title: The dynamics of methicillin-resistant Staphylococcus aureus exposure in a hospital model and the potential for environmental intervention.
abstract: BACKGROUND
  Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated infections. An important control strategy is hand hygiene; however, non-compliance has been a major problem in healthcare settings. Furthermore, modeling studies have suggested that the law of diminishing return applies to hand hygiene. Other additional control strategies such as environmental cleaning may be warranted, given that MRSA-positive individuals constantly shed contaminated desquamated skin particles to the environment.
  
  
  METHODS
  We constructed and analyzed a deterministic environmental compartmental model of MRSA fate, transport, and exposure between two hypothetical hospital rooms: one with a colonized patient, shedding MRSA; another with an uncolonized patient, susceptible to exposure. Healthcare workers (HCWs), acting solely as vectors, spread MRSA from one patient room to the other.
  
  
  RESULTS
  Although porous surfaces became highly contaminated, their low transfer efficiency limited the exposure dose to HCWs and the uncolonized patient. Conversely, the high transfer efficiency of nonporous surfaces allows greater MRSA transfer when touched. In the colonized patient's room, HCW exposure occurred more predominantly through the indirect (patient to surfaces to HCW) mode compared to the direct (patient to HCW) mode. In contrast, in the uncolonized patient's room, patient exposure was more predominant in the direct (HCW to patient) mode compared to the indirect (HCW to surfaces to patient) mode. Surface wiping decreased MRSA exposure to the uncolonized patient more than daily surface decontamination. This was because wiping allowed higher cleaning frequency and cleaned more total surface area per day.
  
  
  CONCLUSIONS
  Environmental cleaning should be considered as an integral component of MRSA infection control in hospitals. Given the previously under-appreciated role of surface contamination in MRSA transmission, this intervention mode can contribute to an effective multiple barrier approach in concert with hand hygiene.
authors.affiliation: Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA. nplipat@umich.edu.
authors.forename: Nottasorn
authors.initials: N
authors.lastname: Plipat
authors.forename: Ian H
authors.initials: IH
authors.lastname: Spicknall
authors.forename: James S
authors.initials: JS
authors.lastname: Koopman
authors.forename: Joseph Ns
authors.initials: JN
authors.lastname: Eisenberg
mesh_terms: D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission*; D003666:Decontamination; D006761:Hospitals; D006801:Humans; D006920:Hygiene; D017053:Infection Control; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control / Q000706:statistics & numerical data; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D008954:Models, Biological; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission*