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Multidrug-resistant organisms in a routine ward environment: differential propensity for environmental dissemination
Thean Yen Tan1, Jasmine Shi Min Tan2, Huiyi Tay2
1Department of Laboratory Medicine, Changi General Hospital, Singapore.
Abstract:
Multidrug-resistant organisms (MDROs) pose significant infection-control challenges in settings with high prevalence and limited isolation facilities. This observational study in an 800-bed hospital determined the prevalence, bacterial density and genetic relatedness of MDROs isolated from ward surfaces, medical devices and the hands of healthcare professionals. The targeted MDROs were meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Escherichia coli and Klebsiella pneumoniae resistant to extended-spectrum cephalosporins, and carbapenem-resistant (CR) Acinetobacter baumannii. During a 2-month period, microbiological sampling and molecular typing were performed on environment isolates, clinical isolates and isolates recovered from the hands of healthcare professionals. The target MDROs were recovered from 79% of sampled surfaces, predominantly MRSA (74% of all tested surfaces) and CR A. baumannii (29%) but also VRE (2%) and K. pneumoniae (1%). MRSA was recovered from most tested surfaces throughout the ward, whilst CR A. baumannii was significantly more likely to be recovered from near-patient surfaces. Hand sampling demonstrated infrequent recovery of MRSA (5%), CR A. baumannii (1%) and VRE (1%). Molecular typing of the study isolates identified seven MRSA and five Acinetobacter clonal clusters, respectively, and typing identified similar strains from the environment, patients and hands. Thus, in a healthcare setting with endemic circulation of MDROs, MRSA and CR A. baumannii were the predominant organisms recovered from ward surfaces, with MRSA in particular demonstrating widespread environmental dissemination. Molecular typing demonstrated the presence of related strains in patients, in the environment and on the hands of healthcare workers.
Insights
Multidrug-resistant organisms like MRSA and carbapenem-resistant Acinetobacter baumannii are common on hospital surfaces. Related strains were found on surfaces, patients, and healthcare workers’ hands, highlighting environmental contamination risks.
Area of Science:
- Infectious Diseases
- Microbiology
- Hospital Epidemiology
Background:
- Multidrug-resistant organisms (MDROs) present significant infection control challenges, particularly in hospitals with high prevalence and limited isolation capacity.
- Understanding the environmental reservoir and transmission routes of MDROs is crucial for effective infection prevention strategies.
Purpose of the Study:
- To determine the prevalence, bacterial density, and genetic relatedness of MDROs on ward surfaces, medical devices, and healthcare professionals' hands.
- To investigate the environmental dissemination patterns of key MDROs, including MRSA, VRE, ESBL-producing E. coli and K. pneumoniae, and CR A. baumannii.
Main Methods:
- Observational study involving microbiological sampling and molecular typing over a 2-month period in an 800-bed hospital.
- Targeted MDROs included meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum cephalosporin-resistant E. coli and K. pneumoniae, and carbapenem-resistant (CR) Acinetobacter baumannii.
- Isolates were collected from ward surfaces, medical devices, and hands of healthcare professionals for analysis.
Main Results:
- MDROs were recovered from 79% of sampled surfaces, with MRSA (74%) and CR A. baumannii (29%) being predominant.
- CR A. baumannii showed a higher likelihood of recovery from near-patient surfaces compared to MRSA, which was widespread.
- Molecular typing revealed related strains of MRSA and A. baumannii circulating between the environment, patients, and healthcare worker hands.
Conclusions:
- MRSA and CR A. baumannii are the predominant MDROs found on hospital ward surfaces in settings with endemic MDRO circulation.
- Widespread environmental dissemination of MRSA and targeted near-patient contamination by CR A. baumannii were observed.
- The genetic relatedness of isolates from different sources underscores the potential for MDRO transmission within the healthcare environment.
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