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BACKGROUND: Limited information is available on the natural history of Clostridioides difficile colonization and infection in patients with new acquisition of C. difficile in healthcare settings. METHODS: In 3 hospitals and affiliated long-term care facilities, we collected serial perirectal cultures from patients with no diarrhea on enrollment to identify new acquisition of toxigenic C. difficile carriage and determined the duration and burden of carriage. Asymptomatic carriage was defined as transient if only 1 culture was positive, with negative cultures before and after, or persistent if 2 or more cultures were positive. Clearance of carriage was defined as 2 consecutive negative perirectal cultures. RESULTS: Of 1432 patients with negative initial cultures and at least 1 follow-up culture, 39 (2.7%) developed C. difficile infection (CDI) without prior detection of carriage and 142 (9.9%) acquired asymptomatic carriage, with 19 (13.4%) subsequently diagnosed with CDI. Of 82 patients analyzed for persistence of carriage, 50 (61.0%) had transient carriage and 32 (39.0%) had persistent carriage, with an estimated median of 77 days to clearance of colonization (range, 14-133 days). Most persistent carriers had a relatively high burden of carriage and maintained the same ribotype over time, whereas most transient carriers had a low burden of carriage detected only using broth enrichment cultures. CONCLUSIONS: In 3 healthcare facilities, 9.9% of patients acquired asymptomatic carriage of toxigenic C. difficile, and 13.4% were subsequently diagnosed with CDI. Most carriers had transient rather than persistent carriage and most patients developing CDI did not have prior detection of carriage.
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Clostridioides difficile , Infecciones por Clostridium , Humanos , Clostridioides , Estudios Prospectivos , Infecciones por Clostridium/epidemiología , Portador Sano/epidemiologíaRESUMEN
BACKGROUND: Hospitalized patients are at risk to acquire severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from roommates with unrecognized coronavirus disease 2019 (COVID-19). We hypothesized that airflow patterns might contribute to SARS-CoV-2 transmission in double-occupancy patient rooms. METHODS: A device emitting condensed moisture was used to identify airflow patterns in double-occupancy patient rooms. Simulations were conducted to assess transfer of fluorescent microspheres, 5% sodium chloride aerosol, and aerosolized bacteriophage MS2 between patient beds 3 meters apart and to assess the effectiveness of privacy curtains and portable air cleaners in reducing transfer. RESULTS: Air flowed from inlet vents in the center of the room to an outlet vent near the door, resulting in air currents flowing toward the bed adjacent to the outlet vent. Fluorescent microspheres (212-250-µm diameter), 5% sodium chloride aerosol, and aerosolized bacteriophage MS2 released from the inner bed were carried on air currents toward the bed adjacent to the outlet vent. Closing curtains between the patient beds reduced transfer of each of the particles. Operation of a portable air cleaner reduced aerosol transfer to the bed adjacent to the outlet vent but did not offer a benefit over closing the curtains alone, and in some situations, resulted in an increase in aerosol exposure. CONCLUSIONS: Airflow patterns in double-occupancy patient rooms may contribute to risk for transmission of SARS-CoV-2 between roommates. Keeping curtains closed between beds may be beneficial in reducing risk.
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COVID-19 , SARS-CoV-2 , Humanos , Habitaciones de Pacientes , Cloruro de Sodio , Aerosoles y Gotitas RespiratoriasRESUMEN
BACKGROUND: Environmental contamination is an important source of hospital multidrug-resistant organism (MDRO) transmission. Factors such as patient MDRO contact precautions (CP) status, patient proximity to surfaces, and unit type likely influence MDRO contamination and bacterial bioburden levels on patient room surfaces. Identifying factors associated with environmental contamination in patient rooms and on shared unit surfaces could help identify important environmental MDRO transmission routes. METHODS: Surfaces were sampled from MDRO CP and non-CP rooms, nursing stations, and mobile equipment in acute care, intensive care, and transplant units within 6 acute care hospitals using a convenience sampling approach blinded to cleaning events. Precaution rooms had patients with clinical or surveillance tests positive for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, carbapenem-resistant Enterobacteriaceae or Acinetobacter within the previous 6 months, or Clostridioides difficile toxin within the past 30 days. Rooms not meeting this definition were considered non-CP rooms. Samples were cultured for the above MDROs and total bioburden. RESULTS: Overall, an estimated 13% of rooms were contaminated with at least 1 MDRO. MDROs were detected more frequently in CP rooms (32% of 209 room-sample events) than non-CP rooms (12% of 234 room-sample events). Surface bioburden did not differ significantly between CP and non-CP rooms or MDRO-positive and MDRO-negative rooms. CONCLUSIONS: CP room surfaces are contaminated more frequently than non-CP room surfaces; however, contamination of non-CP room surfaces is not uncommon and may be an important reservoir for ongoing MDRO transmission. MDRO contamination of non-CP rooms may indicate asymptomatic patient MDRO carriage, inadequate terminal cleaning, or cross-contamination of room surfaces via healthcare personnel hands.
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Infección Hospitalaria , Staphylococcus aureus Resistente a Meticilina , Cuidados Críticos , Infección Hospitalaria/prevención & control , Farmacorresistencia Bacteriana Múltiple , Humanos , Habitaciones de PacientesRESUMEN
We examined the impact of systemic antibiotics on the burden of nasal Staphylococcus aureus in hospitalized patients. Of 1,482 patients, 237 (16%) had nasal methicillin-susceptible S. aureus (MSSA) and 92 (6%) had nasal methicillin-resistant S. aureus (MRSA) on admission. Treatment regimens that included agents with inhibitory activity against MRSA or MSSA significantly reduced the burden of carriage, whereas regimens lacking anti-MRSA activity, including fluoroquinolones, promoted MRSA overgrowth.
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Antibacterianos/uso terapéutico , Nariz/microbiología , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/patogenicidad , Anciano , Femenino , Hospitalización , Humanos , Masculino , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/patogenicidadAsunto(s)
Clostridioides difficile , Enterocolitis Seudomembranosa , Adulto , Heces , Humanos , Técnicas para InmunoenzimasRESUMEN
A commercial PCR assay of perirectal swab specimens detected 17 (68%) of 25 asymptomatic carriers of toxigenic Clostridium difficile, including 93% with skin and/or environmental contamination. A clinical prediction rule, followed by PCR screening, could be used to identify carriers at high risk of C. difficile shedding.
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Toxinas Bacterianas/biosíntesis , Portador Sano/diagnóstico , Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/diagnóstico , Técnicas de Apoyo para la Decisión , Reacción en Cadena de la Polimerasa/métodos , Adulto , Anciano , Anciano de 80 o más Años , Portador Sano/microbiología , Infecciones por Clostridium/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recto/microbiologíaRESUMEN
In laboratory testing, a mobile enclosed disinfection cabinet using ultraviolet-C light and aerosolized hydrogen peroxide was effective for disinfection of hard and soft surfaces. The addition of aerosolized hydrogen peroxide to ultraviolet-C light resulted in improved disinfection of soft surfaces and Clostridioides difficile spores.
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Clostridioides difficile , Desinfección , Humanos , Desinfección/métodos , Peróxido de Hidrógeno/farmacología , Rayos Ultravioleta , Esporas BacterianasRESUMEN
Background: Community-associated Clostridioides difficile infection is a major public health hazard to adults and older children. Infants frequently excrete toxigenic C difficile asymptomatically in their stool, but their importance as a community reservoir of C difficile is uncertain. Methods: Families of healthy infants were recruited at the baby's 4-month well child visit and were followed longitudinally until the baby was approximately 9 months old. Babies and mothers submitted stool or rectal swabs every 2 weeks that were cultivated for C difficile; fathers' participation was encouraged but not required. Clostridioides difficile isolates were strain-typed by fluorescent polymerase chain reaction ribotyping and by core genome multilocus sequence typing, and the number of families in whom the same strain was cultivated from >1 family member ("strain sharing") was assessed. Results: Thirty families were enrolled, including 33 infants (3 sets of twins) and 30 mothers; 19 fathers also participated. Clostridioides difficile was identified in 28 of these 30 families over the course of the study, and strain sharing was identified in 17 of these 28. In 3 families, 2 separate strains were shared. The infant was involved in 17 of 20 instances of strain sharing, and in 13 of these, the baby was identified first, with or without a concomitantly excreting adult. Excretion of shared strains usually was persistent. Conclusions: Clostridioides difficile strain sharing was frequent in healthy families caring for an infant, increasing the likelihood that asymptomatically excreting babies and their families represent a reservoir of the organism in the community.
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Barriers are commonly installed in workplace situations where physical distancing cannot be maintained, but their effectiveness in decreasing viral transmission is unknown. In simulations, physical barriers with no openings were effective in reducing contamination with an aerosolized benign virus or fluorescent microspheres, but barriers with openings were not.
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COVID-19 , SARS-CoV-2 , Humanos , COVID-19/prevención & control , Polimetil Metacrilato , Distanciamiento FísicoRESUMEN
A novel 1-step anionic surfactant disinfectant was effective against Candida auris isolates from the 4 major phylogenetic clades as well as methicillin-resistant Staphylococcus aureus (MRSA) and the enveloped virus bacteriophage Phi6. This anionic surfactant disinfectant may be a useful addition to the disinfectant products available for use against C. auris.
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Desinfectantes , Staphylococcus aureus Resistente a Meticilina , Humanos , Candida auris , Candida , Filogenia , Pruebas de Sensibilidad Microbiana , AntifúngicosRESUMEN
In an unventilated room, 2 commercial portable air cleaners with high efficiency particulate air (HEPA) filters and a do-it-yourself box fan air cleaner with minimum efficiency reporting value (MERV)-13 filters significantly reduced aerosolized bacteriophage MS2. Increasing airflow and addition of ultraviolet-C light plus titanium dioxide-generated photocatalytic oxidation enhanced viral clearance.
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Filtros de Aire , Filtración , Humanos , LevivirusRESUMEN
We demonstrated that methicillin-resistant Staphylococcus aureus (MRSA) contamination on floors in the rooms of colonized long-term care facility residents was frequently transferred by shoes to adjacent patient rooms. A benign virus inoculated onto the floor was transferred to floors and high-touch surfaces in adjacent rooms and the nursing station. These results suggest that shoes may serve as a vector for dissemination of health care-associated pathogens from rooms of MRSA-colonized patients.
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Infección Hospitalaria , Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas , Humanos , Levivirus , Staphylococcus aureus , Cuidados a Largo Plazo , Resistencia a la Meticilina , Infecciones Estafilocócicas/prevención & control , Habitaciones de Pacientes , Infección Hospitalaria/prevención & controlRESUMEN
Poorly ventilated indoor spaces pose a risk for airborne transmission of SARS-CoV-2. We measured carbon dioxide levels in a multiple areas in an acute care hospital to assess the adequacy of ventilation. Carbon dioxide levels remained below 800 parts per million in most areas but exceeded this level in a small conference room with 8 occupants, an office with 3 occupants, and a bathroom with 2 occupants. Measuring carbon dioxide levels could provide a simple means for healthcare facilities to assess the adequacy of ventilation.
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Contaminación del Aire Interior , COVID-19 , Contaminación del Aire Interior/análisis , Dióxido de Carbono/análisis , Hospitales , Humanos , SARS-CoV-2 , VentilaciónRESUMEN
Reprinted with permission, Cleveland Clinic Foundation ©2022. All Rights Reserved. Background: Barriers are commonly installed in workplace situations where physical distancing cannot be maintained to reduce the risk for transmission of respiratory viruses. Although some types of barriers have been shown to reduce exposure to aerosols in laboratory-based testing, limited information is available on the efficacy of barriers in real-world settings. Methods: In an acute care hospital, we tested the effectiveness of in-use plexiglass barriers in reducing exposure of staff to aerosolized particles. A nebulizer was used to release 5% NaCl aerosol 1 meter from staff members with and without the barrier positioned between the point of aerosol release and the hospital staff. Particle counts on the staff side of the barrier were measured using a 6-channel particle counter. A condensed moisture (fog) generating device was used to visualize the airflow patterns. Results: Of 13 in-use barriers tested, 6 (46%) significantly reduced aerosol particle counts detected behind the barrier, 6 (46%) reduced particle counts to a modest, non-significant degree, and 1 (8%) significantly increased particle counts behind the barrier. Condensed moisture fog accumulated in the area where staff were seated behind the barrier that increased particle exposure, but not behind the other barriers. After repositioning the ineffective barrier, the condensed moisture fog no longer accumulated behind the barrier and aerosol exposure was reduced. Conclusion: In real-world settings, plexiglass barriers vary widely in effectiveness in reducing staff exposure to aerosols, and some barriers may increase risk for exposure if not positioned correctly. Devices that visualize airflow patterns may be useful as simple tools to assess barriers.
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OBJECTIVE: To evaluate the use of colorimetric indicators for monitoring ultraviolet-C (UV-C) light delivery to sites in patient rooms. METHODS: In laboratory testing, we examined the correlation between changes in color of 2 commercial colorimetric indicators and log10 reductions in methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile spores with exposure to increasing doses of UV-C from a low-pressure mercury room decontamination device. In patient rooms, 1 of the colorimetric indicators was used to assess UV-C dose delivery to 27 sites in the room. RESULTS: In laboratory testing, the manufacturer's reference colors for MRSA and C. difficile reduction corresponded with doses of â¼10,000 and 46,000 µJ/cm2; these doses resulted in >3 log10 reductions in MRSA and C. difficile spores, respectively. In patient rooms, the colorimetric indicators demonstrated suboptimal delivery of UV-C dosing to shadowed areas, which was improved by providing cycles on each side of the patient bed rather than in a single position and altering device placement. Increasing duration of exposure increased the number of sites achieving adequate dosing to kill C. difficile spores. CONCLUSIONS: Commercial colorimetric indicators provide rapid and easy-to-interpret information on the UV-C dose delivered to sites in patient rooms. The indicators may be useful for training environmental services personnel and optimizing the effectiveness of UV-C room decontamination devices.
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Clostridioides difficile , Infección Hospitalaria , Staphylococcus aureus Resistente a Meticilina , Recuento de Colonia Microbiana , Colorimetría , Infección Hospitalaria/prevención & control , Descontaminación/métodos , Desinfección/métodos , Humanos , Habitaciones de Pacientes , Rayos UltravioletaRESUMEN
A single spray application of a continuously active disinfectant on portable equipment resulted in significant reductions in aerobic colony counts over 7 days and in recovery of Staphylococcus aureus and enterococci: 3 of 93 cultures (3%) versus 11 of 97 (11%) and 20 of 97 (21%) in quaternary ammonium disinfectant and untreated control groups, respectively.
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Desinfectantes , Infecciones Estafilocócicas , Descontaminación/métodos , Desinfectantes/farmacología , Desinfección/métodos , Humanos , Staphylococcus aureusRESUMEN
BACKGROUND: Ultraviolet-C (UV-C) light devices could be useful to reduce environmental contamination with Candida auris. However, variable susceptibility of C. auris strains to UV-C has been reported, and the high cost of many devices limits their use in resource-limited settings. OBJECTIVE: To evaluate the efficacy of relatively low-cost (<$15,000 purchase price) UV-C devices against C. auris strains from the 4 major phylogenetic clades. METHODS: A modification of the American Society for Testing and Materials (ASTM) standard quantitative disk carrier test method (ASTM E 2197) was used to examine and compare the effectiveness of UV-C devices against C. auris, methicillin-resistant Staphylococcus aureus (MRSA), and bacteriophage Phi6. Reductions of 3 log10 were considered effective. UV-C irradiance measurements and colorimetric indicators were used to assess UV-C output. RESULTS: Of 8 relatively low-cost UV-C devices, 6 met the criteria for effective decontamination of C. auris isolates from clades I and II, MRSA, and bacteriophage Phi6, including 3 room decontamination devices and 3 UV-C box devices. Candida auris isolates from clades III and IV were less susceptible to UV-C than clade I and II isolates; 1 relatively low-cost room decontamination device and 2 enclosed box devices met the criteria for effective decontamination of clade III and IV isolates. UV-C irradiance measurements and colorimetric indicator results were consistent with microorganism reductions. CONCLUSIONS: Some relatively low-cost UV-C light technologies are effective against C. auris, including isolates from clades III and IV with reduced UV-C susceptibility. Studies are needed to evaluate the effectiveness of UV-C devices in clinical settings.
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Candida , Staphylococcus aureus Resistente a Meticilina , Antifúngicos/uso terapéutico , Candida auris , Humanos , Pruebas de Sensibilidad Microbiana , Filogenia , Rayos UltravioletaRESUMEN
OBJECTIVE: To investigate the frequency of environmental contamination in hospital areas outside patient rooms and in outpatient healthcare facilities. DESIGN: Culture survey. SETTING: This study was conducted across 4 hospitals, 4 outpatient clinics, and 1 surgery center. METHODS: We conducted 3 point-prevalence culture surveys for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Clostridioides difficile, Candida spp, and gram-negative bacilli including Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter baumanii, and Stenotrophomonas maltophilia in each facility. In hospitals, high-touch surfaces were sampled from radiology, physical therapy, and mobile equipment and in emergency departments, waiting rooms, clinics, and endoscopy facilities. In outpatient facilities, surfaces were sampled in exam rooms including patient and provider areas, patient bathrooms, and waiting rooms and from portable equipment. Fluorescent markers were placed on high-touch surfaces and removal was assessed 1 day later. RESULTS: In the hospitals, 110 (9.4%) of 1,195 sites were positive for 1 or more bacterial pathogens (range, 5.3%-13.7% for the 4 hospitals) and 70 (5.9%) were positive for Candida spp (range, 3.7%-5.9%). In outpatient facilities, 31 of 485 (6.4%) sites were positive for 1 or more bacterial pathogens (range, 2% to 14.4% for the 5 outpatient facilities) and 50 (10.3%) were positive for Candida spp (range, 3.9%-23.3%). Fluorescent markers had been removed from 33% of sites in hospitals (range, 28.4%-39.7%) and 46.3% of sites in outpatient clinics (range, 7.4%-82.8%). CONCLUSIONS: Surfaces in hospitals outside patient rooms and in outpatient facilities are frequently contaminated with healthcare-associated pathogens. Improvements in cleaning and disinfection practices are needed to reduce contamination.
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Infección Hospitalaria , Staphylococcus aureus Resistente a Meticilina , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Infección Hospitalaria/prevención & control , Desinfección , Hospitales , Humanos , Pacientes Internos , Pacientes Ambulatorios , Habitaciones de PacientesRESUMEN
A novel 4% hydrogen peroxide disinfectant was effective against methicillin-resistant Staphylococcus aureus (MRSA), Clostridioides difficile spores, carbapenem-resistant Escherichia coli, and 2 strains of Candida auris. In laboratory testing, a sodium hypochlorite disinfectant caused fading and loss of pliability of a hospital mattress, but the hydrogen peroxide disinfectant did not. These findings suggest that the hydrogen peroxide-based disinfectant may be a useful addition to the sporicidal disinfectant products available for use in healthcare settings.