Assessment of the Overall and Multidrug-Resistant Organism Bioburden on Environmental Surfaces in Healthcare Facilities.
OBJECTIVE To determine the typical microbial bioburden (overall bacterial and multidrug-resistant organisms [MDROs]) on high-touch healthcare environmental surfaces after routine or terminal cleaning. DESIGN Prospective 2.5-year microbiological survey of large surface areas (>1,000 cm2). SETTING MDRO contact-precaution rooms from 9 acute-care hospitals and 2 long-term care facilities in 4 states. PARTICIPANTS Samples from 166 rooms (113 routine cleaned and 53 terminal cleaned rooms). METHODS Using a standard sponge-wipe sampling protocol, 2 composite samples were collected from each room; a third sample was collected from each Clostridium difficile room. Composite 1 included the TV remote, telephone, call button, and bed rails. Composite 2 included the room door handle, IV pole, and overbed table. Composite 3 included toileting surfaces. Total bacteria and MDROs (ie, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci [VRE], Acinetobacter baumannii, Klebsiella pneumoniae, and C. difficile) were quantified, confirmed, and tested for drug resistance. RESULTS The mean microbial bioburden and range from routine cleaned room composites were higher (2,700 colony-forming units [CFU]/100 cm2; ≤1-130,000 CFU/100 cm2) than from terminal cleaned room composites (353 CFU/100 cm2; ≤1-4,300 CFU/100 cm2). MDROs were recovered from 34% of routine cleaned room composites (range ≤1-13,000 CFU/100 cm2) and 17% of terminal cleaned room composites (≤1-524 CFU/100 cm2). MDROs were recovered from 40% of rooms; VRE was the most common (19%). CONCLUSIONS This multicenter bioburden summary provides a first step to determining microbial bioburden on healthcare surfaces, which may help provide a basis for developing standards to evaluate cleaning and disinfection as well as a framework for studies using an evidentiary hierarchy for environmental infection control. Infect Control Hosp Epidemiol 2016;1426-1432.
1Division of Healthcare Quality Promotion,National Center for Emerging and Zoonotic Infectious Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia.
Alicia M
AM
Shams
1Division of Healthcare Quality Promotion,National Center for Emerging and Zoonotic Infectious Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia.
Laura J
LJ
Rose
1Division of Healthcare Quality Promotion,National Center for Emerging and Zoonotic Infectious Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia.
Jonathan R
JR
Edwards
2University of Illinois at Chicago School of Public Health,Chicago,Illinois.
Salvatore
S
Cali
3University of Maryland School of Medicine,Baltimore,Maryland.
Anthony D
AD
Harris
4Emory University School of Medicine,Atlanta,Georgia.
Jesse T
JT
Jacob
4Emory University School of Medicine,Atlanta,Georgia.
Anna
A
LaFae
3University of Maryland School of Medicine,Baltimore,Maryland.
Lisa L
LL
Pineles
3University of Maryland School of Medicine,Baltimore,Maryland.
Kerri A
KA
Thom
1Division of Healthcare Quality Promotion,National Center for Emerging and Zoonotic Infectious Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia.
L Clifford
LC
McDonald
1Division of Healthcare Quality Promotion,National Center for Emerging and Zoonotic Infectious Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia.
Matthew J
MJ
Arduino
1Division of Healthcare Quality Promotion,National Center for Emerging and Zoonotic Infectious Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia.
Judith A
JA
Noble-Wang
D003428:Cross Infection / Q000382:microbiology*; D004202:Disinfectants / Q000008:administration & dosage; D024901:Drug Resistance, Multiple, Bacterial; D004866:Equipment Contamination; D004865:Equipment and Supplies, Hospital; D006092:Gram-Negative Facultatively Anaerobic Rods / Q000302:isolation & purification*; D016937:Gram-Positive Endospore-Forming Rods / Q000302:isolation & purification*; D006268:Health Facilities; D006801:Humans; D010362:Patients' Rooms; D011446:Prospective Studies
D004202:Disinfectants