Hostname: page-component-5d84bcc8dc-2qh69 Total loading time: 0 Render date: 2026-09-07T03:17:40.927Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  14 November 2018

Luke F. Chen ,
Lauren P. Knelson ,
Maria F. Gergen ,
Olga M. Better ,
Bradly P. Nicholson ,
Christopher W. Woods ,
William A. Rutala ,
David J. Weber ,
Daniel J. Sexton  and
Deverick J. Anderson
...Show all authors
Luke F. Chen*
Affiliation:
Duke University Health System, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
Lauren P. Knelson
Affiliation:
Duke University Health System, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
Maria F. Gergen
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina
Olga M. Better
Affiliation:
Durham Veterans Affairs Medical Center, Durham, North Carolina
Bradly P. Nicholson
Affiliation:
Durham Veterans Affairs Medical Center, Durham, North Carolina
Christopher W. Woods
Affiliation:
Duke University Health System, Durham, North Carolina Durham Veterans Affairs Medical Center, Durham, North Carolina
William A. Rutala
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina
David J. Weber
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina
Daniel J. Sexton
Affiliation:
Duke University Health System, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
Deverick J. Anderson
Affiliation:
Duke University Health System, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
for the CDC Prevention Epicenters Program
Affiliation:
Duke University Health System, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina Durham Veterans Affairs Medical Center, Durham, North Carolina Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina
*
Author for correspondence: Luke F. Chen, Duke University Health System, Durham, North Carolina, 27710. E-mail: LukeChenDuke@gmail.com.
Get access Rights & Permissions [Opens in a new window]

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.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 1 , January 2019 , pp. 47 - 52
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

PREVIOUS PRESENTATION: This study was presented in part at the IDWeek 2015 Conference on October 9th, 2015, in San Diego, California.

Cite this article: Chen LF, et al. (2019). A prospective study of transmission of Multidrug-Resistant Organisms (MDROs) between environmental sites and hospitalized patients—the TransFER Study. Infection Control & Hospital Epidemiology 2019, 40, 47–52. doi: 10.1017/ice.2018.275

References

1. Weber, DJ, Rutala, WA. Understanding and preventing transmission of healthcare-associated pathogens due to the contaminated hospital environment. Infect Control Hosp Epidemiol 2013;34:449–452.Google Scholar
2. Weber, DJ, Anderson, D, Rutala, WA. The role of the surface environment in healthcare-associated infections. Curr Opin Infect Dis 2013;26:338–344.Google Scholar
3. Harris, AD. How important is the environment in the emergence of nosocomial antimicrobial-resistant bacteria? Clin Infect Dis 2008;46:686–688.Google Scholar
4. Anderson, DJ, Chen, LF, Weber, DJ, et al. Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study. Lancet 2017;389:805–814.Google Scholar
5. Mermel, LA, Cartony, JM, Covington, P, Maxey, G, Morse, D. Methicillin-resistant Staphylococcus aureus colonization at different body sites: a prospective, quantitative analysis. J Clin Microbiol 2011;49:1119–1121.Google Scholar
6. Bitterman, Y, Laor, A, Itzhaki, S, Weber, G. Characterization of the best anatomical sites in screening for methicillin-resistant Staphylococcus aureus colonization. Eur J Clin Microbiol Infect Dis 2010;29:391–397.Google Scholar
7. Mahida, N, Boswell, T. Improving the detection rate of vancomycin-resistant enterococci colonisation using groin swabs. J Clin Pathol 2014;67:544–545.Google Scholar
8. Gordon, NC, Wareham, DW. Evaluation of CHROMagar Acinetobacter for detection of enteric carriage of multidrug-resistant Acinetobacter baumannii in samples from critically ill patients. J Clin Microbiol 2009;47:2249–2251.Google Scholar
9. Huslage, K, Rutala, WA, Sickbert-Bennett, E, Weber, DJ. A quantitative approach to defining “high-touch” surfaces in hospitals. Infect Control Hosp Epidemiol 2010;31:850–853.Google Scholar
10. Anderson, DJ, Gergen, MF, Smathers, E, et al. Decontamination of targeted pathogens from patient rooms using an automated ultraviolet-C-emitting device. Infect Control Hosp Epidemiol 2013;34:466–471.Google Scholar
11. D’Agata, EM, Horn, MA, Ruan, S, Webb, GF, Wares, JR. Efficacy of infection control interventions in reducing the spread of multidrug-resistant organisms in the hospital setting. PLoS One 2012;7:e30170.Google Scholar
12. Mitchell, BG, Dancer, SJ, Anderson, M, Dehn, E. Risk of organism acquisition from prior room occupants: a systematic review and meta-analysis. J Hosp Infect 2015;91:211–217.Google Scholar
13. Shaughnessy, MK, Micielli, RL, DePestel, DD, et al. Evaluation of hospital room assignment and acquisition of Clostridium difficile infection. Infect Control Hosp Epidemiol 2011;32:201–206.Google Scholar
14. Han, JH, Sullivan, N, Leas, BF, Pegues, DA, Kaczmarek, JL, Umscheid, CA. Cleaning hospital room surfaces to prevent health care-associated infections: a technical brief. Ann Intern Med 2015;163:598–607.Google Scholar
15. Riggs, MM, Sethi, AK, Zabarsky, TF, Eckstein, EC, Jump, RL, Donskey, CJ. Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium ifficile strains among long-term care facility residents. Clin Infect Dis 2007;45:992–998.Google Scholar
16. Muto, CA. Asymptomatic Clostridium difficile colonization: Is this the tip of another iceberg? Clin Infect Dis 2007;45:999–1000.Google Scholar
17. Chen, LF, Carriker, C, Staheli, R, et al. Observing and improving hand hygiene compliance: implementation and refinement of an electronic-assisted direct-observer hand hygiene audit program. Infect Control Hosp Epidemiol 2013;34:207–210.Google Scholar
Supplementary material: File

Chen et al. supplementary material

Appendix

Download Chen et al. supplementary material(File)
File 303.2 KB