Infection Control & Hospital Epidemiology (2019), 40,47–52 doi:10.1017/ice.2018.275
Original Article
A prospective study of transmission of Multidrug-Resistant Organisms (MDROs) between environmental sites and hospitalized patients—the TransFER study
Luke F. Chen MBBS, MPH, MBA, CIC, FRACP, FIDSA, FSHEA1,2, Lauren P. Knelson MSPH1,2, Maria F. Gergen MT (ASCP)4, Olga M. Better BS3, Bradly P. Nicholson PhD3, Christopher W. Woods MD, MHS1,3, William A. Rutala PhD, MPH4, David J. Weber MD, MPH4, Daniel J. Sexton MD1,2 and Deverick J. Anderson MD, MPH, FIDSA, FSHEA1,2 for
the CDC Prevention Epicenters Program 1Duke University Health System, Durham, North Carolina, 2Duke Infection Control Outreach Network, Durham, North Carolina, 3Durham Veterans Affairs Medical Center, Durham, North Carolina and 4Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina
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.
(Received 25 March 2018; accepted 6 October 2018; electronically published 14 November 2018)
Hospital environmental surfaces are frequently contaminated by microorganisms.1 When contaminated, such surfaces can potentially act as vectors for transmission of bacteria that can lead to healthcare- associated infections (HAIs).2 Although contaminated surfaces have been hypothesized to play an important role in the causal pathway of HAIs, the nature, direction, persistence, and quantity of bacterial transfer between surfaces and patients remain poorly understood. Nevertheless, the concept of bacterial contamination of the environment as a source of transmission is still debated. Flaws with
Author for correspondence: Luke F. Chen, Duke University Health System, Durham,
North Carolina, 27710. E-mail:
LukeChenDuke@gmail.com. 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
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
previous studies have included (1) studies taking place during an outbreak setting, (2) suboptimal study design,3 and (3) lack of molecular epidemiology to show correlation between isolates from the environmental and those from patients. However, our group recently reported results from a large, multicenter randomized controlled trial on interventions to improve disinfection practices.4 Although our study only focused on strategies that improve terminal room disinfection, the results suggest that the environ- ment is responsible for at least 10%–30% of MDRO acquisitions. Thus, we undertook this prospective multicenter study as a
substudy of our large trial to characterize the nature of MDRO transmission between the environment and patients using a combination of standard microbiological and molecular techni- ques. The objective of this study was to determine whether, when, and in what direction epidemiologically important pathogens transfer between patients and surfaces within hospital rooms.
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