Infection Control & Hospital Epidemiology (2019), 40,328–332 doi:10.1017/ice.2018.342
Original Article
Shedding of methicillin-resistant Staphylococcus aureus by colonized patients during procedures and patient care activities
Heba Alhmidi MD1,
JenniferL.Cadnum BS1,Sreelatha Koganti MD1, Annette L. Jencson CIC1, Joseph D. Rutter BS1, Robert A. Bonomo MD2,3,Brigid M. Wilson PhD2,JeanMarie Mayer MD4,
Matthew H. Samore MD5 and Curtis J. Donskey MD2,3 1Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio, 2Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, 3Case Western Reserve University School of Medicine, Cleveland, Ohio, 4University of Utah School of Medicine, Salt Lake City, Utah and 5University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, Utah
Abstract
Objective: Medical procedures and patient care activities may facilitate environmental dissemination of healthcare-associated pathogens such as methicillin-resistant Staphylococcus aureus (MRSA).
Design: Observational cohort study of MRSA-colonized patients to determine the frequency of and risk factors for environmental shedding of MRSA during procedures and care activities in carriers with positive nares and/or wound cultures. Bivariate analyses were performed to identify factors associated with environmental shedding.
Setting: A Veterans Affairs hospital. Participants: This study included 75 patients in contact precautions for MRSA colonization or infection.
Results: Of 75 patients in contact precautions for MRSA, 55 (73%) hadMRSAin nares and/or wounds and 25 (33%) had positive skin cultures. For the 52 patients with MRSA in nares and/or wounds and at least 1 observed procedure, environmental shedding of MRSA occurred more frequently during procedures and care activities than in the absence of a procedure (59 of 138, 43% vs 8 of 83, 10%; P < .001). During procedures, increased shedding occurred ≤0.9 m versus >0.9 m from the patient (52 of 138, 38% vs 25 of 138, 18%; P = .0004). Contamination occurred frequently on surfaces touched by personnel (12 of 38, 32%) and on portable equipment used for procedures (25 of 101, 25%). By bivariate analysis, the presence of a wound withMRSA was associated with shedding (17 of 29, 59%versus 6 of 23, 26%; P = .04).
Conclusions: Environmental shedding of MRSA occurs frequently during medical procedures and patient care activities. There is a need for effective strategies to disinfect surfaces and equipment after procedures.
(Received 17 August 2018; accepted 9 December 2018)
Methicillin-resistant Staphylococcus aureus (MRSA) is an impor- tant healthcare-associated pathogen that can be spread from patient to patient. The hands of healthcare personnel are generally considered the most important vector for MRSA transmission. However, environmental surfaces may also contribute to transmis- sion.1–3 Patients may acquire MRSA through direct contact with contaminated surfaces, or indirect transfer may occur when per- sonnel touch contaminated surfaces prior to contacting patients.2 To prevent MRSA transmission, there is a need for a better
understanding of patient andmedical care characteristics that confer an increased risk for sheddingMRSA. In previous studies, skin and/ or environmental contamination has been associated with increased
Author for correspondence: Curtis J. Donskey, Email: Curtis.
Donskey@va.gov. Cite this article: Alhmidi H, et al. (2019). Shedding of methicillin-resistant
Staphylococcus aureus by colonized patients during procedures and patient care activities. Infection Control & Hospital Epidemiology, 40: 328–332,
https://doi.org/ 10.1017/ice.2018.342
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.
nasal density of MRSA, indwelling devices, decreased mobility, and diarrhea in the setting of a high burden of MRSA in stool.4–9 Recently, Pineles et al10 identified certain types of care activities that were associated with increased risk for contamination of cover gowns and gloves, including wound care, dressing, and providing hygiene and bathing assistance. We hypothesized that medical procedures and patient care activities would similarly facilitate environmental dissemination of MRSA. To test this hypothesis, we conducted an observational cohort study of MRSA-colonized patients to determine the frequency of and risk factors for environ- mental shedding during procedures and care activities.
Methods Setting
The Louis Stokes Cleveland VA Medical Center includes a 215-bed hospital and an adjacent 250-bed long-termcare facility (LTCF). For routine surveillance, the anterior nares of all patients are screened for MRSA upon admission, ward transfer, and discharge. Patients
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