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Assessment of the Overall and Multidrug-Resistant Organism Bioburden on Environmental Surfaces in Healthcare Facilities

Published online by Cambridge University Press:  13 September 2016

Alicia M. Shams ,
Laura J. Rose ,
Jonathan R. Edwards ,
Salvatore Cali ,
Anthony D. Harris ,
Jesse T. Jacob ,
Anna LaFae ,
Lisa L. Pineles ,
Kerri A. Thom  and
L. Clifford McDonald
...Show all authors
Alicia M. Shams*
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Laura J. Rose
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Jonathan R. Edwards
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Salvatore Cali
Affiliation:
University of Illinois at Chicago School of Public Health, Chicago, Illinois
Anthony D. Harris
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Jesse T. Jacob
Affiliation:
Emory University School of Medicine, Atlanta, Georgia
Anna LaFae
Affiliation:
Emory University School of Medicine, Atlanta, Georgia
Lisa L. Pineles
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Kerri A. Thom
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
L. Clifford McDonald
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Matthew J. Arduino
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Judith A. Noble-Wang
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Address correspondence to Alicia M. Shams, 1600 Clifton Rd NE, MS: C-16, Atlanta, GA 30329 ([email protected]).
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Abstract

OBJECTIVE

To determine the typical microbial bioburden (overall bacterial and multidrug-resistant organisms [MDROs]) on high-touch healthcare environmental surfaces after routine or terminal cleaning.

DESIGN

Prospective 2.5-year microbiological survey of large surface areas (>1,000 cm2).

SETTING

MDRO contact-precaution rooms from 9 acute-care hospitals and 2 long-term care facilities in 4 states.

PARTICIPANTS

Samples from 166 rooms (113 routine cleaned and 53 terminal cleaned rooms).

METHODS

Using a standard sponge-wipe sampling protocol, 2 composite samples were collected from each room; a third sample was collected from each Clostridium difficile room. Composite 1 included the TV remote, telephone, call button, and bed rails. Composite 2 included the room door handle, IV pole, and overbed table. Composite 3 included toileting surfaces. Total bacteria and MDROs (ie, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci [VRE], Acinetobacter baumannii, Klebsiella pneumoniae, and C. difficile) were quantified, confirmed, and tested for drug resistance.

RESULTS

The mean microbial bioburden and range from routine cleaned room composites were higher (2,700 colony-forming units [CFU]/100 cm2; ≤1–130,000 CFU/100 cm2) than from terminal cleaned room composites (353 CFU/100 cm2; ≤1–4,300 CFU/100 cm2). MDROs were recovered from 34% of routine cleaned room composites (range ≤1–13,000 CFU/100 cm2) and 17% of terminal cleaned room composites (≤1–524 CFU/100 cm2). MDROs were recovered from 40% of rooms; VRE was the most common (19%).

CONCLUSIONS

This multicenter bioburden summary provides a first step to determining microbial bioburden on healthcare surfaces, which may help provide a basis for developing standards to evaluate cleaning and disinfection as well as a framework for studies using an evidentiary hierarchy for environmental infection control.

Infect Control Hosp Epidemiol 2016;1426–1432

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 12 , December 2016 , pp. 1426 - 1432
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:1198–1208.Google Scholar
2. Boyce, JM. Environmental contamination makes an important contribution to hospital infection. J Hosp Infect 2007;65:50–54.Google Scholar
3. Clabots, CR, Johnson, S, Olson, MM, Peterson, LR, Gerding, DN. Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection. J Infect Dis 1992;166:561–567.Google Scholar
4. Simor, AE, Lee, M, Vearncombe, M, et al. An outbreak due to multiresistant Acinetobacter baumannii in a burn unit: risk factors for acquisition and management. Infect Control Hosp Epidemiol 2002;23:261–267.CrossRefGoogle Scholar
5. Aygun, G, Demirkiran, O, Utku, T, et al. Environmental contamination during a carbapenem-resistant Acinetobacter baumannii outbreak in an intensive care unit. J Hosp Infect 2002;52:259–262.CrossRefGoogle Scholar
6. Cimolai, N. MRSA and the environment: implications for comprehensive control measures. Eur J Clin Microbiol Infect Dis 2008;27:481–493.CrossRefGoogle ScholarPubMed
7. Carling, PC, Briggs, JL, Perkins, J, Highlander, D. Improved cleaning of patient rooms using a new targeting method. Clin Infect Dis 2006;42:385–388.Google Scholar
8. Hota, B. Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection? Clin Infect Dis 2004;39:1182–1189.Google Scholar
9. Dubberke, ER, Reske, KA, Noble-Wang, J, et al. Prevalence of Clostridium difficile environmental contamination and strain variability in multiple health care facilities. Am J Infect Control 2007;35:315–318.Google Scholar
10. Sexton, T, Clarke, P, O’Neill, E, Dillane, T, Humphreys, H. Environmental reservoirs of methicillin-resistant Staphylococcus aureus in isolation rooms: correlation with patient isolates and implications for hospital hygiene. J Hosp Infect 2006;62:187–194.CrossRefGoogle ScholarPubMed
11. Verity, P, Wilcox, MH, Fawley, W, Parnell, P. Prospective evaluation of environmental contamination by Clostridium difficile in isolation side rooms. J Hosp Infect 2001;49:204–209.Google Scholar
12. Dancer, S, White, L, Robertson, C. Monitoring environmental cleanliness on two surgical wards. Int J Environment Health Res 2008;18:357–364.CrossRefGoogle ScholarPubMed
13. Carling, PC, Beheren, SV, Kimc, P, Woods, C. Intensive care unit environmental cleaning: an evaluation in sixteen hospitals using a novel assessment tool. J Hosp Infect 2008;68:39–44.Google Scholar
14. Pfeiffer, EH, Wittig, JR, Dunkelberg, H, Werner, HP. Hygienic and bacteriological comparative studies in 50 hospitals V. bacterial contamination of hospital surfaces. Zbl Bakt Hyg 1978;167:11–21.Google ScholarPubMed
15. Frabetti, A, Vandini, A, Balboni, P, Triolo, F, Mazzacane, S. Experimental evaluation of the efficacy of sanitation procedures in operating rooms. Am J Infect Control 2009;37:658–664.CrossRefGoogle ScholarPubMed
16. Boyce, JM, Havill, NL, Otter, JA, Adams, NMT. Widespread environmental contamination associated with patients with diarrhea and methicillin-resistant Staphylococcus aureus colonization of the gastrointestinal tract. Infect Control Hosp Epidemiol 2007;28:1142–1147.Google Scholar
17. Oie, S, Kamiya, A. Contamination of environmental surfaces by methicillin-resistant Staphylococcus aureus (MRSA). Biomed Lett 1998;57:115–119.Google Scholar
18. Oie, S, Hosokawa, I, Kamiya, A. Contamination of room door handles by methicillin-sensitive/methicillin-resistant Staphylococcus aureus . J Hosp Infect 2002;51:140–143.CrossRefGoogle ScholarPubMed
19. Moore, GP, Muzslay, M, Wilson, AP. The type, level, and distribution of microorganisms within the ward environment: a zonal analysis of an intensive care unit and a gastrointestinal surgical ward. Infect Control Hosp Epidemiol 2013;34:500–506.Google Scholar
20. Rutala, WA, Katz, EBS, Sherertz, RJ, Sarubbi, FA. Environmental study of a methicillin-resistant Staphylococcus aureus epidemic in a burn unit. J Clin Microbiol 1983;18:683–688.Google Scholar
21. Claro, T, O’Reilly, M, Daniels, S, Humphreys, H. Surface microbial contamination in hospitals: a pilot study on methods of sampling and the use of proposed microbiologic standards. Am J Infect Control 2015;43:1000–1002.Google Scholar
22. Schmidt, MG, Anderson, T, Attaway, HH, Fairey, S, Kennedy, C, Salgado, CD. Patient environment microbial burden reduction: a pilot study comparison of 2 terminal cleaning methods. Am J Infect Control 2012;40:559–561.Google Scholar
23. Schmidt, MG, Attaway, HH, Fairey, SE, Steed, LL, Michels, HT, Salgado, CD. Copper continuously limits the concentration of bacteria resident on bed rails within the intensive care unit. Infect Control Hosp Epidemiol 2013;34:530–533.Google Scholar
24. Attaway, HH, Fairey, S, Steed, LL, Salgado, CD, Michels, HT, Schmidt, MG. Intrinsic bacterial burden associated with intensive care unit hospital beds: effects of disinfection on population recovery and mitigation of potential infection risk. Am J Infect Control 2012;40:907–912.Google Scholar
25. Carling, P, Perkins, J. Ferguson, J. Thomasser, A. Evaluating a new paradigm for comparing surface disinfection in clinical practice. Infect Control Hosp Epidemiol 2014;35:1349–1355.CrossRefGoogle ScholarPubMed
26. Boyce, JM, Havill, N, Dumigan, D, Golebiewski, M, Balogun, O, Rizvani, R. Monitoring the effectiveness of hospital cleaning practices by use of an adenosine triphosphate bioluminescence assay. Infect Control Hosp Epidemiol 2009;30:678–684.Google Scholar
27. Suzuki, A, Namba, Y, Matsuura, M, Horisawa, A. Bacterial contamination of floors and other surfaces in operating rooms: a five-year study. J Hyg Camb 1984;93:559–566.Google Scholar
28. Sehulster, S, Chinn, R. Guidelines for environmental infection control in health care facilities: recommendations of CDC and the Healthcare Infection Control Advisory Committee (HICPAC). MMWR 2003;52:1–42.Google ScholarPubMed
29. Dancer, SJ. How do we assess hospital cleaning? A proposal for microbiological standards for surface hygiene in hospitals. J Hosp Infect 2004;56:10–15.Google Scholar
30. Malik, R, Cooper, RA, Griffith, CJ. Use of audit tools to evaluate the efficacy of cleaning systems in hospitals. Am J of Infect Ctrl 2003;31:181–187.Google Scholar
31. Dancer, SJ. Pitfalls in microbiological sampling of the healthcare environment. A response to “Evaluating a New Paradigm for Comparing Surface Disinfection in Clinical Practice”. Infect Control Hosp Epidemiol 2015;36:849–850.CrossRefGoogle Scholar
32. Mulvey, D, Redding, P, Robertson, C, et al. Finding a benchmark for monitoring hospital cleanliness. J Hosp Infect 2011;77:25–30.Google Scholar
33. White, LF, Dancer, SJ, Robertson, C, McDonald, J. Are hygiene standards useful in assessing infection risk? Am J Infect Control 2008;36:381–384.Google Scholar
34. Nerandzic, MM, Donskey, CJ. Effective and reduced-cost modified selective medium for isolation of Clostridium difficile . J Clin Microbiol 2009;47:397–400.Google Scholar
35. Persson, S, Torpdahl, M, Olsen, KEP. New multiplex PCR method for the detection of Clostridium difficile toxin A (tcdA) and toxin B (tcdB) and the binary toxin (cdtA/cdtB) genes applied to a Danish strain collection. Clin Microbiol Infect 2008;14:1057–1064.CrossRefGoogle ScholarPubMed
36. CLSI. Performance standards for antimicrobial susceptibility testing; 22nd informational supplement. CLSI document M100-S22 Vol 32. Wayne, PA: Clinical and Laboratory Standards Institute; 2012.Google Scholar
37. Kallen, AJ, Hidron, AI, Patel, J, Srinivasan, A. Multidrug resistance among Gram‐negative pathogens that caused healthcare‐associated infections reported to the National Healthcare Safety Network, 2006–2008. Infect Control Hosp Epidemiol 2010;31:528–531.Google Scholar
38. Multiplex real-time PCR detection of Klebsiella pneumoniae carbapenemase (KPC) and New Delhi metallo-β-lactamase (NDM-1) genes. Centers for Disease Control and Prevention website. http://www.cdc.gov/HAI/settings/lab/kpc-ndm1-lab-protocol.html. Published 2011. Accessed January 24, 2012.Google Scholar
39. McDonald, LC, Arduino, M. Editorial Commentary: climbing the evidentiary hierarchy for environmental infection control. Clin Infect Dis 2013;56:36–39.Google Scholar
40. Rutala, WA, Weber, DJ. The benefits of surface disinfection. Am J Infect Control 2004;32:226–231.Google Scholar
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