scholarly journals Dissemination of Methicillin-Resistant Staphylococcus aureus (MRSA) and Viral Surrogate Markers Outside Patient Rooms

2020 ◽  
Vol 41 (S1) ◽  
pp. s193-s194
Author(s):  
Daniel Li ◽  
Natalia Pinto Herrera ◽  
Heba Alhmidi ◽  
Jennifer Cadnum ◽  
Curtis Donskey
Keyword(s):  
Staphylococcus Aureus ◽  
Mosaic Virus ◽  
Dna Marker ◽  
Pathogen Transmission ◽  
Cauliflower Mosaic Virus ◽  
Surrogate Markers ◽  
Viral Dna ◽  
Term Care ◽  
Methicillin Resistant ◽  
Bacteriophage Ms2

Background: Patients with methicillin-resistant Staphylococcus aureus (MRSA) colonization often shed MRSA, resulting in contamination of surfaces in their room. It is not known whether MRSA-colonized patients also frequently contaminate surfaces during medical appointments and other activities outside their room. Methods: We conducted an observational cohort study of MRSA-colonized long-term care facility (LTCF) residents to determine the frequency and mechanisms of contamination of surfaces outside patient rooms. Nares, skin, and clothing of patients in contact precautions for MRSA were cultured for MRSA, and high-touch surfaces in the residents’ room were contaminated with the live virus bacteriophage MS2 and cauliflower mosaic virus DNA. The participants were observed during activities and medical appointments outside their rooms for 3 days, and sites that were contacted were sampled for recovery of MRSA, bacteriophage MS2, and cauliflower mosaic virus DNA. Results: As shown in Fig. 1, bacteriophage MS2 and cauliflower mosaic virus DNA was transferred to 1 or more surfaces outside the resident’s room by 5 of the 7 participants, and MRSA was recovered from surfaces touched by 6 (86%) participants. MRSA was recovered during 16 of 35 episodes (46%) where sampling was performed, and recovery was similar for medical appointments (eg, hemodialysis, physical therapy) and nonmedical activities (eg, using the dining room or activity center). Moreover, MRSA, MS2, and the viral DNA marker were recovered both from sites contacted only by participants’ hands and from sites contacted only by clothing. Bacteriophage MS2 and the viral DNA marker were also recovered from portable equipment and from the nursing station. Conclusions: MRSA-colonized LTCF residents frequently disseminated MRSA and viral surrogate markers to surfaces outside their rooms through contact with contaminated hands and clothing. Efforts to reduce contamination of hands and clothing might reduce the risk for pathogen transmission.Funding: NoneDisclosures: None

Use of simulations to evaluate the effectiveness of barrier precautions to prevent patient-to-patient transfer of healthcare-associated pathogens

2020 ◽  
pp. 1-6
Author(s):  
Heba Alhmidi ◽  
Daniel F. Li ◽  
Jennifer L. Cadnum ◽  
Muhammed F. Haq ◽  
Natalia C. Pinto-Herrera ◽  
...  
Keyword(s):  
Mosaic Virus ◽  
Pathogen Transmission ◽  
Cauliflower Mosaic Virus ◽  
Surrogate Markers ◽  
Fluorescent Tracer ◽  
Clostridioides Difficile ◽  
Bacteriophage Ms2 ◽  
Different Types ◽  
Healthcare Associated ◽  
Standardized Examinations

Abstract Background: There is controversy regarding whether the addition of cover gowns offers a substantial benefit over gloves alone in reducing personnel contamination and preventing pathogen transmission. Design: Simulated patient care interactions. Objective: To evaluate the efficacy of different types of barrier precautions and to identify routes of transmission. Methods: In randomly ordered sequence, 30 personnel each performed 3 standardized examinations of mannequins contaminated with pathogen surrogate markers (cauliflower mosaic virus DNA, bacteriophage MS2, nontoxigenic Clostridioides difficile spores, and fluorescent tracer) while wearing no barriers, gloves, or gloves plus gowns followed by examination of a noncontaminated mannequin. We compared the frequency and routes of transfer of the surrogate markers to the second mannequin or the environment. Results: For a composite of all surrogate markers, transfer by hands occurred at significantly lower rates in the gloves-alone group (OR, 0.02; P < .001) and the gloves-plus-gown group (OR, 0.06; P = .002). Transfer by stethoscope diaphragms was common in all groups and was reduced by wiping the stethoscope between simulations (OR, 0.06; P < .001). Compared to the no-barriers group, wearing a cover gown and gloves resulted in reduced contamination of clothing (OR, 0.15; P < .001), but wearing gloves alone did not. Conclusions: Wearing gloves alone or gloves plus gowns reduces hand transfer of pathogens but may not address transfer by devices such as stethoscopes. Cover gowns reduce the risk of contaminating the clothing of personnel.

scholarly journals Bare Below the Elbows: A Randomized Trial to Determine Whether Wearing Short-Sleeved Coats Reduces the Risk for Pathogen Transmission

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S34-S34
Author(s):  
Amrita John ◽  
Heba Alhmidi ◽  
Melany Gonzalez-Orta ◽  
Jennifer Cadnum ◽  
Curtis J Donskey
Keyword(s):  
Patient Care ◽  
Randomized Trial ◽  
Mosaic Virus ◽  
Dna Marker ◽  
Pathogen Transmission ◽  
Cauliflower Mosaic Virus ◽  
Healthcare Personnel ◽  
Dress Code ◽  
Viral Dna ◽  
The Uk

Abstract Background Physician’s white coats are frequently contaminated, but seldom cleaned. Therefore, in the UK, a “bare below the elbows” dress code policy includes a recommendation that personnel wear short sleeves. However, it has not been demonstrated that wearing short sleeves reduces the likelihood of pathogen transmission. Methods We conducted a randomized, cross-over trial involving simulated patient care interactions to test the hypothesis that transmission of pathogens occurs less frequently when personnel wear short- vs long-sleeved coats. Healthcare personnel were randomized to wear either long- or short-sleeved white coats while examining a mannequin contaminated with cauliflower mosaic virus DNA followed by examination of an uncontaminated mannequin. We compared the frequency of transfer of the DNA marker with the sleeves and/or wrists and with the uncontaminated mannequin. During work rounds, physicians were observed to determine how often the sleeves of white coats contacted patients or the environment. Results During work rounds and simulated examinations, the sleeve cuff of long-sleeved coats frequently contacted the patient/mannequin or environment. Contamination with the DNA marker was detected significantly more often on the sleeves and/or wrists when personnel wore long- vs short-sleeved coats (5 of 20, 25% vs 0 of 20, 0%; P = 0.02). In one of five (20%) instances of sleeve and/or wrist contamination, the DNA marker was transferred to the second mannequin. It was also observed that healthcare personnel were less likely to include their wrist in handwashing between simulations if they were wearing long-sleeved coats. Conclusion During simulations of patient care, the sleeve cuff of long-sleeved white coats frequently became contaminated with a viral DNA marker that could be transferred. These results provide support for the recommendation that healthcare personnel wear short sleeves to reduce the risk for pathogen transmission. Disclosures All authors: No reported disclosures.

scholarly journals Evaluation of Viral Surrogate Markers for Study of Pathogen Dissemination During Simulations of Patient Care

2017 ◽  
Vol 4 (3) ◽  
Author(s):  
Heba Alhmidi ◽  
Amrita John ◽  
Thriveen C. Mana ◽  
Sreelatha Koganti ◽  
Jennifer L. Cadnum ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Patient Care ◽  
Mosaic Virus ◽  
Personal Protective Equipment ◽  
Cauliflower Mosaic Virus ◽  
Protective Equipment ◽  
Surrogate Markers ◽  
Bacteriophage Ms2

Abstract During patient care simulations, cauliflower mosaic virus DNA and bacteriophage MS2 performed similarly as surrogate markers of pathogen dissemination. These markers disseminated to the environment in a manner similar to Clostridium difficile spores but were more frequently detected on skin and clothing of personnel after personal protective equipment removal.

Effectiveness of barrier precautions for prevention of patient-to-patient transfer of a viral DNA surrogate marker

2020 ◽  
pp. 1-6
Author(s):  
Heba Alhmidi ◽  
Jennifer L. Cadnum ◽  
Yilen K. Ng-Wong ◽  
Annette L. Jencson ◽  
Brigid M. Wilson ◽  
...  
Keyword(s):  
Dna Markers ◽  
Odds Ratio ◽  
Dna Marker ◽  
Surrogate Marker ◽  
Pathogen Transmission ◽  
Cauliflower Mosaic Virus ◽  
Patient Transfer ◽  
Viral Dna ◽  
Patient Interactions ◽  
Subsequent Patient

Abstract Background: Gloves and gowns are used during patient care to reduce contamination of personnel and prevent pathogen transmission. Objective: To determine whether the use of gowns adds a substantial benefit over gloves alone in preventing patient-to-patient transfer of a viral DNA surrogate marker. Methods: In total, 30 source patients had 1 cauliflower mosaic virus surrogate marker applied to their skin and clothing and a second to their bed rail and bedside table. Personnel caring for the source patients were randomized to wear gloves, gloves plus cover gowns, or no barrier. Interactions with up to 7 subsequent patients were observed, and the percentages of transfer of the DNA markers were compared among the 3 groups. Results: In comparison to the no-barrier group (57.8% transfer of 1 or both markers), there were significant reductions in transfer of the DNA markers in the gloves group (31.1% transfer; odds ratio [OR], 0.16; 95% confidence interval [CI], 0.02-0.73) and the gloves-plus-gown group (25.9% transfer; OR, 0.11; 95% CI, 0.01–0.51). The addition of a cover gown to gloves during the interaction with the source patient did not significantly reduce the transfer of the DNA marker (P = .53). During subsequent patient interactions, transfer of the DNA markers was significantly reduced if gloves plus gowns were worn and if hand hygiene was performed (P < .05). Conclusions: Wearing gloves or gloves plus gowns reduced the frequency of patient-to-patient transfer of a viral DNA surrogate marker. The use of gloves plus gowns during interactions with the source patient did not reduce transfer in comparison to gloves alone.

scholarly journals Use of Simulations to Evaluate the Effectiveness of Barrier Precautions for Prevention of pathogen Transmission

2020 ◽  
Vol 41 (S1) ◽  
pp. s82-s83
Author(s):  
Heba Alhmidi ◽  
Daniel Li ◽  
Jennifer Cadnum ◽  
Natalia Pinto Herrera ◽  
Muhammed Fawwaz Haq ◽  
...  
Keyword(s):  
Group Versus ◽  
Pathogen Transmission ◽  
Cauliflower Mosaic Virus ◽  
Clinical Settings ◽  
Surrogate Markers ◽  
Bacteriophage Ms2 ◽  
Different Types ◽  
Healthcare Associated ◽  
Standardized Examinations ◽  
Different Levels

Background: Barrier precautions (eg, gloves and gowns) are often used in clinical settings to reduce the risk for transmission of healthcare-associated pathogens. However, uncertainty persists regarding the efficacy of different types of barrier precautions in preventing transmission. Methods: We used simulated patient care interactions to compare the effectiveness of different levels of barrier precautions in reducing transfer of pathogen surrogate markers. Overall, 30 personnel performed standardized examinations of contaminated mannequins while wearing either no barriers, gloves, or gloves plus cover gowns followed by examination of a noncontaminated mannequin; the order of the barrier precautions was randomly assigned. Participants used their usual technique for hand hygiene, stethoscope cleaning, and protective equipment removal. The surrogate markers included cauliflower mosaic virus DNA, bacteriophage MS2, nontoxigenic Clostridium difficile spores, and a fluorescent tracer. We compared the frequency and route of transfer of each of the surrogate markers to the second mannequin or to the surrounding environment. Results: As shown in Fig. 1, wearing gloves alone or gloves plus gowns significantly reduced transfer of each of the surrogate markers by the hands of participants (P < .05 for each marker). However, wearing gloves or gloves plus gowns only modestly reduced transfer by stethoscopes despite cleaning of stethoscopes between exams by approximately half of the participants. Contamination of the clothing of participants was significantly reduced in the glove plus gown group versus the gloves only or no-barriers groups (P < .05). Conclusion: Barrier precautions are effective in reducing hand transfer of pathogens from patient to patient, but transfer may still occur via devices such as stethoscopes. Cover gowns reduce the risk for contamination of the clothing of personnel.Funding: Proprietary Organization: The Center for Disease Control.Disclosures: None

Intravenous Antibiotics Used in the Treatment of Methicillin-Resistant Staphylococcus Aureus

2015 ◽  
Vol 26 (3) ◽  
pp. 233-243
Author(s):  
Kristine Anne Scordo
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Multidrug Resistant ◽  
Medical Procedures ◽  
Term Care ◽  
Methicillin Resistant ◽  
Intravenous Antibiotics ◽  
Resistant Strains ◽  
Hospital Acquired

Methicillin-resistant Staphylococcus aureus (MRSA) continues to cause significant morbidity and mortality. Despite advances in medical care, the prevalence of both community-acquired and hospital-acquired MRSA has progressively increased. Community-acquired MRSA typically occurs in patients without recent illness or hospitalization, presents as acute skin and soft tissue infections, and is usually not multidrug resistant. Hospital-acquired MRSA, however, presents in patients recently hospitalized or treated in long-term care settings and in those who have had medical procedures and is usually associated with multidrug-resistant strains. Both types of infections, if not properly treated, have the potential to become invasive. This article discusses current intravenous antibiotics that are available for the empiric treatment of MRSA infections along with a newer phenomenon known as the “seesaw effect.”

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