants had lower hand hygiene adherence (OR, 0.31; 95% CI, 0.15–0.67) before patient care and physical/occupational therapists (OR, 0.22; 95% CI, 0.11–0.44) after patient care. Hand hygiene varied by activity performed and time in the room. HCP hands were contaminated with AROs in 35 of 385 cultures of hands before patient care (0.9%) and 22 of 350 cultures of hands after patient care (6.3%).Conclusions:Hand hygiene adherence in NFs remain low; it is influenced by job title, type of care activity, and glove use. Hand hygiene programs should incorporate these unique care and staffing factors to reduce ARO transmission.

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“…As reservoirs, environmental fomites have an increasingly evident role in direct and indirect transmission of nosocomial pathogens . For example, we recently demonstrated that contamination of the patient room environment correlates with patient colonization in both acute and post‐acute care settings …”

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confidence: 99%

“…A growing body of evidence has focused on the contribution of the proximal patient room environment, medical equipment, and nursing‐associated surfaces to the persistence and transmission of MDROs in both acute and post‐acute care settings. However, little is known about the contamination of high‐touch surfaces in common areas.…”

mentioning

confidence: 99%

“…[14][15][16] For example, we recently demonstrated that contamination of the patient room environment correlates with patient colonization in both acute and post-acute care settings. [17][18][19] A growing body of evidence has focused on the contribution of the proximal patient room environment, 18,[20][21][22] medical equipment, 23 and nursing-associated surfaces [24][25][26] to the persistence and transmission of MDROs in both acute and post-acute care settings. However, little is known about the contamination of high-touch surfaces in common areas.…”

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confidence: 99%

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

Gontjes

Gibson

Lansing

et al. 2019

J American Geriatrics Society

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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

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Environmental Panels as a Proxy for Nursing Facility Patients With Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus Colonization

Cited by 23 publications

References 29 publications

Predictors of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci co-colonization among nursing facility patients

Predictors of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci co-colonization among nursing facility patients

The devil is in the details: Factors influencing hand hygiene adherence and contamination with antibiotic-resistant organisms among healthcare providers in nursing facilities

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

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