Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-29T04:32:38.409Z Has data issue: false hasContentIssue false
  • English
  • Français

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])
Get access Rights & Permissions [Opens in a new window]

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 

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. Jarvis, WR. The epidemiology of colonization. Infect Control Hosp Epidemiol 1995;17:47–52.Google Scholar
2. McFarland, LV, Mulligan, ME, Kwok, RYY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204–210.Google Scholar
3. McNeil, SA, Malani, PN, Chenoweth, CE, et al. Vancomycin-resistant enterococcal colonization and infection in liver transplant candidates and recipients: a prospective surveillance study. Clin Infect Dis 2006;42:195–203.Google Scholar
4. Muder, RR, Brennen, C, Wagener, MM, et al. Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991;114:107–112.Google Scholar
5. Squier, C, Rihs, JD, Risa, KJ, et al. Staphylococcus aureus rectal carriage and its association with infections in patients in a surgical intensive care unit and a liver transplant unit. Infect Control Hosp Epidemiol 2002;23:495–501.Google Scholar
6. Ray, AJ, Pultz, NJ, Bhalla, A, Aron, DC, Donskey, CJ. Coexistence of vancomycin-resistant enterococci and Staphylococcus aureus in the intestinal tracts of hospitalized patients. Clin Infect Dis 2003;37:875–881.Google Scholar
7. Livornese, LL Jr, Dias, S, Samel, C, et al. Hospital-acquired infection with vancomycin-resistant Enterococcus faecium transmitted by electronic thermometers. Ann Intern Med 1992;117:112–116.Google Scholar
8. Brooks, SE, Veal, RO, Kramer, M, Dore, L, Schupf, N, Adachi, M. Reduction in the incidence of Clostridium difficile-associated diarrhea in an acute care hospital and a skilled nursing facility following replacement of electronic thermometers with single-use disposables. Infect Control Hosp Epidemiol 1992;13:98–103.Google Scholar
9. Martinez, JA, Ruthazer, R, Hansjosten, K, Barefoot, L, Snydman, DR. Role of environmental contamination as a risk factor for acquisition of vancomycin-resistant enterococci in patients treated in a medical intensive care unit. Arch Intern Med 2003;163:1905–1912.Google Scholar
10. Bhalla, A, Pultz, NJ, Gries, DM, et al. Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients. Infect Control Hosp Epidemiol 2004;25:164–167.Google Scholar
11. Duckro, AN, Blom, DW, Lyle, EA, Weinstein, RA, Hayden, MK. Transfer of vancomycin-resistant enterococci via health care worker hands. Arch Intern Med 2005;165:302–307.Google Scholar
12. Samore, MH, Venkataraman, L, DeGirolami, PC, Levin, E, Karchmer, AW. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med 1996;100:32–40.Google Scholar
13. Bonten, MJM, Hayden, MK, Nathan, C, et al. Epidemiology of colonisation of patients and environment with vancomycin-resistant enterococci. Lancet 1996;348:1615–1619.Google Scholar
14. Boyce, JM, Opal, SM, Chow, JW, et al. Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol 1994;32:1148–1153.Google Scholar
15. Beezhold, DW, Slaughter, S, Hayden, MK, et al. Skin colonization with vancomycin-resistant enterococci among hospitalized patients with bacteremia. Clin Infect Dis 1997;24:704–706.Google Scholar
16. Trick, WE, Temple, RS, Chen, D, Wright, MO, Solomon, SL, Peterson, LR. Patient colonization and environmental contamination by vancomycin-resistant enterococci in a rehabilitation facility. Arch Phys Med Rehabil 2002;83:899–902.Google Scholar
17. Mayer, RA, Geha, RC, Helfand, MS, Hoyen, CK, Salata, RA, Donskey, CJ. Role of fecal incontinence in contamination of the environment with vancomycin-resistant enterococci. Am J Infect Control 2003;31:221–225.Google Scholar
18. Crossley, K, Landesman, B, Zaske, D. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. II. Epidemiologic studies. J Infect Dis 1979;139:280–287.Google Scholar
19. Rimland, D, Roberson, B. Gastrointestinal carriage of methicillin-resistant Staphylococcus aureus . J Clin Microbiol 1986;24:137–138.Google Scholar
20. Gravet, A, Rondeau, M, Harf-Monteil, C, et al. Predominant Staphylococcus aureus isolated from antibiotic-associated diarrhea is clinically relevant and produces enterotoxin A and the bicomponent toxin LukE-LukD. J Clin Microbiol 1999;37:4012–4019.Google Scholar
21. Boyce, JM, Havill, NL, Maria, B. Frequency and possible infection control implications of gastrointestinal colonization with methicillin-resistant Staphylococcus aureus . J Clin Microbiol 2005;43:5992–5995.Google Scholar
22. McDougal, LK, Steward, CD, Killgore, GE, Chaitram, JM, McAllister, SK, Tenover, FC. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003;41:5113–5120.Google Scholar
23. 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
24. Boyce, JM, Potter-Bynoe, G, Chenevert, C, King, T. Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications. Infect Control Hosp Epidemiol 1997;18:622–627.Google Scholar
25. Duckworth, GJ, Jordens, JZ. Adherence and survival properties of an epidemic methicillin-resistant strain of Staphylococcus aureus compared with those of methicillin-sensitive strains. Med Microbiol 1990;32:195–200.Google Scholar
26. Wagenvoort, JHT, Sluijsmans, W, Penders, RJR. Better environmental survival of outbreak vs sporadic MRSA isolates. Hosp Infect 2000;45:231–234.Google Scholar
27. Bures, S, Fishbain, JT, Uyehara, CFT, Parker, JM, Berg, BW. Computer keyboards and faucet handles as reservoirs of nosocomial pathogens in the intensive care unit. Am J Infect Control 2000;28:465–470.Google Scholar
28. Rampling, A, Wiseman, S, Davis, L, et al. Evidence that hospital hygiene is important in the control of methicillin-resistant Staphylococcus aureus . J Hosp Infect 2001;49:109–116.Google Scholar
29. Hardy, KJ, Oppenheim, BA, Gossain, S, Gao, F, Hawkey, PM. A study of the relationship between environmental contamination with methicillin-resistant Staphylococcus aureus (MRSA) and patients' acquisition of MRSA. Infect Control Hosp Epidemiol 2006;27:127–132.Google Scholar
30. Espersen, F, Nielsen, PB, Lund, K, Sylvest, B, Jensen, K. Hospital-acquired infections in a burns unit caused by an imported strain of Staphylococcus aureus with unusual multi-resistance. J Hyg (Lond) 1982;88:535–541.Google Scholar
31. Rutala, WA, Katz, EBS, Sherertz, RJ, Sarubbi, FA Jr. Environmental study of a methicillin-resistant Staphylococcus aureus epidemic in a burn unit. J Clin Microbiol 1983;18:683–688.Google Scholar
32. Snyder, LL, Wiebelhaus, P, Boon, SE, Morin, RA, Goering, R. Methicillin-resistant Staphylococcus aureus eradication in a burn center. J Burn Care Rehabil 1993;14:164–168.Google Scholar
33. Thompson, RL, Cabezudo, I, Wenzel, RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus . Ann Intern Med 1982;97:309–317.Google Scholar
34. French, GL, Otter, FA, Shannon, KP, Adams, NMT, Watling, D, Parks, MJ. Tackling contamination of the hospital environment by methicillin-resistant Staphylococcus aureus (MRSA): a comparison between conventional terminal cleaning and hydrogen peroxide vapour decontamination. J Hosp Infect 2004;57:31–37.Google Scholar
35. Asoh, N, Masaki, H, Watanabe, H, et al. Molecular characterization of the transmission between the colonization of methicillin-resistant Staphylococcus aureus to human and environmental contamination in geriatric long-term care wards. Internal Medicine 2005;44:41–45.Google Scholar
36. Sexton, T, Clarke, P, O'Neill, E, Dilland, 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.Google Scholar
37. Dupeyron, C, Campillo, B, Bordes, M, Faubert, E, Richardet, J-P, Mangeney, N. A clinical trial of mupirocin in the eradication of methicillin-resistant Staphylococcus aureus nasal carriage in a digestive disease unit. J Hosp Infect 2002;52:281–287.Google Scholar