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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 (AShams@cdc.gov).
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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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