Skip to main content Accessibility help
×
×
Home

Assessment of the Overall and Multidrug-Resistant Organism Bioburden on Environmental Surfaces in Healthcare Facilities

  • Alicia M. Shams (a1), Laura J. Rose (a1), Jonathan R. Edwards (a1), Salvatore Cali (a2), Anthony D. Harris (a3), Jesse T. Jacob (a4), Anna LaFae (a4), Lisa L. Pineles (a3), Kerri A. Thom (a3), L. Clifford McDonald (a1), Matthew J. Arduino (a1) and Judith A. Noble-Wang (a1)...

Abstract

OBJECTIVE

To determine the typical microbial bioburden (overall bacterial and multidrug-resistant organisms [MDROs]) on high-touch healthcare environmental surfaces after routine or terminal cleaning.

DESIGN

Prospective 2.5-year microbiological survey of large surface areas (>1,000 cm2).

SETTING

MDRO contact-precaution rooms from 9 acute-care hospitals and 2 long-term care facilities in 4 states.

PARTICIPANTS

Samples from 166 rooms (113 routine cleaned and 53 terminal cleaned rooms).

METHODS

Using a standard sponge-wipe sampling protocol, 2 composite samples were collected from each room; a third sample was collected from each Clostridium difficile room. Composite 1 included the TV remote, telephone, call button, and bed rails. Composite 2 included the room door handle, IV pole, and overbed table. Composite 3 included toileting surfaces. Total bacteria and MDROs (ie, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci [VRE], Acinetobacter baumannii, Klebsiella pneumoniae, and C. difficile) were quantified, confirmed, and tested for drug resistance.

RESULTS

The mean microbial bioburden and range from routine cleaned room composites were higher (2,700 colony-forming units [CFU]/100 cm2; ≤1–130,000 CFU/100 cm2) than from terminal cleaned room composites (353 CFU/100 cm2; ≤1–4,300 CFU/100 cm2). MDROs were recovered from 34% of routine cleaned room composites (range ≤1–13,000 CFU/100 cm2) and 17% of terminal cleaned room composites (≤1–524 CFU/100 cm2). MDROs were recovered from 40% of rooms; VRE was the most common (19%).

CONCLUSIONS

This multicenter bioburden summary provides a first step to determining microbial bioburden on healthcare surfaces, which may help provide a basis for developing standards to evaluate cleaning and disinfection as well as a framework for studies using an evidentiary hierarchy for environmental infection control.

Infect Control Hosp Epidemiol 2016;1426–1432

Copyright

Corresponding author

Address correspondence to Alicia M. Shams, 1600 Clifton Rd NE, MS: C-16, Atlanta, GA 30329 (AShams@cdc.gov).

References

Hide All
1. Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:11981208.
2. Boyce, JM. Environmental contamination makes an important contribution to hospital infection. J Hosp Infect 2007;65:5054.
3. Clabots, CR, Johnson, S, Olson, MM, Peterson, LR, Gerding, DN. Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection. J Infect Dis 1992;166:561567.
4. Simor, AE, Lee, M, Vearncombe, M, et al. An outbreak due to multiresistant Acinetobacter baumannii in a burn unit: risk factors for acquisition and management. Infect Control Hosp Epidemiol 2002;23:261267.
5. Aygun, G, Demirkiran, O, Utku, T, et al. Environmental contamination during a carbapenem-resistant Acinetobacter baumannii outbreak in an intensive care unit. J Hosp Infect 2002;52:259262.
6. Cimolai, N. MRSA and the environment: implications for comprehensive control measures. Eur J Clin Microbiol Infect Dis 2008;27:481493.
7. Carling, PC, Briggs, JL, Perkins, J, Highlander, D. Improved cleaning of patient rooms using a new targeting method. Clin Infect Dis 2006;42:385388.
8. Hota, B. Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection? Clin Infect Dis 2004;39:11821189.
9. Dubberke, ER, Reske, KA, Noble-Wang, J, et al. Prevalence of Clostridium difficile environmental contamination and strain variability in multiple health care facilities. Am J Infect Control 2007;35:315318.
10. Sexton, T, Clarke, P, O’Neill, E, Dillane, T, Humphreys, H. Environmental reservoirs of methicillin-resistant Staphylococcus aureus in isolation rooms: correlation with patient isolates and implications for hospital hygiene. J Hosp Infect 2006;62:187194.
11. Verity, P, Wilcox, MH, Fawley, W, Parnell, P. Prospective evaluation of environmental contamination by Clostridium difficile in isolation side rooms. J Hosp Infect 2001;49:204209.
12. Dancer, S, White, L, Robertson, C. Monitoring environmental cleanliness on two surgical wards. Int J Environment Health Res 2008;18:357364.
13. Carling, PC, Beheren, SV, Kimc, P, Woods, C. Intensive care unit environmental cleaning: an evaluation in sixteen hospitals using a novel assessment tool. J Hosp Infect 2008;68:3944.
14. Pfeiffer, EH, Wittig, JR, Dunkelberg, H, Werner, HP. Hygienic and bacteriological comparative studies in 50 hospitals V. bacterial contamination of hospital surfaces. Zbl Bakt Hyg 1978;167:1121.
15. Frabetti, A, Vandini, A, Balboni, P, Triolo, F, Mazzacane, S. Experimental evaluation of the efficacy of sanitation procedures in operating rooms. Am J Infect Control 2009;37:658664.
16. Boyce, JM, Havill, NL, Otter, JA, Adams, NMT. Widespread environmental contamination associated with patients with diarrhea and methicillin-resistant Staphylococcus aureus colonization of the gastrointestinal tract. Infect Control Hosp Epidemiol 2007;28:11421147.
17. Oie, S, Kamiya, A. Contamination of environmental surfaces by methicillin-resistant Staphylococcus aureus (MRSA). Biomed Lett 1998;57:115119.
18. Oie, S, Hosokawa, I, Kamiya, A. Contamination of room door handles by methicillin-sensitive/methicillin-resistant Staphylococcus aureus . J Hosp Infect 2002;51:140143.
19. Moore, GP, Muzslay, M, Wilson, AP. The type, level, and distribution of microorganisms within the ward environment: a zonal analysis of an intensive care unit and a gastrointestinal surgical ward. Infect Control Hosp Epidemiol 2013;34:500506.
20. Rutala, WA, Katz, EBS, Sherertz, RJ, Sarubbi, FA. Environmental study of a methicillin-resistant Staphylococcus aureus epidemic in a burn unit. J Clin Microbiol 1983;18:683688.
21. Claro, T, O’Reilly, M, Daniels, S, Humphreys, H. Surface microbial contamination in hospitals: a pilot study on methods of sampling and the use of proposed microbiologic standards. Am J Infect Control 2015;43:10001002.
22. Schmidt, MG, Anderson, T, Attaway, HH, Fairey, S, Kennedy, C, Salgado, CD. Patient environment microbial burden reduction: a pilot study comparison of 2 terminal cleaning methods. Am J Infect Control 2012;40:559561.
23. Schmidt, MG, Attaway, HH, Fairey, SE, Steed, LL, Michels, HT, Salgado, CD. Copper continuously limits the concentration of bacteria resident on bed rails within the intensive care unit. Infect Control Hosp Epidemiol 2013;34:530533.
24. Attaway, HH, Fairey, S, Steed, LL, Salgado, CD, Michels, HT, Schmidt, MG. Intrinsic bacterial burden associated with intensive care unit hospital beds: effects of disinfection on population recovery and mitigation of potential infection risk. Am J Infect Control 2012;40:907912.
25. Carling, P, Perkins, J. Ferguson, J. Thomasser, A. Evaluating a new paradigm for comparing surface disinfection in clinical practice. Infect Control Hosp Epidemiol 2014;35:13491355.
26. Boyce, JM, Havill, N, Dumigan, D, Golebiewski, M, Balogun, O, Rizvani, R. Monitoring the effectiveness of hospital cleaning practices by use of an adenosine triphosphate bioluminescence assay. Infect Control Hosp Epidemiol 2009;30:678684.
27. Suzuki, A, Namba, Y, Matsuura, M, Horisawa, A. Bacterial contamination of floors and other surfaces in operating rooms: a five-year study. J Hyg Camb 1984;93:559566.
28. Sehulster, S, Chinn, R. Guidelines for environmental infection control in health care facilities: recommendations of CDC and the Healthcare Infection Control Advisory Committee (HICPAC). MMWR 2003;52:142.
29. Dancer, SJ. How do we assess hospital cleaning? A proposal for microbiological standards for surface hygiene in hospitals. J Hosp Infect 2004;56:1015.
30. Malik, R, Cooper, RA, Griffith, CJ. Use of audit tools to evaluate the efficacy of cleaning systems in hospitals. Am J of Infect Ctrl 2003;31:181187.
31. Dancer, SJ. Pitfalls in microbiological sampling of the healthcare environment. A response to “Evaluating a New Paradigm for Comparing Surface Disinfection in Clinical Practice”. Infect Control Hosp Epidemiol 2015;36:849850.
32. Mulvey, D, Redding, P, Robertson, C, et al. Finding a benchmark for monitoring hospital cleanliness. J Hosp Infect 2011;77:2530.
33. White, LF, Dancer, SJ, Robertson, C, McDonald, J. Are hygiene standards useful in assessing infection risk? Am J Infect Control 2008;36:381384.
34. Nerandzic, MM, Donskey, CJ. Effective and reduced-cost modified selective medium for isolation of Clostridium difficile . J Clin Microbiol 2009;47:397400.
35. Persson, S, Torpdahl, M, Olsen, KEP. New multiplex PCR method for the detection of Clostridium difficile toxin A (tcdA) and toxin B (tcdB) and the binary toxin (cdtA/cdtB) genes applied to a Danish strain collection. Clin Microbiol Infect 2008;14:10571064.
36. CLSI. Performance standards for antimicrobial susceptibility testing; 22nd informational supplement. CLSI document M100-S22 Vol 32. Wayne, PA: Clinical and Laboratory Standards Institute; 2012.
37. Kallen, AJ, Hidron, AI, Patel, J, Srinivasan, A. Multidrug resistance among Gram‐negative pathogens that caused healthcare‐associated infections reported to the National Healthcare Safety Network, 2006–2008. Infect Control Hosp Epidemiol 2010;31:528531.
38. Multiplex real-time PCR detection of Klebsiella pneumoniae carbapenemase (KPC) and New Delhi metallo-β-lactamase (NDM-1) genes. Centers for Disease Control and Prevention website. http://www.cdc.gov/HAI/settings/lab/kpc-ndm1-lab-protocol.html. Published 2011. Accessed January 24, 2012.
39. McDonald, LC, Arduino, M. Editorial Commentary: climbing the evidentiary hierarchy for environmental infection control. Clin Infect Dis 2013;56:3639.
40. Rutala, WA, Weber, DJ. The benefits of surface disinfection. Am J Infect Control 2004;32:226231.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×
Type Description Title
WORD
Supplementary materials

Shams supplementary material
Supplementary Tables

 Word (24 KB)
24 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed