Understanding short-term transmission dynamics of methicillin-resistant Staphylococcus aureus in the patient room.

Wolfensberger, Aline; Mang, Nora; Gibson, Kristen E; Gontjes, Kyle; Cassone, Marco; Brugger, Silvio D; Mody, Lona; Sax, Hugo (2022). Understanding short-term transmission dynamics of methicillin-resistant Staphylococcus aureus in the patient room. Infection control and hospital epidemiology, 43(9), pp. 1147-1154. Cambridge University Press 10.1017/ice.2021.350

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OBJECTIVE

Little is known about the short-term dynamics of methicillin-resistant Staphylococcus aureus (MRSA) transmission between patients and their immediate environment. We conducted a real-life microbiological evaluation of environmental MRSA contamination in hospital rooms in relation to recent patient activity.

DESIGN

Observational pilot study.

SETTING

Two hospitals, hospital 1 in Zurich, Switzerland, and hospital 2 in Ann Arbor, Michigan, United States.

PATIENTS

Inpatients with MRSA colonization or infection.

METHODS

At baseline, the groin, axilla, nares, dominant hands of 10 patients and 6 environmental high-touch surfaces in their rooms were sampled. Cultures were then taken of the patient hand and high-touch surfaces 3 more times at 90-minute intervals. After each swabbing, patients' hands and surfaces were disinfected. Patient activity was assessed by interviews at hospital 1 and analysis of video footage at hospital 2. A contamination pressure score was created by multiplying the number of colonized body sites with the activity level of the patient.

RESULTS

In total, 10 patients colonized and/or infected with MRSA were enrolled; 40 hand samples and 240 environmental samples were collected. At baseline, 30% of hands and 20% of high-touch surfaces yielded MRSA. At follow-up intervals, 8 (27%) of 30 patient hands, and 10 (6%) of 180 of environmental sites were positive. Activity of the patient explained 7 of 10 environmental contaminations. Patients with higher contamination pressure score showed a trend toward higher environmental contamination.

CONCLUSION

Environmental MRSA contamination in patient rooms was highly dynamic and was likely driven by the patient's MRSA body colonization pattern and the patient activity.

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