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Widespread Environmental Contamination Associated With Patients With Diarrhea and Methicillin-Resistant Staphylococcus aureus Colonization of the Gastrointestinal Tract

Published online by Cambridge University Press:  02 January 2015

John M. Boyce ,
Nancy L. Havill ,
Jonathan A. Otter  and
Nicholas M. T. Adams
John M. Boyce*
Affiliation:
Hospital of Saint Raphael, New Haven, Connecticut Yale University School of Medicine, New Haven, Connecticut
Nancy L. Havill
Affiliation:
Hospital of Saint Raphael, New Haven, Connecticut
Jonathan A. Otter
Affiliation:
Bioquell (UK), Andover, Hampshire, United Kingdom
Nicholas M. T. Adams
Affiliation:
Bioquell (UK), Andover, Hampshire, United Kingdom
*
Hospital of Saint Raphael, 1450 Chapel Street, New Haven, CT 06511 ([email protected])
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Abstract

Objective.

Patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) may contaminate their immediate environment with this organism. However, the extent to which gastrointestinal colonization with MRSA affects environmental contamination is not known. We investigated the frequency of environmental contamination in the rooms of patients with diarrheal stools and heavy gastro-intestinal colonization with MRSA.

Design.

Prospective observational study.

Setting.

A 500-bed teaching hospital.

Methods.

Stool specimens submitted for Clostridium difficile toxin assays were inoculated onto colistin-naladixic acid agar. MRSA was identified with standard methods. Samples from a standardized list of 10 environmental surfaces were cultured, from the rooms of 8 patients who had diarrhea that yielded heavy growth of MRSA (case patients) and from the rooms of 6 MRSA-positive patients with stool cultures negative for MRSA (control patients). MRSA isolates from 13 patients (8 case patients and 5 control patients) and 64 of the environmental isolates recovered from their rooms were compared by pulsed-field gel electrophoresis (PFGE). One clinical isolate from a control patient was excluded because there was no corresponding environmental MRSA isolate with which to compare it.

Results.

Overall, MRSA were recovered from 47 (58.8%) of 80 surfaces in the rooms of case patients, compared with 14 (23.3%) of 60 surfaces in the rooms of control patients (58.8% [95% CI, 47.8-68.9] vs 23.3% [95% CI, 14.3-35.5];P<.0001). The items most commonly contaminated were bedside rails, blood pressure cuffs, television remote controls, and toilet seats. Seventy-eight percent of the environmental isolates in patients' rooms had PFGE types that were indistinguishable or closely related to those recovered from the patients' clinical specimens.

Conclusions.

Patients who have diarrheal stools and heavy gastrointestinal colonization with MRSA are associated with significantly greater environmental MRSA contamination than patients without MRSA in their stool, and they are likely to be the source of that contamination.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 10 , October 2007 , pp. 1142 - 1147
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007 

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