Contamination of hands with methicillin-resistant Staphylococcus aureus after contact with environmental surfaces and after contact with the skin of colonized patients.

In a study of 40 methicillin-resistant Staphylococcus aureus (MRSA) carriers, hand contamination was equally likely after contact with commonly examined skin sites and commonly touched environmental surfaces in patient rooms (40% vs 45%). These findings suggest that contaminated surfaces may be an important source of MRSA transmission.

Skin and environmental contamination with methicillin-resistant Staphylococcus aureus among carriers identified clinically versus through active surveillance.

In a prospective study involving 115 patients with methicillin-resistant Staphylococcus aureus nares carriage, we found that skin and environmental contamination with methicillin-resistant S. aureus was as likely among individuals whose S. aureus carriage was identified only through active surveillance as it was among those individuals whose S. aureus carriage was identified clinically, which suggests that strategies to limit transmission must address colonized patients, as well as infected patients.

What is on that keyboard? Detecting hidden environmental reservoirs of Clostridium difficile during an outbreak associated with North American pulsed-field gel electrophoresis type 1 strains.

BACKGROUND: Numerous studies have demonstrated that environmental surfaces in the rooms of patients with Clostridium difficile infection (CDI) are often contaminated with spores. However, less information is available regarding the frequency of contamination of environmental surfaces outside of CDI isolation rooms. METHODS: We performed a point-prevalence culture survey for C difficile in rooms of patients not in isolation for CDI, in physician and nurse work areas, and on portable equipment, including pulse oximetry devices, electrocardiogram machines, mobile computers, and medication distribution carts. Isolates were characterized by assessment of toxin production, polymerase chain reaction (PCR) ribotyping, and PCR for binary toxin genes. RESULTS: Of 105 nonisolation rooms, 17 (16%) were contaminated with toxin-producing C difficile, with the highest rate of contamination on the spinal cord injury unit (32%). Of 87 surfaces cultured outside of patient rooms, 20 (23%) were contaminated, including 9 of 29 (31%) in physician work areas, 1 of 10 (10%) in nurse work areas, and 9 of 43 (21%) portable pieces of equipment, including a pulse oximetry finger probe, medication carts, and bar code scanners on medication carts. Of 26 isolates subjected to typing, 19 (73%) matched ribotype patterns detected in stool samples from CDI patients and 13 (50%) were epidemic, binary toxin-positive strains. CONCLUSION: In the context of a CDI outbreak, we found that environmental contamination was common in nonisolation rooms, in physician and nurse work areas, and on portable equipment. Further research is needed to determine whether contamination in these areas plays a significant role in transmission.

Evaluation of patient participation in a patient empowerment initiative to improve hand hygiene practices in a Veterans Affairs medical center.

BACKGROUND: In patient empowerment initiatives, patients are encouraged to ask caregivers if they have washed their hands. However, relatively little is known about the willingness of patients to participate in such initiatives. METHODS: Patients were presented with a "Partners in Your Care" script asking them to remind health care workers to wash their hands, and follow-up interviews were conducted. Compliance was reassessed using a modified script in which patients were asked to thank health care workers for washing and/or to display a sign stating "Thanks for Washing." RESULTS: Of the 193 patients presented with the initial script, 5 (3%) stated that they had reminded health care workers to wash, and 15 (8%) had not commented despite observing health care workers failing to wash in their presence. Of the 38 patients given the modified script instructing them to thank health care workers for washing, 17 (45%) reported mentioning hand hygiene to health care workers (13 of whom thanked the caregivers), and 6 (16%) did not comment despite observing health care workers failing to wash in their presence. Most patients displayed a sign thanking caregivers for washing; however, no patients were observed to comment on hand hygiene during physician work rounds, and only 2 of 30 (7%) nurses on the study wards reported being thanked for washing. CONCLUSION: In this Veterans Affairs hospital, patients were unlikely to remind health care workers to wash their hands. Patient empowerment initiatives may be more effective if patients are encouraged to provide positive reinforcement and/or display prompting visual reminders.

Reduction of Clostridium Difficile and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods.

BACKGROUND: Contaminated environmental surfaces may play an important role in transmission of some healthcare-associated pathogens. In this study, we assessed the adequacy of cleaning practices in rooms of patients with Clostridium difficile-associated diarrhea (CDAD) and vancomycin-resistant Enterococcus (VRE) colonization or infection and examined whether an intervention would result in improved decontamination of surfaces. METHODS: During a 6-week period, we cultured commonly touched surfaces (i.e. bedrails, telephones, call buttons, door knobs, toilet seats, and bedside tables) in rooms of patients with CDAD and VRE colonization or infection before and after housekeeping cleaning, and again after disinfection with 10% bleach performed by the research staff. After the housekeeping staff received education and feedback, additional cultures were collected before and after housekeeping cleaning during a 10-week follow-up period. RESULTS: Of the 17 rooms of patients with VRE colonization or infection, 16 (94%) had one or more positive environmental cultures before cleaning versus 12 (71%) after housekeeping cleaning (p = 0.125), whereas none had positive cultures after bleach disinfection by the research staff (p < 0.001). Of the 9 rooms of patients with CDAD, 100% had positive cultures prior to cleaning versus 7 (78%) after housekeeping cleaning (p = 0.50), whereas only 1 (11%) had positive cultures after bleach disinfection by research staff (p = 0.031). After an educational intervention, rates of environmental contamination after housekeeping cleaning were significantly reduced. CONCLUSION: Our findings provide additional evidence that simple educational interventions directed at housekeeping staff can result in improved decontamination of environmental surfaces. Such interventions should include efforts to monitor cleaning and disinfection practices and provide feedback to the housekeeping staff.