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Come Out, Come Out, Wherever You Are! Environmental Bacteriology Surveillance of In-Patient Hospital Rooms
Poster Abstracts / American Journal of Infection Control 41 (2013) S25-S145
require verbal disclosure by the patient, but children in LTCFs often have limited ability to communicate. Additionally, the pediatric LTCF population has numerous comorbid conditions associated with signs and symptoms, e.g., difficulty regulating body temperature and increased secretions, which may result in misclassification as HAIs. While the new case definitions provide a much-needed update for HAI surveillance in adult LTCFs, definitions specific to the pediatric LTCF population should be developed.
Presentation Number 4-300 Come Out, Come Out, Wherever You Are! Environmental Bacteriology Surveillance of InPatient Hospital Rooms Joan Godich BSN, RN, Infection Control Specialist, Walter Reed National Military Medical Center; Karen Cromwell RN, MSM, CIC, Deputy Chief, Infection Prevention & Control Service, Walter Reed National Military Medical Center; Todd Gleeson MD, Associate clerkship director and assistant professor at the Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine (USUHS), Uniformed Services University of the Health Sciences; Robin Howard MA, Biostatistician, Walter Reed National Military Medical Center; Tyler Warkentien MD, Infectious Disease Physician, Walter Reed National Military Medical Center; Nikunj Bhatt MD, Resident Physician US Navy, Naval Medical Center Portsmouth; Kyle Peterson DO, Commanding Officer, Naval Medical Research Unit 6 Peru; Perry Malcolm MD, PhD, ASD(R&E)/RFD/Force Support Lead, Physical Science & Medical Technologies; Naomi Aronson MD, Professor of Medicine, Director, Infectious Diseases Division, Uniformed Services University of the Health Sciences BACKGROUND/OBJECTIVES: Infections due to multidrug-resistant organisms (MDROs), particularly Acinetobacter baumannii (AB) and extended spectrum beta lactamase (ESBL) Enterobacteriaciae have challenged the care of wounded servicemembers. Environmental contamination in overseas austere conditions may contribute to rates of MDRO colonization on admission to United States (U.S.) military medical centers of >5%. Research supports
S57
practices such as hand hygiene compliance, timely patient isolation, active surveillance, and focused education as effective infection prevention strategies. Environmental contamination and its role in transmission of pathogens requires further exploration. Our objectives: to survey the in-patient room environment to determine extent of microbial contamination and to identify locations with highest bacterial burden. METHODS: We selected 19 patient rooms in a tertiary care medical center, each occupied for at least 48 hours. Locations included five Intensive Care Unit (ICU), eight medical and six surgical ward rooms. Nine surfaces were sampled in each room prior to “terminal” cleaning using a sampling sponge. Areas selected were high-touch (door/wardrobe handles, siderails, keyboards, nurse call, television [tv] remote, telephone [phone]) and high-risk for environmental contamination (sink, toilet, shower). Spongesticks were processed at Centers for Disease Control and Prevention to semi-quantitatively measure overall bacterial load and identify five target organisms: methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli (EC), Acinetobacter baumanii (AB), Klebsiella pneumoniae (KP) and Pseudomonas aeruginosa (PSA). Bacterial burden was compared between sites using Wilcoxon signed rank test. RESULTS: Using “door handle” site as basis for comparison, most sites had statistically significant higher Colony Forming Units (CFUs) per centimeter squared (cm2), p<0.05, Table 1. Thirteen (68%) rooms had at least one site with bacteria levels >5 CFUs/cm2. Target organisms were identified in 12 rooms (63%) from at least one of the surfaces sampleddexcept bedside table. Four rooms with overall lowest total bacterial counts were in the ICU; however, target organisms were recovered from multiple sites in four of five ICU rooms sampled. CONCLUSIONS: Over 20% of surveyed sites had bacterial counts >5 CFU/cm2. Most commonly contaminated room sites were bedside table, bedrails, keyboard, bathroom fixtures, and phone/ call button. Highest bacterial burden was found on the healthcare computer keyboards and the call button/tv remote/phone. Over 12% of sites had a target organism isolated: PSA (8 rooms) and KP (10 rooms) were most frequently isolated. While the ICU had the lowest overall CFU/cm2 levels, the highest proportion of target organisms was found there. Data provides opportunity to reassess surface cleaning procedures and research patient characteristics/infection control strategies on room bioburden.
Table 1: Overall Bacterial Burden and Target Organisms Identified for each Site
Hard Surface Site Door Handles Wardrobe Handles Bathroom Handrails Bedside (Tray) Table Bedrails Sink/Shower/Faucet Handles Toilet Seat/Flush Handle Computer Keyboard Call Button/TV Remote/ Phone
Median CFUs/cm2 (25th-75th Percentile) 0.45 0.43 0.87 0.96 1.02 1.29 1.68 2.19 4.08
(0.21 (0.06 (0.32 (0.21 (0.32 (0.65 (0.28 (0.93 (1.75
e e e e e e e e e
0.91) 1.90) 2.04) 5.62) 6.96) 21.81) 4.80) 4.43) 11.83)
P value compared to Door Handles N/A 0.95 0.17 0.009 0.012 0.001 0.003 <0.001 <0.001
Number of rooms with *target organisms identified n (%) of Rooms with > 5 CFUs/cm2 1 1 0 5 4/15 9 4 4 7
(5%) (5%) (0%) (26%) (27%) (47%) (21%) (21%) (37%)
MRSA
AB
EC
KP
PSA
1 1 1
1
1 1
1 1 2 1 2
1 6 1
Disclaimer: The content and views expressed in this presentation are the sole responsibility of the authors and do not necessarily reflect the views or policies of the Department of Defense or the US Government. Mention of trade names, commercial products, or organizations does not imply endorsement by the US Government. * MRS; AB ¼ Acinetobacter baumanii; EC ¼ Escherichia coli; KP ¼ Klebsiella pneumoniae; PSA ¼ Pseudomonas aeruginosa
APIC 40th Annual Conference j Ft Lauderdale, FL j June 8-10, 2013
require verbal disclosure by the patient, but children in LTCFs often have limited ability to communicate. Additionally, the pediatric LTCF population has numerous comorbid conditions associated with signs and symptoms, e.g., difficulty regulating body temperature and increased secretions, which may result in misclassification as HAIs. While the new case definitions provide a much-needed update for HAI surveillance in adult LTCFs, definitions specific to the pediatric LTCF population should be developed.
Presentation Number 4-300 Come Out, Come Out, Wherever You Are! Environmental Bacteriology Surveillance of InPatient Hospital Rooms Joan Godich BSN, RN, Infection Control Specialist, Walter Reed National Military Medical Center; Karen Cromwell RN, MSM, CIC, Deputy Chief, Infection Prevention & Control Service, Walter Reed National Military Medical Center; Todd Gleeson MD, Associate clerkship director and assistant professor at the Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine (USUHS), Uniformed Services University of the Health Sciences; Robin Howard MA, Biostatistician, Walter Reed National Military Medical Center; Tyler Warkentien MD, Infectious Disease Physician, Walter Reed National Military Medical Center; Nikunj Bhatt MD, Resident Physician US Navy, Naval Medical Center Portsmouth; Kyle Peterson DO, Commanding Officer, Naval Medical Research Unit 6 Peru; Perry Malcolm MD, PhD, ASD(R&E)/RFD/Force Support Lead, Physical Science & Medical Technologies; Naomi Aronson MD, Professor of Medicine, Director, Infectious Diseases Division, Uniformed Services University of the Health Sciences BACKGROUND/OBJECTIVES: Infections due to multidrug-resistant organisms (MDROs), particularly Acinetobacter baumannii (AB) and extended spectrum beta lactamase (ESBL) Enterobacteriaciae have challenged the care of wounded servicemembers. Environmental contamination in overseas austere conditions may contribute to rates of MDRO colonization on admission to United States (U.S.) military medical centers of >5%. Research supports
S57
practices such as hand hygiene compliance, timely patient isolation, active surveillance, and focused education as effective infection prevention strategies. Environmental contamination and its role in transmission of pathogens requires further exploration. Our objectives: to survey the in-patient room environment to determine extent of microbial contamination and to identify locations with highest bacterial burden. METHODS: We selected 19 patient rooms in a tertiary care medical center, each occupied for at least 48 hours. Locations included five Intensive Care Unit (ICU), eight medical and six surgical ward rooms. Nine surfaces were sampled in each room prior to “terminal” cleaning using a sampling sponge. Areas selected were high-touch (door/wardrobe handles, siderails, keyboards, nurse call, television [tv] remote, telephone [phone]) and high-risk for environmental contamination (sink, toilet, shower). Spongesticks were processed at Centers for Disease Control and Prevention to semi-quantitatively measure overall bacterial load and identify five target organisms: methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli (EC), Acinetobacter baumanii (AB), Klebsiella pneumoniae (KP) and Pseudomonas aeruginosa (PSA). Bacterial burden was compared between sites using Wilcoxon signed rank test. RESULTS: Using “door handle” site as basis for comparison, most sites had statistically significant higher Colony Forming Units (CFUs) per centimeter squared (cm2), p<0.05, Table 1. Thirteen (68%) rooms had at least one site with bacteria levels >5 CFUs/cm2. Target organisms were identified in 12 rooms (63%) from at least one of the surfaces sampleddexcept bedside table. Four rooms with overall lowest total bacterial counts were in the ICU; however, target organisms were recovered from multiple sites in four of five ICU rooms sampled. CONCLUSIONS: Over 20% of surveyed sites had bacterial counts >5 CFU/cm2. Most commonly contaminated room sites were bedside table, bedrails, keyboard, bathroom fixtures, and phone/ call button. Highest bacterial burden was found on the healthcare computer keyboards and the call button/tv remote/phone. Over 12% of sites had a target organism isolated: PSA (8 rooms) and KP (10 rooms) were most frequently isolated. While the ICU had the lowest overall CFU/cm2 levels, the highest proportion of target organisms was found there. Data provides opportunity to reassess surface cleaning procedures and research patient characteristics/infection control strategies on room bioburden.
Table 1: Overall Bacterial Burden and Target Organisms Identified for each Site
Hard Surface Site Door Handles Wardrobe Handles Bathroom Handrails Bedside (Tray) Table Bedrails Sink/Shower/Faucet Handles Toilet Seat/Flush Handle Computer Keyboard Call Button/TV Remote/ Phone
Median CFUs/cm2 (25th-75th Percentile) 0.45 0.43 0.87 0.96 1.02 1.29 1.68 2.19 4.08
(0.21 (0.06 (0.32 (0.21 (0.32 (0.65 (0.28 (0.93 (1.75
e e e e e e e e e
0.91) 1.90) 2.04) 5.62) 6.96) 21.81) 4.80) 4.43) 11.83)
P value compared to Door Handles N/A 0.95 0.17 0.009 0.012 0.001 0.003 <0.001 <0.001
Number of rooms with *target organisms identified n (%) of Rooms with > 5 CFUs/cm2 1 1 0 5 4/15 9 4 4 7
(5%) (5%) (0%) (26%) (27%) (47%) (21%) (21%) (37%)
MRSA
AB
EC
KP
PSA
1 1 1
1
1 1
1 1 2 1 2
1 6 1
Disclaimer: The content and views expressed in this presentation are the sole responsibility of the authors and do not necessarily reflect the views or policies of the Department of Defense or the US Government. Mention of trade names, commercial products, or organizations does not imply endorsement by the US Government. * MRS; AB ¼ Acinetobacter baumanii; EC ¼ Escherichia coli; KP ¼ Klebsiella pneumoniae; PSA ¼ Pseudomonas aeruginosa
APIC 40th Annual Conference j Ft Lauderdale, FL j June 8-10, 2013