title: Methicillin-resistant Staphylococcus aureus (MRSA) contamination in bedside surfaces of a hospital ward and the potential effectiveness of enhanced disinfection with an antimicrobial polymer surfactant.
abstract: The aim in this study was to assess the effectiveness of a quaternary ammonium chloride (QAC) surfactant in reducing surface staphylococcal contamination in a routinely operating medical ward occupied by patients who had tested positive for methicillin-resistant Staphylococcus aureus (MRSA). The QAC being tested is an antibacterial film that is sprayed onto a surface and can remain active for up to 8 h. A field experimental study was designed with the QAC plus daily hypochlorite cleaning as the experimental group and hypochlorite cleaning alone as the control group. The method of swabbing on moistened surfaces was used for sampling. It was found that 83% and 77% of the bedside surfaces of MRSA-positive and MRSA-negative patients respectively were contaminated with staphylococci at 08:00 hours, and that the staphylococcal concentrations increased by 80% at 1200 h over a 4-hour period with routine ward and clinical activities. Irrespective of the MRSA status of the patients, high-touch surfaces around the bed-units within the studied medical ward were heavily contaminated (ranged 1 to 276 cfu/cm2 amongst the sites with positive culture) with staphylococcal bacteria including MRSA, despite the implementation of daily hypochlorite wiping. However, the contamination rate dropped significantly from 78% to 11% after the application of the QAC polymer. In the experimental group, the mean staphylococcal concentration of bedside surfaces was significantly (p<0.0001) reduced from 4.4±8.7 cfu/cm2 at 08:00 hours to 0.07±0.26 cfu/cm2 at 12:00 hours by the QAC polymer. The results of this study support the view that, in addition to hypochlorite wiping, the tested QAC surfactant is a potential environmental decontamination strategy for preventing the transmission of clinically important pathogens in medical wards.
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, China. john.yuen@polyu.edu.hk.
authors.forename: John W M
authors.initials: JW
authors.lastname: Yuen
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, China. terencechungwk@gmail.com.|Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong, China. terencechungwk@gmail.com.
authors.forename: Terence W K
authors.initials: TW
authors.lastname: Chung
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, China. alice.yuen.loke@polyu.edu.hk.
authors.forename: Alice Y
authors.initials: AY
authors.lastname: Loke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004202:Disinfectants / Q000008:administration & dosage / Q000494:pharmacology*; D004203:Disinfection / Q000379:methods*; D005260:Female; D006723:Hong Kong; D006761:Hospitals; D006801:Humans; D006997:Hypochlorous Acid / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D008875:Middle Aged; D010362:Patients' Rooms; D011108:Polymers / Q000008:administration & dosage / Q000494:pharmacology; D000644:Quaternary Ammonium Compounds / Q000008:administration & dosage / Q000494:pharmacology*; D013501:Surface-Active Agents / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D004202:Disinfectants; D011108:Polymers; D000644:Quaternary Ammonium Compounds; D013501:Surface-Active Agents; D006997:Hypochlorous Acid