title: A study of the relationship between environmental contamination with methicillin-resistant Staphylococcus aureus (MRSA) and patients' acquisition of MRSA.
abstract: OBJECTIVE
  The study aimed to examine the presence of methicillin-resistant Staphylococcus aureus (MRSA) in the environment and its relationship to patients' acquisition of MRSA.
  
  
  METHODS
  A prospective study was conducted in a 9-bed intensive care unit for 14 months. At every environmental screening, samples were obtained from the same 4 sites in each bed space. Patients were screened at admission and then 3 times weekly. All environmental and patient strains were typed using pulsed-field gel electrophoresis.
  
  
  RESULTS
  MRSA was isolated from the environment at every environmental screening, when both small and large numbers of patients were colonized. Detailed epidemiological typing of 250 environmental and 139 patient isolates revealed 14 different pulsed-field gel electrophoresis profiles, with variants of EMRSA-15 being the predominant type. On only 20 (35.7%) of 56 occasions were the strains isolated from the patients and the strains isolated from their immediate environment indistinguishable. There was strong evidence to suggest that 3 of 26 patients who acquired MRSA while in the intensive care unit acquired MRSA from the environment.
  
  
  CONCLUSIONS
  This study reveals widespread contamination of the hospital environment with MRSA, highlights the complexities of the problem of contamination, and confirms the need for more-effective cleaning of the hospital environment to eliminate MRSA.
authors.affiliation: West Midlands Public Health Laboratory, Health Protection Agency, Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK. Katie.Hardy@heartofengland.nhs.uk
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Hardy
authors.forename: Beryl A
authors.initials: BA
authors.lastname: Oppenheim
authors.forename: Savita
authors.initials: S
authors.lastname: Gossain
authors.forename: Fang
authors.initials: F
authors.lastname: Gao
authors.forename: Peter M
authors.initials: PM
authors.lastname: Hawkey
mesh_terms: D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology*; D004586:Electrophoresis; D004781:Environmental Exposure; D006801:Humans; D007362:Intensive Care Units; D016106:Methicillin Resistance; D011446:Prospective Studies; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D006113:United Kingdom / Q000453:epidemiology