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Shedding of methicillin-resistant Staphylococcus aureus by colonized patients during procedures and patient care activities

Published online by Cambridge University Press:  19 February 2019

Heba Alhmidi ,
Jennifer L. Cadnum ,
Sreelatha Koganti ,
Annette L. Jencson ,
Joseph D. Rutter ,
Robert A. Bonomo ,
Brigid M. Wilson ,
JeanMarie Mayer ,
Matthew H. Samore  and
Curtis J. Donskey
Heba Alhmidi
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Jennifer L. Cadnum
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Sreelatha Koganti
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Annette L. Jencson
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Joseph D. Rutter
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Robert A. Bonomo
Affiliation:
Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio Case Western Reserve University School of Medicine, Cleveland, Ohio
Brigid M. Wilson
Affiliation:
Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
JeanMarie Mayer
Affiliation:
University of Utah School of Medicine, Salt Lake City, Utah
Matthew H. Samore
Affiliation:
University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, Utah
Curtis J. Donskey*
Affiliation:
Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio Case Western Reserve University School of Medicine, Cleveland, Ohio
*
Author for correspondence: Curtis J. Donskey, Email: Curtis. Donskey@va.gov.
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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%) had MRSA in 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 with MRSA 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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 3 , March 2019 , pp. 328 - 332
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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