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did not occur significantly more often for wound care procedures than for other procedures and patient care activities. Our study has some limitations. The study was conducted in a
setting with a predominantly male patient population, and most of the procedures and activities took place on medical-surgical wards. The number of procedures varied among participants and a multivariate analysis was not performed to assess risk factors for shedding given the small number of patients studied. Thus, addi- tional studies are needed to confirm the finding that wounds with MRSA may be associated with increased risk for shedding during procedures.Our observations suggest that shedding ofMRSAto sur- faces often occurred through direct transfer via the hands of person- nel or contaminated equipment used in procedures. However, we cannot exclude the possibility that airborne dispersal ofMRSA con- tributed to shedding during procedures. Others have demonstrated that airborne dispersal may occur during activities such as bedding changes.26 In a minority of cases isolates recovered from surfaces or equipment after procedures did notmatch the concurrent nasal iso- late. Thus, it is possible that some of the MRSA shed during proce- dures was derived from healthcare personnel or from other sources. In conclusion, our results suggest that environmental shedding
of MRSA occurs frequently during medical procedures and patient care activities. Such shedding could contribute to transmission of MRSA in healthcare facilities. Studies are needed to determine whether measures such as cleaning of surfaces and equipment after procedures can reduce the risk for transmission.
Acknowledgments. We would like to thank the nursing staff of the Cleveland VA Medical Center for assistance with coordination of research assessments during procedures and patient care activities.
Financial support. This work was supported by the Centers for Disease Control and Prevention (contract 2002011-42039 to M.S.) and by the Department of Veterans Affairs.
Conflicts of interest. C.J.D. has received research funding from Clorox, GOJO, PDI, Pfizer, Avery Dennison, and Boehringer Laboratories. All other authors report no potential conflicts.
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