Methods: The bedrail, overbed table, remote control, and toilet seat in occupied patient rooms were sampled and assessed with: adenosine triphosphate (ATP) luminescence technology (LT), Replicate Organism Detection And Counting (RODAC) plates, C diff Banana Broth™ (CDBB), conventional aerobic culture (CC) and antimicrobial susceptibility testing, and shotgun next-generation sequencing (NGS) and analysis using metagenomic software.
Results: 140 surfaces from 35 rooms were sampled. Of 70 surfaces sampled by both ATP LT and RODAC, 42 (60%) had concordant “pass” or “fail” results. Of 28 discordant samples, 26 (93%) passed by RODAC but failed by ATP LT. CDBB testing identified Clostridioides difficile on 2 surfaces in 1 room; C. difficile was also identified by NGS in this room. NGS had 100% concordance with organisms identified by CC, and identified approximately 20 additional organisms not identified by CC per surface. 38% of organisms identified by NGS were potential pathogens, compared to 13% through CC. No correlations were found between the primary quantitative assessments (RODAC bacterial concentrations and ATP LT ATP concentrations) and quantitative components of CC (presence/absence of organisms) and NGS (read numbers).
Conclusion: ATP LT and RODAC plates both provide useful quantitative cleanliness data, though high ATP values did not always indicate the presence of viable aerobic bacteria. CDBB may be a useful method for identifying C. difficile in the environment, but larger studies of the performance characteristics of CDBB are needed. CC and NGS provided useful organism identification information, but NGS had higher sensitivity for detecting potentially pathogenic organisms. The clinical implications of NGS results must be further studied and cost and technical expertise are important considerations.
K. Callan, None
N. B. O'Hara, Biotia: Board Member , Employee and Shareholder , Salary .
R. Ounit, BIOTIA: Board Member , Employee and Shareholder , Educational support and Salary .
L. F. Westblade, Accelerate Diagnostics: Grant Investigator , Grant recipient . Biomerieux: Grant Investigator , Grant recipient . Allergan: Grant Investigator , Grant recipient . Merck: Grant Investigator , Grant recipient .
C. E. Mason, None
M. S. Simon, None
L. Saiman, None
E. Y. Furuya, None
D. P. Calfee, None
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