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Environmental Contamination Due to Methicillin-Resistant Staphylococcus aureus: Possible Infection Control Implications

Published online by Cambridge University Press:  02 January 2015

John M. Boyce ,
Gail Potter-Bynoe ,
Claire Chenevert  and
Thomas King
John M. Boyce
Affiliation:
Miriam Hospital and Brown University, Providence, Rhode Island
Gail Potter-Bynoe
Affiliation:
Miriam Hospital and Brown University, Providence, Rhode Island
Claire Chenevert
Affiliation:
Miriam Hospital and Brown University, Providence, Rhode Island
Thomas King
Affiliation:
Miriam Hospital and Brown University, Providence, Rhode Island
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Abstract

Objective:

To study the possible role of contaminated environmental surfaces as a reservoir of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals.

Design:

A prospective culture survey of inanimate objects in the rooms of patients with MRSA.

Setting:

A 200-bed university-affiliated teaching hospital.

Patients:

Thirty-eight consecutive patients colonized or infected with MRSA. Patients represented endemic MRSA cases.

Results:

Ninety-six (27%) of 350 surfaces sampled in the rooms of affected patients were contaminated with MRSA. When patients had MRSA in a wound or urine, 36% of surfaces were contaminated. In contrast, when MRSA was isolated from other body sites, only 6% of surfaces were contaminated (odds ratio, 8.8; 95% confidence interval, 3.725.5; Pく.0001). Environmental contamination occurred in the rooms of 73% of infected patients and 69% of colonized patients. Frequently contaminated objects included the floor, bed linens, the patient's gown, overbed tables, and blood pressure cuffs. Sixty-five percent of nurses who had performed morning patient-care activities on patients with MRSA in a wound or urine contaminated their nursing uniforms or gowns with MRSA. Forty-two percent of personnel who had no direct contact with such patients, but had touched contaminated surfaces, contaminated their gloves with MRSA.

Conclusions:

We concluded that inanimate surfaces near affected patients commonly become contaminated with MRSA and that the frequency of contamination is affected by the body site at which patients are colonized or infected. That personnel may contaminate their gloves (or possibly their hands) by touching such surfaces suggests that contaminated environmental surfaces may serve as a reservoir of MRSA in hospitals.

Information

Type
Originals Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 9 , September 1997 , pp. 622 - 627
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

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References

1. Boyce, JM. Increasing prevalence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control Hosp Epidemiol 1990;11:639–642.CrossRefGoogle ScholarPubMed
2. Panlilio, AL, Culver, DH, Gaynes, RP, et al. Methicillin-resistant Staphylococcus aureus in US hospitals, 1975-1991. Infect Control Hosp Epidemiol 1992;13:582–586.Google Scholar
3. Garner, JS, Simmons, BP. Centers for Disease Control guideline for isolation precautions in hospitals. Infect Control 1983;4:245–325.Google ScholarPubMed
4. Lynch, P, Jackson, MM, Cummings, MJ, Stamm, WE. Rethinking the role of isolation practices in the prevention of nosocomial infections. Ann Intern Med 1987;107:243–246.CrossRefGoogle ScholarPubMed
5. Jackson, MM, Lynch, P. An attempt to make an issue less murky: a comparison of four systems for infection precautions. Infect Control Hosp Epidemiol 1991;12:448–449.CrossRefGoogle ScholarPubMed
6. Larson, E. Compliance with isolation technique. Am J Infect Control 1983;11:221–225.CrossRefGoogle ScholarPubMed
7. Pettinger, A, Nettleman, MD. Epidemiology of isolation precautions. Infect Control Hosp Epidemiol 1991;12:303–307.CrossRefGoogle ScholarPubMed
8. National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests. 5th ed. Approved Standard. NCCLS Document M2-A5. Villanova, PA: NCCLS; 1993.Google Scholar
9. National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. 3rd ed. Approved Standard M7-A3. Villanova, PA: NCCLS; 1993.Google Scholar
10. Mazurier, S-I, Wernars, K. Typing of Listeria strains by random amplification of polymorphic DNA. Res Microbiol 1992;143:499–505.CrossRefGoogle ScholarPubMed
11. Thompson, RL, Cabezudo, I, Wenzel, RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus . Ann Intern Med 1982;97:309–317.CrossRefGoogle ScholarPubMed
12. Reagan, DR, Doebbeling, BN, Pfaller, MA, et al. Elimination of coincident Staphylococcus aureus nasal and hand carriage with intranasal application of mupirocin calcium ointment. Ann Intern Med 1991;114:101–106.CrossRefGoogle ScholarPubMed
13. Coovadia, YM, Bhana, RH, Johnson, AP, Haffejee, I, Marples, RR. A laboratory-confirmed outbreak of rifampicin-methicillin resistant Staphylococcus aureus (RMRSA) in a newborn nursery. J Hosp Infect 1989;14:303–312.CrossRefGoogle Scholar
14. Gaynes, R, Marosok, R, Mowry-Hanley, J, et al. Mediastinitis following coronary artery bypass surgery: a 3-year review. J Infect Dis 1991;163:117–121.CrossRefGoogle ScholarPubMed
15. Boyce, JM, Opal, SM, Potter-Bynoe, G, Medeiros, AA. Spread of methicillin-resistant Staphylococcus aureus in a hospital after exposure to a health care worker with chronic sinusitis. Clin Infect Dis 1993;17:496–504.CrossRefGoogle Scholar
16. Sherertz, RJ, Reagan, DR, Hampton, KD, et al. A cloud adult: the Staphylococcus aureus-virus interaction revisited. Ann Intern Med 1996;124:539–547.CrossRefGoogle ScholarPubMed
17. Walter, CW, Kundsin, RB, Shilkret, MA, Day, MM. The spread of staphylococci to the environment. Antibiotics Annual 1958:952–957.Google Scholar
18. Colbeck, JC. Environmental aspects of staphylococcal infections acquired in hospitals. Am J Public Health 1960;50:468–473.CrossRefGoogle ScholarPubMed
19. Beard-Pegler, MA, Stubbs, E, Vickery, AM. Observations on the resistance to drying of staphylococcal strains. J Med Microbiol 1988;26:251–255.CrossRefGoogle ScholarPubMed
20. Farrington, M, Brenwald, N, Haines, D, Walpole, E. Resistance to desiccation and skin fatty acids in outbreak strains of methicillin-resistant Staphylococcus aureus . J Med Microbiol 1992;36:56–60.CrossRefGoogle ScholarPubMed
21. Hinton, NA, Maltman, JR, Orr, JH. The effect of desiccation on the ability of Staphylococcus pyogenes to produce disease in mice. American Journal of Hygiene 1960;72:343–350.Google ScholarPubMed
22. McDade, JJ, Hall, LB. Survival of Staphylococcus aureus in the environment, I: exposure on surfaces. American Journal of Hygiene 1963;78:330–337.Google Scholar
23. Centers for Disease Control. Isolation Techniques for Use in Hospitals. Washington, DC: US Government Printing Office; 1975.Google Scholar
24. Boyce, JM, White, RL, Causey, WA, Lockwood, WR. Burn units as a source of methicillin-resistant Staphylococcus aureus infections. JAMA 1983;249:2803–2807.CrossRefGoogle ScholarPubMed
25. Arnow, PM, Allyn, PA, Nichols, EM, Hill, DL, Pezzlo, M, Bartlett, RH. Control of methicillin-resistant Staphylococcus aureus in a burn unit: role of nurse staffing. J Trauma 1982;22:954–959.CrossRefGoogle Scholar
26. Saroglou, G, Cromer, M, Bisno, AL. Methicillin-resistant Staphylococcus aureus: interstate spread of nosocomial infections with emergence of gentamicin-methicillin resistant strains. Infect Control 1980;1:81–89.CrossRefGoogle ScholarPubMed
27. Crossley, K, Landesman, B, Zaske, D. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides, II: epidemiologic studies. J Infect Dis 1979;139:280–287.CrossRefGoogle ScholarPubMed
28. Everett, ED, McNitt, TR, Rahm, AE Jr, Stevens, DL, Peterson, HE. Epidemiologic investigation of methicillin-resistant Staphylococcus aureus in a burn unit. Military Medicine 1978;143:165–167.CrossRefGoogle Scholar
29. Espersen, F, Nielsen, PB, Lund, K, Sylvest, B, Jensen, K. Hospital-acquired infections in a burn unit caused by an imported strain of Staphylococcus aureus with unusual multi-resistance. J Hyg (Lond) 1982;88:535–541.CrossRefGoogle Scholar
30. Rutala, WA, Katz, EBS, Sherertz, RJ, Sarubbi, FA Jr. Environmental study of a methicillin-resistant Staphylococcus aureus epidemic in a burn unit. J Clin Microbiol 1983;18:683–688.CrossRefGoogle Scholar
31. Snyder, LL, Wiebelhaus, P, Boon, SE, Morin, RA, Goering, R. Methicillin-resistant Staphylococcus aureus eradication in a burn center. J Burn Care Rehabil 1993;14:164–168.CrossRefGoogle Scholar
32. Walsh, TJ, Vlahov, D, Hansen, SL, et al. Prospective microbiologic surveillance in control of nosocomial methicillin-resistant Staphylococcus aureus . Infect Control 1987;8:7–14.CrossRefGoogle ScholarPubMed
33. Duckworth, GJ, Lothian, JL, Williams, JD. Methicillin-resistant Staphylococcus aureus: report of an outbreak in a London teaching hospital. J Hosp Infect 1988;11:1–15.CrossRefGoogle Scholar
34. Bitar, CM, Mayhall, CG, Lamb, VA, Bradshaw, TJ, Spadora, AC, Dalton, HP. Outbreak due to methicillin- and rifampin-resistant Staphylococcus aureus: epidemiology and eradication of the resistant strain from the hospital. Infect Control 1987;8:15–23.CrossRefGoogle ScholarPubMed
35. Bartzokas, CA, Paton, JH, Gibson, MF, Graham, F, McLoughlin, GA, Croton, RS. Control and eradication of methicillin-resistant Staphylococcus aureus on a surgical unit. N Engl J Med 1984;311:1422–1425.CrossRefGoogle ScholarPubMed
36. Ward, TT, Winn, RE, Hartstein, AI, Sewell, DL. Observations relating to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus: role of antimicrobial therapy in infection control. Infect Control 1981;2:453–459.CrossRefGoogle Scholar
37. Shanson, DC, Kensit, JC, Duke, R. Outbreak of hospital infection with a strain of Staphylococcus aureus resistant to gentamicin and methicillin. Lancet 1976;2:1347–1348.CrossRefGoogle ScholarPubMed
38. O'Toole, RD, Drew, WL, Dahlgren, BJ, Beaty, HN. An outbreak of methicillin-resistant Staphylococcus aureus infection. Observations in hospital and nursing home. JAMA 1970;213:257–262.CrossRefGoogle ScholarPubMed
39. Craven, DE, Reed, C, Kollisch, N, et al. A large outbreak of infections caused by a strain of Staphylococcus aureus resistant to oxacillin and aminoglycosides. Am J Med 1981;71:53–58.CrossRefGoogle ScholarPubMed
40. Lejeune, B, Buzit-Losquin, F, Simitzis-Le Flohic, AM, Le Bras, MP, Alix, D. Outbreak of gentamicin-methicillin-resistant Staphylococcus aureus infection in an intensive care unit for children. J Hosp Infect 1986;7:21–25.CrossRefGoogle Scholar
41. Cookson, B, Peters, B, Webster, M, Phillips, I, Rahman, M, Noble, W. Staff carriage of epidemic methicillin-resistant Staphylococcus aureus . J Clin Microbiol 1989;27:1471–1476.CrossRefGoogle ScholarPubMed
42. Bradley, SF, Terpenning, MS, Ramsey, MA, et al. Methicillin- resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med 1991;115:417–422.CrossRefGoogle Scholar
43. Strausbaugh, LJ, Jacobson, C, Sewell, DL, Potter, S, Ward, TT. Antimicrobial therapy for methicillin-resistant Staphylococcus aureus colonization in residents and staff of a Veterans' Affairs nursing home care unit. Infect Control Hosp Epidemiol 1992;13:151–159.CrossRefGoogle Scholar
44. Farrington, M, Ling, J, Ling, T, French, GL. Outbreaks of infection with methicillin-resistant Staphylococcus aureus on neonatal and burn units of a new hospital. Epidemiol Infect 1990;105:215–228.CrossRefGoogle ScholarPubMed
45. Haddad, Q, Sobayo, EI, Basit, OBA, Rotimi, VO. Outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. J Hosp Infect 1993;23:211–221.CrossRefGoogle Scholar
46. Maki, DG, McCormick, RD, Zilz, MA, Stolz, SM, Alvarado, CJ. An MRSA outbreak in an SICU during Universal Precautions: new epidemiology for nosocomial MRSA: downside for universal precautions. In: Program and Abstracts of the 30th Interscience Conference on Antimicrobial Agents and Chemotherapy; 10 1990; Atlanta, GA. Abstract 473.Google Scholar
47. Olson, DR, Lynch, P, Coyle, MB, Cummings, J, Bokete, T, Stamm, WE. Examination gloves as barriers to hand contamination in clinical practice. JAMA 1993;270:350–353.CrossRefGoogle Scholar
48. Babb, JR, Davies, JG, Ayliffe, GAJ. Contamination of protective clothing and nurses' uniforms in an isolation ward. J Hosp Infect 1983;4:149–157.CrossRefGoogle Scholar
49. Lidwell, OM, Towers, AG, Ballard, J, Gladstone, B. Transfer of micro-organisms between nurses and patients in a clean air environment. J Appl Bacteriol 1974;37:649–656.CrossRefGoogle Scholar
50. Nystrom, B. The contamination of gowns in an intensive care unit. J Hosp Infect 1981;2:167–170.CrossRefGoogle Scholar
51. Hambraeus, A. Transfer of Staphylococcus aureus via nurses' uniforms. J Hyg (Lond) 1973;71:799–814.Google ScholarPubMed
52. Hambraeus, A, Ransjo, U. Attempts to control clothes-borne infection in a burn unit, I: experimental investigations of some clothes for barrier nursing. J Hyg (Lond) 1977;79:193–202.CrossRefGoogle Scholar
53. Centers for Disease Control and Prevention. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:53–80.CrossRefGoogle Scholar