Background: Simulations can be valuable to understand dissemination of pathogens. Bacteriophage MS2 is a non-pathogenic virus commonly used to model spread of viruses in healthcare and non-healthcare settings. However, it is not known how well dissemination of MS2 correlates with dissemination of bacterial pathogens such as Clostridium difficile.
Methods: During simulated patient care interactions, we evaluated environmental dissemination of bacteriophage MS2 and nontoxigenic Clostridium difficile spores inoculated onto a contaminated mannequin. After healthcare personnel performed a physical examination, surfaces (i.e. bedside table, side rail, stethoscope, IV pole, call button, curtains, trash can and floor) were sampled. We compared the C. difficile colony-forming units (CFU) and MS2 plaque-forming units (PFU) recovered from surfaces and frequency of contamination.
Results: Sixty patient care simulations were performed by healthcare personnel. The concentration of MS2 and C. difficile on the mannequin decreased after 10 simulations, but the reduction was not statistically significant (MS2 4.3 vs 2.7 logs, C difficile 2.3 vs 1.8 logs; P>0.05 for both). Both pathogens disseminated to touched surfaces throughout the room (Figure 1). The average concentration of MS2 and C. difficile recovered from contaminated surfaces was similar (1.8 vs 1.1, P=0.01) and there was no difference in frequency of C. difficile and MS2 contamination (43% vs 33%, P=0.35).
Conclusion: During simulations of patient care, dissemination of bacteriophage MS2 correlated well with dissemination of nontoxigenic C. difficile spores. Bacteriophage MS2 may be useful as a benign surrogate marker that can be applied in clinical care settings to investigate routes of dissemination of C. difficile and other pathogens.
Figure 1. Concentrations of Bacteriophage MS2 and C. difficile on Surfaces
Heba Alhmidi, MD1, Sreelatha Koganti, MD1, Myreen Tomas, MD2, Jennifer L. Cadnum, BS2, Annette Jencson, BSMT(ASCP)SM, CIC1, Thriveen Mana, M.S., MBA3 and Curtis J. Donskey, MD2,4, (1)Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, (2)Geriatric Research Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, (3)Case Western Reserve University, Cleveland, Ohio, Cleveland, OH, (4)Department of Medicine, Division of Infectious Diseases, Case Western Reserve University, Cleveland, OH
None M. Tomas,
None J. L. Cadnum,
None A. Jencson,
None T. Mana,
None C. J. Donskey,