731. A Prospective Study of Transmission of Multi-drug Resistant Organisms (MDRO) between Environmental Sites and Hospitalized Patients – the TransFER study
Session: Oral Abstract Session: Preventing Hospital Transmission: Environment and Hands
Friday, October 9, 2015: 10:30 AM
Room: 7--AB

Background: Contaminated hospital surfaces are vectors of bacterial transmission. However, the nature and efficiency of bacterial transmission between patients and surfaces in hospital rooms remain unknown. We describe the nature, dynamic and quantity of MDRO transmission between surfaces and patients admitted into newly-cleaned hospital rooms.  

Methods: We performed a prospective cohort study enrolling patients admitted to newly-cleaned hospital rooms at a tertiary care medical center and a community hospital. Samples from patients and room surfaces were collected and analyzed to describe the level of colonization of 4 MDROs (methicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococci (VRE), MDR Acinetobacter and C. difficile (Cdiff)) at scheduled intervals during hospitalization in the same room (day of enrollment, day 3, day 7, weekly thereafter, and on discharge). Rodac plates were used to sample 8 high-frequency touch surfaces using previously-published methods. Patient specimens were collected from anterior nares, pharynx, axillae, rectum, and if available, from wounds, indwelling devices and feces.   

Results: We enrolled 80 patient-room pairs - 14 (17.5%) admissions were associated with apparent transfer of MDRO between patients and room surfaces (Table). MRSA occurred in 5 (35%) admissions, VRE in 5 (35%) and C. difficile in 4 (30%).  MDROs transferred from room surfaces to patients in six (43%) events, from patient to room in 3 (21%) events and MDROs were detected on room surfaces and patients on the same study visit in 5 (36%) events. Only 11 out of 14 MDRO paired isolates from apparent transfer events were amplifiable for molecular relatedness testing - six (54%) of MDRO isolates transferred between patients and environmental surfaces were indistinguishable. Thus, molecularly indistinguishable isolates of MDROs passed from room surfaces to patients in 2.5-5% of hospital admissions.

Conclusion: Our multicenter study showed that patients and newly-cleaned rooms were frequently colonized with MDROs. Documented clonal transmission of MDRO from room surfaces to patients occurred in approximately 2.5-5% of hospitalizations.  Future research should study interventions to interrupt the patient-environment bi-directional transmission cycle.

 

Luke F. Chen, MBBS, MPH, CIC, FRACP1,2,3, Lauren Knelson, MSPH3, Maria Gergen, MT, ASCP4, Olga Better, RA5, Bradley Nicholson, PhD6, Sarah S. Lewis, MD MPH1, Christopher W Woods, MD, MPH, FIDSA7, William Rutala, PhD, MPH, FSHEA3, David J. Weber, MD, MPH, FIDSA, FSHEA8, Rebekah W. Moehring, MD, MPH1, Daniel J. Sexton, MD, FIDSA, FSHEA1 and Deverick Anderson, MD, MPH, FIDSA, FSHEA1, (1)Division of Infectious Diseases, Duke University Medical Center, Durham, NC, (2)Duke Infection Control Outreach Network, Duke University Medical Center, Durham, NC, (3)Duke University CDC Prevention Epicenter Program, Durham, NC, (4)Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC, (5)Durham VA Medical Center, Durham, NC, (6)Durham Veterans Affairs Medical Center, Durham, NC, (7)Duke University Medical Center, Durham, NC, (8)University of North Carolina, School of Public Health, Chapel Hill, NC

Disclosures:

L. F. Chen, None

L. Knelson, None

M. Gergen, None

O. Better, None

B. Nicholson, None

S. S. Lewis, None

C. W. Woods, Becton Dickinson: Grant Investigator and Scientific Advisor , Consulting fee and Research support
Becton Dickinson: Grant Investigator and Scientific Advisor , Consulting fee and Research support
bioMerieux: Investigator and Scientific Advisor , Consulting fee , Research grant and Speaker honorarium
Nanosphere: Scientific Advisor , Consulting fee
bioMerieux: Investigator and Scientific Advisor , Consulting fee , Research grant and Speaker honorarium
Cempra: Investigator , Research support
Nanosphere: Scientific Advisor , Consulting fee
Cubist: Investigator , Research support
Bill and Melinda Gates Foundation: Grant Investigator , Research grant
Cempra: Investigator , Research support
DARPA: Grant Investigator , Research grant
Cubist: Investigator , Research support
Defense Threat Reduction Agency: Research Contractor , Research support
Bill and Melinda Gates Foundation: Grant Investigator , Research grant
NIAID: Research Contractor , Research support
DARPA: Grant Investigator , Research grant
Defense Threat Reduction Agency: Research Contractor , Research support
NIAID: Research Contractor , Research support

W. Rutala, None

D. J. Weber, None

R. W. Moehring, None

D. J. Sexton, None

D. Anderson, None

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