511. MDRO Carriage in Patients in Two ICUs and Prevalence of Environmental Surface and Healthcare Worker Hand Contamination

Abstract

BackgroundDetermining MDRO (multidrug-resistant organism) transmission routes in intensive care units (ICUs) can be complex and require the evaluation of multiple potential MDRO sources, including patients, the environment, and healthcare worker (HCW) hands. The objective of this study was to determine MDRO carriage in patients in two separate ICUs, and simultaneous environmental and HCW hand contamination from associated rooms.MethodsPatient (P), environmental (E), and HCW hand (H) samples were collected from hospital A (1183 H, 1253 E, 729 P) and hospital B (699 H, 1372 E, 437 P) over approximately 5 weeks in each unit. Environmental and HCW hand samples were collected using a cellulose sponge. HCW hand samples were collected prior to any hand hygiene. Patient samples were collected from the axilla, groin, and perianal areas with a flocked swab with patient consent. All samples were tested semi-quantitatively for Clostridium difficile (Cdiff), vancomycin-resistant enterococci (VRE), and cefotaxime-resistant Enterobacteriaceae (Cef-R-Ent) by selective culture. Cdiff isolates representative of each P/E/H cluster were tested for Cdiff toxin testing by PCR.ResultsCdiff, VRE, and Cef-R-Ent were detected in patients, patient rooms, and on HCW hands in both facilities (Table 1). Cdiff was more prevalent in Facility A, while Cef-R-Ent was more prevalent in Facility B. The prevalence of VRE was minimal in both facilities. Cdiff toxin gene testing revealed that 17% of the Cdiff isolate clusters tested positive for toxin genes. In Facility A, the prevalence of a given MDRO was similar regardless of sample type, but was more widely varied between sample types in Facility B. Prevalence of MDROs on HCW hands and in the environment was typically higher in Facility A compared with Facility B. Individual patient positives were frequently linked to positive HCW hand and environmental cultures.ConclusionWe discovered a low prevalence of all MDROs in both facilities, with most positive cultures associated with patients who were not on MDRO precautions. HCW hand and environmental MDRO prevalence was generally similar for each MDRO, regardless of patient prevalence, supporting previously reported links on HCW hand contamination and hospital room surfaces. Disclosures All authors: No reported disclosures.