Risk of organism acquisition from prior room occupants: a systematic review and meta-analysis

Mitchell, Brett G; Dancer, S.J.; Anderson, Malcolm; Dehn, Emily

doi:10.1016/j.jhin.2015.08.005

Cited by 168 publications

(134 citation statements)

References 36 publications

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“…Nonetheless, ESBL-producing bacteria were recovered from the ward environment in the absence of infected patients; most commonly from surfaces within a private ward, the ICU and a haematology ward (Table II) Contaminated surfaces contribute to the transmission of hospital pathogens 18 and whilst some studies suggest that environmental contamination may not play a role in the transmission of ESBL-producing pathogens 19 others have concluded that admission to a room previously occupied by an infected/colonised patient is a risk factor for acquisition. 20 The majority of patients admitted to the private ward originated from the Middle East where very high rates of ESBL production among Enterobacteriaceae have been reported 21 and which may have contributed to the comparatively high surface contamination rate. ESBL-K. pneumoniae was recovered from the toilet floor, toilet seat and a bin lid in a private room three days before the occupying patient (not known to be colonised at the time of sampling) presented with a urinary tract infection.…”

Section: Discussionmentioning

confidence: 99%

ESBL-producing Gram-negative organisms in the healthcare environment as a source of genetic material for resistance in human infections

Muzslay

Moore

Alhussaini

et al. 2017

Journal of Hospital Infection

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SUMMARY BackgroundThe increasing prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriacae in the healthcare setting and in the community despite established infection control guidelines indicates that these microorganisms may possess survival strategies that allow them to persist in the environment. Aims To determine the extent and variation in endemic ESBL-carrying species in different ward environments. To investigate the potential for cephalosporin resistance to be transferred from environmental isolates to human pathogens. Methods Conventional microbiological methods were used to sample 1436 environmental surfaces for ESBL-producing bacteria. Transconjugation assays (broth mating experiments) were performed using environmental ESBL-producing isolates as donors and streptomycin-resistant Escherichia coli (NCTC 50237) as the recipient. FindingsThe prevalence of ESBL-producing bacteria on surfaces in a non-outbreak setting was low (45/1436; 3.1%). The sites most likely to be contaminated were the drains of handwash basins (28/105; 26.7%) and floors (14/160; 8.8%). Fifty-nine ESBL-carrying organisms were isolated. Of these, Klebsiella spp (33.9%), Enterobacter spp (20.3%), Pantoea spp (15.3%) and Citrobacter spp (13.6%), were the most common isolates. ESBL determinants were successfully transferred from three representative environmental isolates (Pantoea calida, Klebsiella oxytoca, Raoultella ornithinolytica) to the human pathogen E. coli. Conclusion ESBL-producing Gram-negative isolates were recovered from the hospital environment in the absence of any ESBL infection on the wards. The drains of hand wash basins should be considered potential long-term reservoirs of multi-drug resistant bacteria and drug resistance genes. These genes can reside in various genera of hardy environmental organisms and be a potential source of ESBL for more common human pathogens.

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Section: Discussionmentioning

confidence: 99%

ESBL-producing Gram-negative organisms in the healthcare environment as a source of genetic material for resistance in human infections

Muzslay

Moore

Alhussaini

et al. 2017

Journal of Hospital Infection

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“…Growing evidence suggests that contaminated healthcare textiles may be a source for transmission of epidemiologically important pathogens and HAIs. 4 Preclinical data suggested that antimicrobialimpregnated textiles are efficacious at reducing bacterial burden, [8][9][10] but data to support the use of antimicrobialimpregnated scrubs in clinical practice are limited. To date, 4 other trials have examined antimicrobial-impregnated scrubs, with conflicting results.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Clothing of HCPs routinely becomes contaminated during clinical duties, [5][6][7] and it may serve as a source for transmission to patients or recontamination of the HCP or the environment.…”

mentioning

confidence: 99%

The Antimicrobial Scrub Contamination and Transmission (ASCOT) Trial: A Three-Arm, Blinded, Randomized Controlled Trial With Crossover Design to Determine the Efficacy of Antimicrobial-Impregnated Scrubs in Preventing Healthcare Provider Contamination

Anderson

Addison

Lokhnygina

et al. 2017

Infect. Control Hosp. Epidemiol.

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objective. To determine whether antimicrobial-impregnated textiles decrease the acquisition of pathogens by healthcare provider (HCP) clothing.design. We completed a 3-arm randomized controlled trial to test the efficacy of 2 types of antimicrobial-impregnated clothing compared to standard HCP clothing. Cultures were obtained from each nurse participant, the healthcare environment, and patients during each shift. The primary outcome was the change in total contamination on nurse scrubs, measured as the sum of colony-forming units (CFU) of bacteria.participants and setting. Nurses working in medical and surgical ICUs in a 936-bed tertiary-care hospital.intervention. Nurse subjects wore standard cotton-polyester surgical scrubs (control), scrubs that contained a complex element compound with a silver-alloy embedded in its fibers (Scrub 1), or scrubs impregnated with an organosilane-based quaternary ammonium and a hydrophobic fluoroacrylate copolymer emulsion (Scrub 2). Nurse participants were blinded to scrub type and randomly participated in all 3 arms during 3 consecutive 12-hour shifts in the intensive care unit.results. In total, 40 nurses were enrolled and completed 3 shifts. Analyses of 2,919 cultures from the environment and 2,185 from HCP clothing showed that scrub type was not associated with a change in HCP clothing contamination (P = .70). Mean difference estimates were 0.118 for the Scrub 1 arm (95% confidence interval [CI], −0.206 to 0.441; P = .48) and 0.009 for the Scrub 2 rm (95% CI, −0.323 to 0.342; P = .96) compared to the control. HCP became newly contaminated with important pathogens during 19 of the 120 shifts (16%).conclusions. Antimicrobial-impregnated scrubs were not effective at reducing HCP contamination. However, the environment is an important source of HCP clothing contamination. trial registration. Clinicaltrials.gov Identifier: NCT 02645214

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“…39 Use of enhanced methods for terminal cleaning of MRO rooms has been shown to reduce MRSA, VRE and C. difficile acquisition rates. 40 …”

Section: Antibiotic Use and Active C Difficile Infectionmentioning

confidence: 99%

Healthcare‐acquired infections: prevention strategies

Fernando

Gray

Gottlieb

2017

Internal Medicine Journal

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Healthcare‐acquired infections (HAI) impact on patient care and have cost implications for the Australian healthcare system. The management of HAI is exacerbated by rising rates of antimicrobial resistance (AMR). Health‐care workers and a contaminated hospital environment are increasingly implicated in the transmission and persistence of multi‐resistant organisms (MRO), as well as other pathogens, such as Clostridium difficile. This has resulted in a timely focus on a range of HAI prevention actions. Core components include antimicrobial stewardship, to reduce overuse and ensure evidence‐based antimicrobial use; infection prevention strategies, to control MRO – particularly methicillin‐resistant Staphylococcus aureus (MRSA), vancomycin‐resistant Enterococcus spp. (VRE) and, more recently, multi‐resistant Gram‐negative bacteria; enhanced institutional investment in hand hygiene; hospital cleaning and disinfection; and the development of prescribing guidelines and standards of care. AMR surveillance and comparisons of prescribing are useful feedback activities once effectively communicated to end users. Successful implementation of these strategies requires cultural shifts at local hospital level and, to tackle the serious threat posed by AMR, greater co‐ordination at a national level. HAI prevention needs to be multi‐modal, requires broad healthcare collaboration, and the strong support and accountability of all medical staff.

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Risk of organism acquisition from prior room occupants: a systematic review and meta-analysis

Cited by 168 publications

References 36 publications

ESBL-producing Gram-negative organisms in the healthcare environment as a source of genetic material for resistance in human infections

ESBL-producing Gram-negative organisms in the healthcare environment as a source of genetic material for resistance in human infections

The Antimicrobial Scrub Contamination and Transmission (ASCOT) Trial: A Three-Arm, Blinded, Randomized Controlled Trial With Crossover Design to Determine the Efficacy of Antimicrobial-Impregnated Scrubs in Preventing Healthcare Provider Contamination

Healthcare‐acquired infections: prevention strategies

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