Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-13T00:39:01.137Z Has data issue: false hasContentIssue false
  • English
  • Français

Occurrence of Skin and Environmental Contamination with Methicillin-Resistant Staphylococcus aureus before Results of Polymerase Chain Reaction at Hospital Admission Become Available

Published online by Cambridge University Press:  02 January 2015

Shelley Chang ,
Ajay K. Sethi ,
Usha Stiefel ,
Jennifer L. Cadnum  and
Curtis J. Donskey
Shelley Chang
Affiliation:
Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
Ajay K. Sethi
Affiliation:
Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
Usha Stiefel
Affiliation:
Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
Jennifer L. Cadnum
Affiliation:
Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
Curtis J. Donskey*
Affiliation:
Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio Geriatric Research Education and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
*
Geriatric Research Education and Clinical Center, Cleveland Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106 (curtisd123@yahoo.com)
Get access Rights & Permissions [Opens in a new window]

Extract

Background.

Active surveillance to detect patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) is increasingly practiced in healthcare settings. However, inpatients may already become sources of transmission before appropriate precautions are implemented.

Objective.

To examine the frequency of MRSA contamination of commonly touched skin and environmental surfaces before patient carriage status became known.

Methods.

We conducted a 6-week prospective study of patients who were identified by use of polymerase chain reaction (PCR) at hospital admission as having nasal MRSA colonization. Skin and environmental contamination was assessed within hours of completion of PCR screening.

Results.

There were 116 patients identified by PCR screening as having nasal MRSA colonization during the period from mid-April to May 2008, of whom 83 (72%) were enrolled in our study. Overall, MRSA was detected on the skin of 38 (51%) of 74 patients and in the environment of 37 (45%) of 83 patients Of 83 environmental culture samples, 63 (76%) were obtained within 7 hours after PSR results became available, and 73 (88%) were obtained before wards were notified of PCR Results. Of the 83 MRSA-colonized patients, 15 (18%) had contaminated their environment 25 hours after admission, and 29 (35%) had contaminated their environment 33 hours after admission. Thirty-two (39%) of the 83 patients had roommates, 13 (41%) of whom contaminated their environment. The median interval from admission to PCR result was 20 hours, and the median interval from PCR result to notification was 23 hours. An increased quantity of MRSA cultured from a nasal sample was significantly associated with contamination.

Conclusions.

Before any contact precautions can be implemented, newly identified MRSA carriers frequently have contaminated their environment with MRSA and have contamination of commonly examined skin sites. In hospitals that perform active surveillance, strategies are needed to minimize delays in screening or to preemptively identify patients at high risk for disseminating MRSA.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 6 , June 2010 , pp. 607 - 612
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Huang, SS, Platt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003;36: 281–285.CrossRefGoogle ScholarPubMed
2.Datta, R, Huang, SS. Risk of infection and death due to methicillin-resistant Staphylococcus aureus in long-term carriers. Clin Infect Dis 2008;47:176–181.Google Scholar
3.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al.SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol 2003;24: 362–386.CrossRefGoogle ScholarPubMed
4.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007;35(10suppl 2):S165–S193.CrossRefGoogle ScholarPubMed
5.Harbarth, S, Masuet-Aumateil, C, Schrenzel, J, et al.Evaluation of rapid Screening and pre-emptive contact isolation for detecting and controlling methicillin-resistant Staphylococcus aureus in critical care: an interventional cohort study. Crit Care 2006;10:R25.CrossRefGoogle ScholarPubMed
6. United States Department of Veterans Affairs. VA Pittsburgh Healthcare System. MRSA Prevention Initiative. VHA MRSA Initiative Directive 2007-002. http://www.pittsburgh.va.gov/MRSA/MRSA_Prevention_Initiative.asp. Accessed April 8, 2010.Google Scholar
7.National Committee for Clinical Laboratory Standards (NCCLS). Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically: approved standard, M7. Wayne, PA: NCCLS, 1993.Google Scholar
8.Bhalla, A, Aron, DC, Donskey, CJ. Staphylococcus aureus intestinal colonization is associated with increased frequency of S. aureus on skin of hospitalized patients. BMC Infect Dis 2007;7:105.Google Scholar
9.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
10.Harbarth, S, Fankhauser, C, Schrenzel, J, et al.Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 2008;299:1149–1157.CrossRefGoogle ScholarPubMed
11.Jeyaratnam, D, Whitty, CJ, Phillips, K, et al.Impact of rapid screening tests on acquisition of meticillin resistant Staphylococcus aureus: cluster randomised crossover trial. BMJ 2008;336:927–930.Google Scholar
12.Pittet, D, Safran, E, Harbarth, S, et al.Automatic alerts for methicillin-resistant Staphylococcus aureus surveillance and control: role of a hospital information system. Infect Control Hosp Epidemiol 1996;17:496–502.Google Scholar
13.Moore, C, Dhaliwal, J, Tong, A, et al.Risk factors for methicillin-resistant Staphylococcus aureus (MRSA) acquisition in roommate contacts of patients colonized or infected with MRSA in an acute-care hospital. Infect Control Hosp Epidemiol 2008;29:600–606.CrossRefGoogle ScholarPubMed
14.Huang, SS, Datta, R, Platt, R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006;166:1945–1951.CrossRefGoogle ScholarPubMed
15.Lucet, JC, Paoletti, X, Lolom, I, et al.Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med 2005;31:1051–1057.CrossRefGoogle ScholarPubMed
16.Safdar, N, Marx, J, Meyer, NA, Maki, DG. Effectiveness of preemptive barrier precautions in controlling nosocomial colonization and infection by methicillin-resistant Staphylococcus aureus in a burn unit. Am J Infect Control 2006;34:476–483.CrossRefGoogle Scholar
17.Struelens, MJ, Denis, O. Rapid molecular detection of methicillin-resistant Staphylococcus aureus: a cost-effective tool for infection control in critical care? Crit Care 2006;10:128.CrossRefGoogle ScholarPubMed
18.Evans, RS, Wallace, CJ, Lloyd, JF, et al.Rapid identification of hospitalized patients at high risk for methicillin-resistant Staphylococcus aureus carriage. J Am Med Inform Assoc 2008;15:506–512.CrossRefGoogle Scholar
19.Harbarth, S, Sax, H, Fankhauser-Rodriguez, C, Schrenzel, J, Agostinho, A, Pittet, D. Evaluating the probability of previously unknown carriage of MRSA at hospital admission. Am J Med 2006;119(3):275.e15-275.e23.Google Scholar