ebd environmental dna and infections 1137
figure 3. Environmental pathogen presence and inpatient infections. For each of N=16 months of surveillance conducted, the number of nosocomial infections per 1,000 inpatients was plotted relative to the number of target organism (TO)–positive assays per 20 rooms. (A) A regression plot utilizing all 16 PCR-based E. coli measurements is shown with a dashed line (Y-intercept: 3.21, slope: 0.61). A Pearson’s product–moment correlation coefficient of r=0.48 was computed for these data, which corresponds to P=.0289. (A 1-tailed test was used because it is reasonable to assume that increased environmental presence of a pathogen leads to increased incidence of disease). Because only 2 rooms were surveyed in December 2011, this data point—(10.00, 3.16), plotted with an empty circle—may not be appropriate for analysis. When ignored, the regression plot shown using a solid line (Y-intercept: 2.00, slope: 1.06) is obtained. For this subset of N=15 measurements, Pearson’s r corresponds to 0.71, with P=.00147. (B) A regression plot utilizing all 16 culture-based Enterococcus spp. measurements is shown with a dashed line (Y-intercept: 1.70, slope: 0.30). A Pearson’s product–moment correlation coefficient of r=0.44 was computed for these data, which corresponds to P=.0436 (1-tailed test). The data point for the December 2011 survey, (10.00, 3.16), is represented by an empty circle. When ignored, the regression plot shown using a solid line (Y-intercept: 1.53, slope: 0.58) obtains. For this subset of N=15 measurements, Pearson’s r corresponds to 0.54, P=.0187.
logistical constraints prevented us from using Petri films, dipped slides, or disinfectant neutralizers. Therefore, the environmental burden of TOs may have been underestimated. However, the PCR assays we used are highly sensitive. Additionally, our findings might not be generalizable to civi- lian hospitals, but patients of all ages and races are treated at FBCH. In conclusion, sinks were frequently contaminated at this
Limitations of this study include the fact that financial and
facility despite EBD; clearly they remain an important potential reservoir for HAI transmission.27–29 We hope that this study spurs similar investigations at other EBD facilities, which are needed to determine how EBD impacts surface contamination, cleaning, and HAI-related outcomes.
acknowledgments
We would like to thank Lee Hudson and the late George Nussbaum for their insights into hospital design and construction, and David B. Goldman for critical review of the manuscript. Financial support: This work was supported by the Military Infectious Dis-
ease Research Program; the Congressional War Supplement Fund; the Global Emerging Infections Surveillance System; and the US Army Medical Research and Materiel Command. Potential conflicts of interest: There are no conflicts of interest and nothing to
disclose.
Address all correspondence to Emil Lesho, 503 Robert Grant Avenue, Silver Spring, MD 20910 (
carolinelesho@yahoo.com).
supplementary material
To view supplementary material for this article, please visit
http://dx.doi.org/10.1017/ice.2015.151 references
1. Department of Health and Human Services. National action plan to prevent healthcare-associated infections: roadmap to elimination. Washington, DC: Department of Health and Human Services; 2013.
2. Bogusz A, Stewart M, Hunter J, et al. How quickly do hospital surfaces become contaminated after detergent cleaning? Health- care Infect 2013;18:3–9.
3. Sattar SA. Promises and pitfalls of recent advances in chemical means of preventing the spread of nosocomial infections by environmental surfaces. Am J Infect Control 2010;38:S34–S40.
4. WeberDJ, Rutala WA. Understanding and preventing transmission of healthcare-associated pathogens due to the contaminated hos- pital environment. Infect Control Hosp Epidemiol 2013;34:449–452.
5. Huslage K, Rutala WA, Gergen MF, Sickbert-Bennett EE, Weber DJ. Microbial assessment of high-, medium-, and low-touch hospital room surfaces. Infect Control Hosp Epidemiol 2013;34: 211–212.
6. Septimus E, Weinstein RA, Perl TM, Goldmann DA, Yokoe DS. Approaches for preventing healthcare-associated infections: go long or go wide? Infect Control Hosp Epidemio 2014;35: 797–801.
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