Abstract
Little is known about the short-term dynamics of methicillin-resistant Staphylococcus aureus (MRSA) transmission between patients and their immediate environment. We conducted a real-life microbiological evaluation of environmental MRSA contamination in hospital rooms in relation to recent patient activity. Observational pilot study. Two hospitals, hospital 1 in Zurich, Switzerland, and hospital 2 in Ann Arbor, Michigan, United States. Inpatients with MRSA colonization or infection. At baseline, the groin, axilla, nares, dominant hands of 10 patients and 6 environmental high-touch surfaces in their rooms were sampled. Cultures were then taken of the patient hand and high-touch surfaces 3 more times at 90-minute intervals. After each swabbing, patients' hands and surfaces were disinfected. Patient activity was assessed by interviews at hospital 1 and analysis of video footage at hospital 2. A contamination pressure score was created by multiplying the number of colonized body sites with the activity level of the patient. In total, 10 patients colonized and/or infected with MRSA were enrolled; 40 hand samples and 240 environmental samples were collected. At baseline, 30% of hands and 20% of high-touch surfaces yielded MRSA. At follow-up intervals, 8 (27%) of 30 patient hands, and 10 (6%) of 180 of environmental sites were positive. Activity of the patient explained 7 of 10 environmental contaminations. Patients with higher contamination pressure score showed a trend toward higher environmental contamination. Environmental MRSA contamination in patient rooms was highly dynamic and was likely driven by the patient's MRSA body colonization pattern and the patient activity.
Highlights
All patients at hospital 1 were established Methicillin-resistant Staphylococcus aureus (MRSA) carriers at baseline, with positive cultures of at least 1 body site, but this was the case for only 3 patients (60%) at hospital 2
In our pilot study of 10 patients who were colonized or infected with MRSA, 20% of environmental sites were contaminated with MRSA at baseline
Most environmental contaminations were likely explained by the patient’s actions. Patients touched their environment often, many of these sites remained free from MRSA contamination
Summary
This pilot study was conducted from November 2018 to July 2019 in 2 hospitals: the University Hospital of Zurich, Switzerland (hospital 1) and the Michigan Medicine Hospital in Ann Arbor, Michigan (hospital 2). At follow-up visits, sampling included the patient’s dominant hand, the aforementioned high-touch surfaces, and (hospital 1 only) room air. FLOQSwabs with swab rinse kit (SRK) solution (Copan Diagnostics, Murietta, GA), effective to inactivate disinfecting agents including ethanol, were used to sample environmental sites and hands. The activity score was multiplied by the number of colonized body sites to create a contamination pressure score For this pilot study, we determined the sample size of 10 patients and 40 visits with 240 environmental samples to reasonably represent potential colonization and transmission patterns. We determined the sample size of 10 patients and 40 visits with 240 environmental samples to reasonably represent potential colonization and transmission patterns Data for both microbiologic results and patient behavior were analyzed descriptively.
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