To the Editor—The study by Shams et alReference Shams, Rose and Edwards 1 adds to the existing body of literature demonstrating the frequent environmental presence of multidrug-resistant organisms (MDROs), including Clostridium difficile, in the rooms of patients in healthcare facilities. I commend the authors for their work and wish to make a few comments.
First, it might have been helpful to analyze the data from long-term care facilities and acute-care hospitals separately, given the potential differences in infection control protocols, MDRO prevalence, patient mix, and the variable impact of infection control interventions, including environmental cleaning, on healthcare-associated infections between these 2 types of facilities.Reference Nicolle 2 , Reference Makris, Louise, Gaber, Richter and Rubino 3 Second, it would have been useful to report the breakdown of hospital rooms by specialized units (eg, burn or intensive care units) versus general wards to help the reader determine the generalizability of the results to their specific hospital units. Third, given the varied methods of terminal cleaning of patient rooms (including the adoption of “no-touch” technologies) in response to the ongoing transmission of MDROs in healthcare facilities,Reference Rutala and Weber 4 , Reference Manian, Griesnauer and Bryant 5 further clarification of the methodology and type of cleaning products used (reported to have been recorded as stated in the Methods section) by participating facilities would have been welcome. Lastly, with 30% of rooms remaining culture positive for MDROs after terminal cleaning—with their attendant risk of transmission to the new occupantsReference Otter, Yezli, Salkeld and French 6 —the results of the study by Shams et al support those of prior works demonstrating similarly high rates of MDRO-positive rooms despite seemingly adequate terminal cleaning.Reference Manian, Griesnauer and Senkel 7 – Reference Eckstein, Adams and Eckstein 9 Although, as stated by the authors, the relationship between the levels of microbial contamination in the environment and patient acquisition of MDROs remains unclear, one could argue that under the right circumstances in a susceptible host (eg, immunosuppressed or with open wounds), no level of environmental contamination with MDROs in terminally cleaned rooms may be considered safe, and that more effort should be directed now toward devising safe and cost-effective means of eliminating them from the surfaces of all newly vacated patient rooms.
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