274. Assessment of Multidrug-Resistant Organism and Viral Pathogen Transmission from the Rooms of Hospitalized Patients to Healthcare Workers and the Hospital Environment Utilizing Surrogate Markers
Session: Poster Abstract Session: HAI: Environment and Device Cleaning
Thursday, October 27, 2016
Room: Poster Hall

Background: The purpose of this pilot study was to assess multidrug-resistant organism (MDRO) and virus transmission in the hospital environment using surrogate markers.

Methods: Patients (pts) in standard or contact precautions (CP) were recruited from the ED, medicine floors, and ICUs. The pt gown, bedrails x2, IV pump, and bedside table or mouse were contaminated with bacteriophage MS2 (Zeptometrix; 1.0x 10^8 PFU per site) and fluorescent powder (GloGerm; 0.02g per site). After pt contact, 3-4 HCWs per pt were enrolled and assessed for fluorescence and MS2; hands, wrists/sleeves, face, 3 touch surfaces, and areas that fluoresced were sampled. PCR was used for MS2 detection and culture for MRSA/VRE. Chi-square analyses were performed.

Results: 24 pts were enrolled: 17 (71%) were on CP (12 VRE, 4 MRSA, 1 MRSA and VRE). 75 HCWs were enrolled: 49% nurses, 21% physicians, and 29% other. Fluorescence was detected on HCWs’ body, clothing, or touched surface for 23 (31%) HCWs and MS2 from 15 (20%) (Table 1, Figure 1). HCWs caring for pts on CP were less likely to have fluorescence detected or MS2 recovered from their bodies/clothing (Table 2). Fluorescence was most common on hands (11) and scrubs (13). VRE and MRSA were not detected on HCWs. Within pt rooms, VRE was recovered from 12 sites and MRSA from 4, most often from bedrails (8) and pt gowns (4). Outside of pt rooms, no MRSA was recovered; VRE was recovered from a glucose monitor.

Conclusion: HCWs caring for pts on CP were less likely to have contamination with MS2 and fluorescent powder, but contamination was still identified 17% (by MS2 detection) of the time.

 

Table 1. Fluorescence and MS2 by HCW Type

Variable

Nurse* (n=37)

n (%)

 Physician (n=16)

n (%)

Other (n=22)

n (%)

p

Fluorescence

 

 

 

 

   Body/clothing

10 (27)

3 (19)

9 (41)

0.30

   Touched surface

8 (22)

0 (0)

7 (32)

0.05

   Any

10 (27)

3 (19)

10 (46)

0.17

MS2

 

 

 

 

   Body/clothing

1 (3)

5 (31)

3 (14)

0.01

   Touched surface

3 (8)

2 (13)

2 (9)

0.88

   Any  

4 (11)

6 (38)

5 (23)

0.07

* Includes nurse practitioner (n=1) and physician assistant (n=1)

 

 

Table 2. Fluorescence and MS2 by Contact Precautions Status

Variable

CP (n=54 HCWs)

n (%)

No CP (n=21 HCWs)

n (%)

p

Fluorescence

 

 

 

   Body/clothing

9 (17)

13 (62)

<0.01

   Touched surface

5 (9)

10 (48)

<0.01

   Any

9 (17)

14 (67)

<0.01

MS2

 

 

 

   Body/clothing

4 (7)

6 (29)

0.03

   Touched surface

4 (7)

2 (10)

1.00

   Any  

8 (15)

7 (33)

0.07

 

 

 

 

Jennie H. Kwon, DO, MSCI1, Carey-Ann D. Burnham, PhD2, Meghan Wallace, BS3, Stephen Liang, MD, MPHS4, Tiffany Hink, BS5, Angela Shupe, BS6, Kimberly Reske, MPH1, Candice Cass, .6, Sondra Seiler, BA1, Victoria J. Fraser, MD, FIDSA, FSHEA7 and Erik R. Dubberke, MD, MSPH, FIDSA, FSHEA7, (1)Infectious Diseases, Washington University School of Medicine, St. Louis, MO, (2)Pathology & Immunology, Washington University, St. Louis, MO, (3)Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, (4)Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, (5)Infectious Diseases, Washington University School of Medicine, St Louis, MO, (6)Washington University School of Medicine, SAINT LOUIS, MO, (7)Washington University School of Medicine, St. Louis, MO

Disclosures:

J. H. Kwon, None

C. A. D. Burnham, None

M. Wallace, None

S. Liang, None

T. Hink, None

A. Shupe, None

K. Reske, None

C. Cass, None

S. Seiler, None

V. J. Fraser, NIH: Grant Investigator , Research grant
CDC: Grant Investigator , Research grant
The Foundation for Barnes-Jewish Hospital: Grant Investigator , Research grant
Doris Duke Charitable Foundation: Grant Investigator , Research grant
Express Scripts: Spouse is Senior Vice President and Chief Medical Officer at Express Scripts , Spouse employment

E. R. Dubberke, Rebiotix Inc.: Investigator and Scientific Advisor , Consulting fee and Research support
Merck: Consultant and Investigator , Consulting fee and Research support
Sanofi Pasteur: Consultant and Grant Investigator , Consulting fee and Grant recipient
Summitt: Consultant , Consulting fee

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