A prospective study of transmission of Multidrug-Resistant Organisms (MDROs) between environmental sites and hospitalized patients—the TransFER study

Abstract

Objective Hospital environmental surfaces are frequently contaminated by microorganisms. However, the causal mechanism of bacterial contamination of the environment as a source of transmission is still debated. This prospective study was performed to characterize the nature of multidrug-resistant organism (MDRO) transmission between the environment and patients using standard microbiological and molecular techniques. Setting Prospective cohort study at 2 academic medical centers. Design A prospective multicenter study to characterize the nature of bacterial transfer events between patients and environmental surfaces in rooms that previously housed patients with 1 of 4 ‘marker’ MDROs: methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Clostridium difficile, and MDR Acinetobacter baumannii. Environmental and patient microbiological samples were obtained on admission into a freshly disinfected inpatient room. Repeat samples from room surfaces and patients were taken on days 3 and 7 and each week the patient stayed in the same room. The bacterial identity, antibiotic susceptibility, and molecular sequences were compared between organisms found in the environment samples and patient sources. Results We enrolled 80 patient–room admissions; 9 of these patients (11.3%) were asymptomatically colonized with MDROs at study entry. Hospital room surfaces were contaminated with MDROs despite terminal disinfection in 44 cases (55%). Microbiological Bacterial Transfer events either to the patient, the environment, or both occurred in 12 patient encounters (18.5%) from the microbiologically evaluable cohort. Conclusions Microbiological Bacterial Transfer events between patients and the environment were observed in 18.5% of patient encounters and occurred early in the admission. This study suggests that research on prevention methods beyond the standard practice of room disinfection at the end of a patient’s stay is needed to better prevent acquisition of MDROs through the environment.

Sustained improvement in hospital cleaning associated with a novel education and culture change program for environmental services workers

“…The focus on optimizing the thoroughness of daily cleaning and the observed outcomes of the study are supported by another recent study that demonstrated environment-to-patient bacterial transfer during occupancy of hospital rooms, resulting in both asymptomatic carriage and symptomatic infection with pathogens such C. difficile and vancomycin-resistant enterococci. 19 Additional research is needed to assess the longer-term effects and sustainability of this type of intervention as well as its effectiveness in other hospitals and other types of healthcare facilities, such as skilled nursing and long-term care facilities.…”

Understanding ultraviolet light surface decontamination in hospital rooms: A primer

“…1 Contaminated surfaces can act as a source of healthcare personnel hand contamination and may represent a risk to newly admitted patients whose rooms have not been adequately disinfected following discharge of previous patients who were colonized or infected with pathogens. [2][3][4] In many healthcare facilities, only 50% of surfaces in patient rooms are routinely disinfected by environmental services personnel. 5 As a result, additional strategies may be needed, such as the use of mobile ultraviolet light (UV) devices to minimize contamination of environmental surfaces in hospitals.…”

Impact of surface disinfection with hydrogen peroxide on the prevalence of vancomycin-resistant enterococci (VRE) in hospital wards

“…UHF therefore offers a range of periodic and intensive tutorials, for instance addressing the epidemiology and current scientific status of multidrug-resistant organisms (MDRO), e.g., methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant gram-negative organisms (MDRGN), and VRE. These tutorials also address basic infection control strategies, e.g., hand hygiene, cleaning and disinfection procedures for patients’ and wards’ inanimate environments, which have been shown to play a key role in the spread of MDRO [ 13 ], [ 14 ], [ 15 ], [ 16 ], [ 17 ]. A small outbreak at UHF (five patients affected) of Klebsiella pneumoniae with carbapenem resistance in spring 2017 [ 18 ] impelled a change from glucoprotamin to H 2 O 2 -containing wipes for surface disinfection.…”