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Clin Infect Dis. 2018 Aug 31;67(6):861-868. doi: 10.1093/cid/ciy115.

Environmental Panels as a Proxy for Nursing Facility Patients With Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus Colonization.

Author information

1
Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor.
2
Henry Ford Health System, Detroit.
3
Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor.
4
Department of Internal Medicine, Division of Infectious Diseases, Veterans Affairs Ann Arbor Healthcare System, Michigan.
5
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
6
Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
7
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
8
Wayne State University School of Medicine, Detroit.
9
Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Michigan.

Erratum in

Abstract

Background:

Most nursing facilities (NFs) lack methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) surveillance programs due to limited resources and high costs. We investigated the utility of environmental screening of high-touch surfaces in patient rooms as a way to circumvent these challenges.

Methods:

We compared MRSA and VRE culture data from high-touch surfaces in patients' rooms (14450 samples from 6 NFs) and ranked each site's performance in predicting patient colonization (7413 samples). The best-performing sites were included in a MRSA- and a VRE-specific panel that functioned as a proxy for patient colonization. Molecular typing was performed to confirm available concordant patient-environment pairs.

Results:

We identified and validated a MRSA panel that consisted of the bed controls, nurse call button, bed rail, and TV remote control. The VRE panel included the toilet seat, bed controls, bed rail, TV remote control, and top of the side table. Panel colonization data tracked patient colonization. Negative predictive values were 89%-92% for MRSA and 82%-84% for VRE. Molecular typing confirmed a strong clonal type relationship in available concordant patient-environment pairs (98% for MRSA, 91% for VRE), pointing to common epidemiological patterns for environmental and patient isolates.

Conclusions:

Environmental panels used as a proxy for patient colonization and incorporated into facility surveillance protocols can guide decolonization strategies, improve awareness of MRSA and VRE burden, and inform efforts to reduce transmission. Targeted environmental screening may be a viable surveillance strategy for MRSA and VRE detection in NFs.

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