title: Occurrence of skin and environmental contamination with methicillin-resistant Staphylococcus aureus before results of polymerase chain reaction at hospital admission become available.
abstract: BACKGROUND
  Active surveillance to detect patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) is increasingly practiced in healthcare settings. However, inpatients may already become sources of transmission before appropriate precautions are implemented.
  
  
  OBJECTIVE
  To examine the frequency of MRSA contamination of commonly touched skin and environmental surfaces before patient carriage status became known.
  
  
  METHODS
  We conducted a 6-week prospective study of patients who were identified by use of polymerase chain reaction (PCR) at hospital admission as having nasal MRSA colonization. Skin and environmental contamination was assessed within hours of completion of PCR screening.
  
  
  RESULTS
  There were 116 patients identified by PCR screening as having nasal MRSA colonization during the period from mid-April to May 2008, of whom 83 (72%) were enrolled in our study. Overall, MRSA was detected on the skin of 38 (51%) of 74 patients and in the environment of 37 (45%) of 83 patients. Of 83 environmental culture samples, 63 (76%) were obtained within 7 hours after PCR results became available, and 73 (88%) were obtained before wards were notified of PCR results. Of the 83 MRSA-colonized patients, 15 (18%) had contaminated their environment 25 hours after admission, and 29 (35%) had contaminated their environment 33 hours after admission. Thirty-two (39%) of the 83 patients had roommates, 13 (41%) of whom contaminated their environment. The median interval from admission to PCR result was 20 hours, and the median interval from PCR result to notification was 23 hours. An increased quantity of MRSA cultured from a nasal sample was significantly associated with contamination.
  
  
  CONCLUSIONS
  Before any contact precautions can be implemented, newly identified MRSA carriers frequently have contaminated their environment with MRSA and have contamination of commonly examined skin sites. In hospitals that perform active surveillance, strategies are needed to minimize delays in screening or to preemptively identify patients at high risk for disseminating MRSA.
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
authors.forename: Shelley
authors.initials: S
authors.lastname: Chang
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Sethi
authors.forename: Usha
authors.initials: U
authors.lastname: Stiefel
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Cadnum
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Donskey
mesh_terms: D000368:Aged; D004783:Environmental Microbiology; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification*; D008875:Middle Aged; D009296:Nasal Cavity / Q000382:microbiology; D009820:Ohio; D010343:Patient Admission; D016133:Polymerase Chain Reaction; D011159:Population Surveillance; D011446:Prospective Studies; D012867:Skin / Q000382:microbiology*