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Contamination of Common Area and Rehabilitation Gym Environment with Multidrug-Resistant Organisms
Kyle J Gontjes1,2, Kristen E Gibson1, Bonnie Lansing1
1Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
Objectives:
To quantify the multidrug-resistant organism (MDRO) burden of high-touch common area and rehabilitation gym surfaces, and to assess microorganism transfer potential during rehabilitation sessions.
Design:
Prospective study of environmental contamination.
Setting:
Nursing home (NH).
Participants:
Six Michigan NHs.
Measurements:
Monthly samples from common area surfaces (eg, living room), rehabilitation equipment, and rehabilitation personnel hands were screened for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and resistant gram-negative bacilli (R-GNB). To assess microorganism transfer potential, we conducted an in-depth assessment of microorganism transfer during 10 rehabilitation sessions. Microorganism transfer was defined as the identification of a microorganism on a destination surface that was uncontaminated before the rehabilitation session. Patient frequency of common area usage was also assessed qualitatively.
Results:
We obtained 1338 common area specimens from 180 monthly facility visits, of which 13.4% (179/1338) were MDRO positive: MRSA, 3.8%; VRE, 5.8%; and R-GNB, 5.1%. A total of 64% (116/180) of sampling visits had at least one MDRO-positive common area specimen. Within rehabilitation gyms, we obtained 521 equipment and 190 personnel hand specimens during 60 monthly visits. Of the equipment specimens collected, 7.7% (40/521) were MDRO positive: MRSA, 2.5%; VRE, 4.0%; and R-GNB, 1.9%. Of the 190 rehabilitation personnel hand specimens collected, 3.7% (7/190) were MDRO positive. Overall, 55% (33/60) of rehabilitation gym visits had at least one MDRO-positive specimen. Microorganism transfer assessment during 10 rehabilitation sessions revealed 35 opportunities for transfer during which microorganism transfer occurred in 17.1% (6/35) of opportunities.
Conclusion:
NH common areas and rehabilitation gyms are MDRO reservoirs that may contribute to the transmission of healthcare-associated pathogens. Because NHs accommodate the increasing short-stay patient population, developing effective interventions that reduce MDRO transmission in the common area and rehabilitation gym environment should be considered an infection prevention priority. J Am Geriatr Soc 68:478-485, 2020.
Insights
Multidrug-resistant organisms (MDROs) are prevalent on surfaces in nursing home common areas and gyms, posing a risk for transmission. Interventions are needed to reduce MDRO spread in these environments.
Area of Science:
- Infection Prevention and Control
- Environmental Microbiology
- Healthcare Epidemiology
Background:
- Nursing homes (NHs) are increasingly accommodating short-stay patients, highlighting the need to understand pathogen reservoirs.
- High-touch surfaces in common areas and rehabilitation gyms can harbor multidrug-resistant organisms (MDROs).
Purpose of the Study:
- To quantify the burden of MDROs on surfaces in NH common areas and rehabilitation gyms.
- To assess the potential for microorganism transfer during rehabilitation sessions.
Main Methods:
- A prospective study involving monthly environmental sampling of surfaces and personnel hands in six Michigan NHs.
- Screening for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and resistant gram-negative bacilli (R-GNB).
- In-depth assessment of microorganism transfer during 10 rehabilitation sessions.
Main Results:
- MDROs were detected on 13.4% of common area surfaces and 7.7% of rehabilitation equipment.
- At least one MDRO was found during 64% of common area sampling visits and 55% of rehabilitation gym visits.
- Microorganism transfer occurred in 17.1% of observed opportunities during rehabilitation sessions.
Conclusions:
- NH common areas and rehabilitation gyms serve as reservoirs for MDROs, potentially contributing to healthcare-associated pathogen transmission.
- Developing effective interventions to reduce MDRO transmission in these environments is an infection prevention priority.
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