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Are Hospital Floors an Underappreciated Reservoir for Transmission of Clostridium difficile and Methicillin-Resistant Staphylococcus aureus?

Session: Poster Abstract Session: Clostridium difficile Infection: Epidemiology, Presentation, Treatment
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Limited attention has been paid to disinfection of floors in healthcare facilities because they are not frequently touched by hands. However, it is plausible that floors could be an underappreciated reservoir for pathogen transmission because they are frequently contacted by surfaces that are subsequently touched by hands (e.g., shoes, wheelchair wheels). 

Methods: In 4 Cleveland area hospitals, we cultured 2 standardized 1 foot2 areas of the floor in Clostridium difficile infection (CDI) isolation rooms and in non-CDI rooms for C. difficile, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Occupied hospital rooms were surveyed to determine the frequency and identification of high-touch objects on floors. Cultures were collected from surfaces or objects that come in direct contact with floors (e.g., shoes, socks, wheelchair wheels) and the potential for transfer from these surfaces to hands was assessed. 

Results: Of 120 floor sites, 86 (72%) were positive for C. difficile, 26 (22%) were positive for MRSA, and 32 (33%) were positive for VRE, with similar results for each of the hospitals. C. difficile was recovered more frequently from non-CDI than from CDI rooms (64% vs 43%; P=.003). Occupied rooms had an average of 1.4 high-touch objects in contact with the floor. Of 24 sampled objects in contact with floors, 14 (24%) were contaminated with one or more of the pathogens. Of the 14 contaminated objects on floors, 8 (57%) transferred pathogens to hands.  

Conclusion: Our results demonstrate that hospital floors are frequently contaminated with pathogens and often contacted by high-touch objects. Hospital floors could be an underappreciated reservoir for transmission of healthcare-associated pathogens.

Abhishek Deshpande, MD, PhD1,2,3, Jennifer Cadnum, B.S.4,5, Dennis Fertelli5,6, Brett Sitzlar, B.S.5,6, Priyaleela Thota, MD7, Thriveen Mana, M.S., MBA5, Annette Jencson, BSMT(ASCP)SM, CIC4, Erica Pozwick5, Holly Doehring2, Jizal Seikali, BS2 and Curtis J. Donskey, MD5, (1)Infectious Diseases, Cleveland Clinic, Cleveland, OH, (2)Medicine, Case Western Reserve University, Cleveland, OH, (3)Medicine, Cleveland Clinic, Cleveland, OH, (4)Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, (5)Infectious Diseases, Case Western Reserve University, Cleveland, OH, (6)Infectious Diseases, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, (7)Infectious Disease, Case Western Reserve Medical School, cleveland, OH


A. Deshpande, None

J. Cadnum, None

D. Fertelli, None

B. Sitzlar, None

P. Thota, None

T. Mana, None

A. Jencson, None

E. Pozwick, None

H. Doehring, None

J. Seikali, None

C. J. Donskey, None

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