Recovery of Vancomycin-Resistant Enterococci on Fingertips and Environmental Surfaces

1995 ◽  
Vol 16 (10) ◽  
pp. 577-581 ◽  
Author(s):  
Gary A. Noskin ◽  
Valentina Stosor ◽  
Isabell Cooper ◽  
Lance R. Peterson
Keyword(s):  
Vancomycin Resistant Enterococci ◽  
Environmental Surfaces ◽  
Vancomycin Resistant

scholarly journals Nursing-Home Patient Functional and Microbiota Status Drive Environmental Contamination with Vancomycin-Resistant Enterococci

2021 ◽  
Vol 1 (S1) ◽  
pp. s68-s68
Author(s):  
Joyce Wang ◽  
Betsy Foxman ◽  
A. Krishna Rao ◽  
Lona Mody ◽  
Evan Snitkin
Keyword(s):  
Nursing Homes ◽  
Gut Microbiota ◽  
Functional Status ◽  
Environmental Contamination ◽  
Functional Dependence ◽  
Patient Factors ◽  
High Functioning ◽  
Vancomycin Resistant Enterococci ◽  
Environmental Surfaces ◽  
Vancomycin Resistant

Background: Patient colonization and shedding of vancomycin-resistant enterococci (VRE) is a major source of environmental contamination leading to VRE transmission in nursing homes. We hypothesize that we can inform mitigation strategies by identifying patient clinical and microbiota features associated with environmental contamination with VRE. Methods: During a 6-month period of active surveillance in 6 Michigan nursing homes, 245 patients (with 806 follow-up visits) were enrolled. Patient clinical data and swabs for VRE were collected from multiple body sites and high-touch environmental surfaces. In total, 316 perirectal swabs were collected from 137 patients for gut microbiota analysis and community status type (CST) assignment based on taxonomic composition. The associations between VRE colonization pattern, gut microbial CST, and patient factors were examined using multivariable generalized estimating equations, adjusting for patient-and facility-level clustering. We used VRE colonization patterns to group study visits: “uncolonized” (patient−/environment−); “environment-only” (patient−/environment+); “patient-only” (patient+/environment−); “both” (patient+/environment+). Results: Across all study visits, VRE colonization on patient hand and groin/perirectal area was positively correlated with VRE contamination of high-touch environmental surfaces, suggesting direct transfer of VRE between patient and environment via patient hands (Figure 1A). We next set out to identify patient factors associated with patient colonization and environmental contamination. At baseline, while patients in the “both” group had anticipated risk factors such as longer prior hospitalization and more frequent broad-spectrum antibiotic use, they were unexpectedly younger than “uncolonized” patients and had similar functional status. This last feature contrasted with the “patient-only” group, characterized by higher urinary catheter use and higher functional dependence, suggestive of lower functional dependence facilitating patient contamination of their environment. No clinical features distinguished “uncolonized” and “environment-only” patients (Table 1). Lastly, in multivariable analyses, we determined the contribution of patient functional status and gut microbiota features to environmental contamination. Low-diversity CST, characterized by reduced anaerobic taxa, was weakly associated with “patient-only” and significantly associated with “both.” Notably, high functional dependence was significantly associated with “environment-only” and “patient-only” but not “both,” indicating high-functioning patients with disrupted gut microbiota as drivers of environmental contamination (Figure 1B). Conclusions: Our findings suggest that antimicrobial exposure disrupts patient gut microbiota, a significant mediator of colonization dynamics between patients and their environment, and that high-functioning patients may be more likely to spread VRE between their body sites and high-touch environmental surfaces (Figure 2). These findings highlight both antibiotic stewardship and patient hand hygiene as important targets for interrupting transmission mediated by environmental contamination.Funding: NoDisclosures: None

scholarly journals A Comparison of Environmental Contamination by Patients Infected or Colonized with Methicillin-Resistant Staphylococcus aureus or Vancomycin-Resistant Enterococci: A Multicenter Study

2014 ◽  
Vol 35 (7) ◽  
pp. 872-875 ◽  
Author(s):  
Lauren P. Knelson ◽  
David A. Williams ◽  
Maria F. Gergen ◽  
William A. Rutala ◽  
David J. Weber ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Multicenter Study ◽  
Environmental Contamination ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Interquartile Range ◽  
Methicillin Resistant ◽  
Vancomycin Resistant Enterococci ◽  
Environmental Surfaces ◽  
Colony Forming Units ◽  
Vancomycin Resistant

A total of 1,023 environmental surfaces were sampled from 45 rooms with patients infected or colonized with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE) before terminal room cleaning. Colonized patients had higher median total target colony-forming units (CFU) of MRSA or VRE than did infected patients (median, 25 CFU [interquartile range, 0–106 CFU] vs 0 CFU [interquartile range, 0–29 CFU]; P = .033).Infect Control Hosp Epidemiol 2014;35(7):872–875

Recovery of Vancomycin-Resistant Enterococci on Fingertips and Environmental Surfaces

1995 ◽  
Vol 16 (10) ◽  
pp. 577-581 ◽  
Author(s):  
Gary A. Noskin ◽  
Valentina Stosor ◽  
Isabell Cooper ◽  
Lance R. Peterson
Keyword(s):  
Vancomycin Resistant Enterococci ◽  
Environmental Surfaces ◽  
Vancomycin Resistant

scholarly journals Comparison of the Rodac Imprint Method to Selective Enrichment Broth for Recovery of Vancomycin-Resistant Enterococci and Drug-Resistant Enterobacteriaceae from Environmental Surfaces

2000 ◽  
Vol 38 (12) ◽  
pp. 4646-4648 ◽  
Author(s):  
Donna M. Hacek ◽  
William E. Trick ◽  
Susan M. Collins ◽  
Gary A. Noskin ◽  
Lance R. Peterson
Keyword(s):  
Amphotericin B ◽  
Brain Heart Infusion ◽  
Multidrug Resistant ◽  
Drug Resistant ◽  
Enrichment Broth ◽  
Selective Enrichment ◽  
Vancomycin Resistant Enterococci ◽  
Environmental Surfaces ◽  
Vancomycin Resistant ◽  
Selective Enrichment Broth

We compared the Rodac imprint technique to selective enrichment broth for detecting vancomycin-resistant enterococci (VRE) and multidrug-resistant Enterobacteriaceae (MDRE) on surfaces. Rodac plates contained tryptic soy agar with 5% sheep blood, vancomycin (6 μg/ml), ceftazidime (2 μg/ml), amphotericin B (2 μg/ml), and clindamycin (1 μg/ml). Two types of broth were used: brain heart infusion (BHI) and BHI plus vancomycin (6 μg/ml) and ceftazidime (2 μg/ml) (BHIVC). Of the 46 surfaces cultured for VRE, 12 (26%) were positive. Of the 12 VRE-positive surfaces, 11 (92%) grew from Rodac, 8 (67%) grew from BHIVC, and 7 (58%) grew from BHI. A larger study is needed for MDRE, as only 4 of 43 surfaces were MDRE positive. The Rodac imprint technique successfully recovered VRE from environmental surfaces.

scholarly journals Impact of an Environmental Cleaning Intervention on the Presence of Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococci on Surfaces in Intensive Care Unit Rooms

2008 ◽  
Vol 29 (7) ◽  
pp. 593-599 ◽  
Author(s):  
Eric R. Goodman ◽  
Richard Piatt ◽  
Richard Bass ◽  
Andrew B. Onderdonk ◽  
Deborah S. Yokoe ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Odds Ratio ◽  
Methicillin Resistant ◽  
Vancomycin Resistant Enterococci ◽  
Black Light ◽  
Environmental Surfaces ◽  
Vancomycin Resistant ◽  
Cleaning Intervention

Objectives.To evaluate the adequacy of discharge room cleaning and the impact of a cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) on environmental surfaces in intensive care unit (ICU) rooms.Design.Prospective environmental study.Setting and sample.Convenience sample of ICU rooms in an academic hospital.Methods and intervention.The intervention consisted of (1) a change from the use of pour bottles to bucket immersion for applying disinfectant to cleaning cloths, (2) an educational campaign, and (3) feedback regarding adequacy of discharge cleaning. Cleaning of 15 surfaces was evaluated by inspecting for removal of a preapplied mark, visible only with an ultraviolet lamp (“black light”). Six surfaces were cultured for MRSA or VRE contamination. Outcomes of mark removal and culture positivity were evaluated by X2 testing and generalized linear mixed models, clustering by room.Results.The black-light mark was removed from 44% of surfaces at baseline, compared with 71 % during the intervention (P < .001). The intervention increased the likelihood of removal of black-light marks after discharge cleaning (odds ratio, 4.4; P < .001), controlling for ICU type (medical vs surgical) and type of surface. The intervention reduced the likelihood of an environmental culture positive for MRSA or VRE (proportion of cultures positive, 45% at baseline vs 27% during the intervention; adjusted odds ratio, 0.4; P = .02). Broad, flat surfaces were more likely to be cleaned than were doorknobs and sink or toilet handles.Conclusions.Increasing the volume of disinfectant applied to environmental surfaces, providing education for Environmental Services staff, and instituting feedback with a black-light marker improved cleaning and reduced the frequency of MRSA and VRE contamination.

scholarly journals 1141. Microbial Assessment of Healthcare-Associated Pathogens on Various Environmental Sites in Patient Rooms After Terminal Room Disinfection

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S342-S343
Author(s):  
Hajime Kanamori ◽  
William Rutala ◽  
Maria Gergen ◽  
Emily Sickbert-Bennett ◽  
Deverick J Anderson ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
Hospital Room ◽  
Toilet Seat ◽  
Vancomycin Resistant Enterococci ◽  
Environmental Surfaces ◽  
Colony Forming Units ◽  
Vancomycin Resistant ◽  
Healthcare Associated ◽  
Uv C ◽  
Better Than

Abstract Background Hospital room environmental surfaces can be contaminated with healthcare-associated pathogens even if terminal room cleaning/disinfection is implemented. We examined the microbiological burden on hospital room environmental sites after standard or enhanced terminal room disinfection. Methods Microbial data from the Benefits of Enhanced Terminal Room Disinfection Study were utilized. All patient rooms were randomly assigned to standard disinfection (Quaternary ammonium [Quat]) or an enhanced disinfection (Quat/ultraviolet light [UV-C], Bleach, or Bleach/UV-C). Microbiological samples were obtained using Rodac plates (25 cm2/plate) from 8 of 10 hospital room sites, including bed rail, over-bed table, supply/medicine cart, chair, side counter, linen hamper lid, sink, toilet seat, shower floor, and bathroom floor. The number of colony forming units (CFU) of four target epidemiologically important pathogens (EIP), including multidrug-resistant Acinetobacter, Clostridium difficile, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci, was counted. A total of 3,680 samples from 736 environmental sites in all 92 patient rooms (21 standard rooms and 71 enhanced rooms) were analyzed. Results Overall, the frequency of all environmental sites positive for EIP was 11% (84/736) in all rooms, 21% (36/168) in standard rooms, and 8% (48/568) in enhanced rooms (P &lt; 0.001) (Figure 1). Environmental sites, other than the toilet seat, in standard rooms were likely to be more frequently contaminated with EIP than in enhanced rooms (P = 0.013 for overbed table, P = 0.010 for bed rail, and P &gt; 0.05 for other sites each). Mean CFU of EIP per room was 19.2 in all rooms, 60.8 in standard rooms, and 6.9 in enhanced rooms (P = 0.006) (Figure 2). All sites in standard rooms tended to have higher mean counts than in enhanced rooms (P = 0.001 for overbed table, P = 0.001 for bed rail, P = 0.012 for side counter, and P &gt; 0.05 for other sites each). Conclusion Our results demonstrate that an enhanced terminal room disinfection reduced microbial burden of healthcare-associated pathogens on environmental sites better than standard room disinfection. Environmental hygiene of touchable surfaces after terminal room cleaning using Quat needs to be improved. Disclosures W. Rutala, PDI: Consultant and Speaker’s Bureau, Consulting fee and Speaker honorarium. D. Weber, PDI: Consultant, Consulting fee.

scholarly journals 917. Persistence of Multidrug-Resistant Organisms during Occupancy Changes in the Nursing Home Setting, and Impact of Patient Hand Hygiene Assistance

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S493-S493
Author(s):  
Marco Cassone ◽  
Bonnie Lansing ◽  
Julia Mantey ◽  
Kristen Gibson ◽  
Kyle Gontjes ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Multidrug Resistant ◽  
Healthcare Personnel ◽  
Home Setting ◽  
Vancomycin Resistant Enterococci ◽  
Environmental Surfaces ◽  
Multidrug Resistant Organisms ◽  
Patient Assistance ◽  
Nursing Home Setting ◽  
Vancomycin Resistant

Abstract Background We investigated the effect of changes in room occupancy, and patient hand hygiene, on the burden of multidrug-resistant organisms (MDRO) in nursing homes. We assessed: 1/ persistence of MDRO after patients are discharged; and 2/ impact of hand hygiene assistance on colonization and room contamination. Methods Prospective cohort study of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and ceftazidime, ciprofloxacin or meropenem-resistant gram-negative bacilli (rGNB) in 9 single rooms screened three times a week for 34 weeks (five environmental surfaces, plus nares, groin, and hands of enrolled patients). Relative risk (RR) for patient colonization and room contamination were calculated in patient visits based on: 1/ performance of hand hygiene, and 2/ receiving assistance to perform it. Results We collected 4670 swabs over a total of 723 visits. Of 143 patient discharges, 31 times the room was swabbed before another patient was admitted (41 total visits), 48 times the next admitted patient was enrolled and available to be swabbed (295 visits), and 64 times the patient was not enrolled but the environment was sampled (387 total visits) (Figure). Twenty-four (50%) patients were colonized at least once with an MDRO. Rooms were contaminated at least once with MDRO in 72 cases (64%). MDRO persistence during occupancy changes involving at least one screened patient was observed in 21 of 73 cases (29%). In addition, we detected 2 cases of contamination of unoccupied, terminally cleaned rooms with MDRO recovered also in the previous (MRSA) or the following occupancy (VRE). In 40 occasions, patients performed hand hygiene with assistance from healthcare personnel, while in 169 occasions they performed hand hygiene by themselves. Requiring assistance was a risk factor for patient colonization (27.5% vs. 12.4% not requiring assistance (RR 2.20, 95% CI 1.16-4.18), and for room contamination (37.5% vs. 18.9%, RR 1.97, 95% CI 1.18-3.27) (Table). Figure. Example of successive changes in room occupancy. Table. Breakdown of colonization and contamination at each visit according to hand hygiene performance and need for assistance. Conclusion MDRO can persist during changes in patient occupancy. Patients requiring assistance with hand hygiene experienced a higher MDRO burden. These observations call for further investigation of improved cleaning practices and patient assistance. Disclosures All Authors: No reported disclosures

Molecular epidemiology of vancomycin-resistant enterococci in Singapore

Pathology ◽  
2009 ◽  
pp. 1-5
Author(s):  
Tse Koh ◽  
Beng Low ◽  
Nicholas Leo ◽  
Li-Yang Hsu ◽  
Raymond Lin ◽  
...  
Keyword(s):  
Molecular Epidemiology ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

Prevalence of Vancomycin Resistant Enterococci in Various Clinical Specimens in Tertiary Care Hospital in North Delhi

2012 ◽  
Vol 3 (3) ◽  
pp. 141-144
Author(s):  
Swati Chaudhary ◽  
◽  
Swastika Aggarwal ◽  
Pawan Kumar ◽  
SK Aggarwal SK Aggarwal ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Clinical Specimens ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant
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