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findings represent the minimum impact of the environment on acquisition of MDROs. Furthermore, this endeavor represents the largest prospective study to confirm and quantify clonal bacterial transmission between hospitalized patients and environmental surfaces using molecular techniques. Our microbiological meth- ods were important for distinguishing between potential and definitive transmission events. These findings have several important implications for future
studies and interventions. The observed transmission of selected MDROs are markers of larger-scale bacterial admixing between the microbial flora of the hospital environment and that of the patient. If microbial transmission occurs early, readily, and frequently between patients and the environment, as shown in the study, the standard hospital cleaning practice of performing a detailed room disinfection only at the end of patient stay (ie, “terminal” cleaning) may be inadequate to prevent the acquisition of MDROs through the environment. Indeed, these results should compel us to develop new technologies and interventions to achieve safe continuous environmental disinfection within the healthcare setting. Future effort and research to reduce transmission of MDROs through the healthcare environment must improve upon the status quo approach to environmental disinfection.
Acknowledgments. None.
Financial support. The current study was supported by the US Centers for Disease Control and Prevention (CDC) as part of the Duke University–Uni- versity of North Carolina Prevention Epicenters Program (grant no. U54CK000164 to Dr Sexton), the National Institutes of Health/National Institute of Allergy and Infectious Diseases (NIH/NIAID grant no. K23AI095357 to Dr Anderson). The views expressed in this article are those of the authors and do not represent the views of the CDC or the NIH.
Conflicts of interest. All authors report no conflicts of interest relevant to this article.
Supplementary material. To view supplementary material for this article, please visit
https://doi.org/10.1017/ice.2018.275
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