ABSTRACT
BACKGROUND: Extended-spectrum ß-lactamase-producing Enterobacterales (ESBLPE) and carbapenemase-producing Enterobacterales (CPE) cause serious infections. Their presence in urine may lead to environmental contamination potentially responsible for cross-transmission. AIM: To evaluate the level of spraying and contamination after emptying urine in the toilet and rinsing in the sink, a common practice in the healthcare setting. METHODS: For each test, the procedure was similar: seat raised, emptying urinal bottle into the toilet at the height of the bowl, rinsing in the sink and flushing. To study splash-drops, water and fluorescein were mixed in the urinal bottle. In each area, the splash-drops frequency and level were assessed with UV. To study contamination, three ESBLPE and one CPE were diluted in saline, 106/mL. Contamination was assessed by sampling before, immediately after and 3 h after the test. The swabs were cultured and the colonies counted and identified. FINDINGS: The areas at the highest risk of spraying were the toilet bowl contour (N = 36/36), the underside of the toilet seat (N = 34) and the inside of the sink (N = 34). Except for gloves (N = 14), there was low clothing contamination. The most frequently contaminated areas were inside the sink (40/48), where the highest levels of contamination were found (14/48). CONCLUSION: Emptying the urinal bottles in the toilet followed by sink rinsing is associated with a significant risk of projection and contamination, depending on the area (highest risk at the sink), but the bacteria did not survive beyond 3 h. This practice, which carries a risk of cross-transmission, should be reviewed.
Subject(s)
Bathroom Equipment/microbiology , Enterobacteriaceae Infections/urine , Enterobacteriaceae/drug effects , Equipment and Supplies, Hospital/microbiology , Colony Count, Microbial , Drug Resistance, Bacterial , Enterobacteriaceae/isolation & purification , Enterobacteriaceae Infections/microbiology , Enterobacteriaceae Infections/transmission , Environmental Microbiology , Equipment Contamination , Humans , beta-LactamasesABSTRACT
OBJECTIVES: Our aim was to evaluate the prevalence and associated factors for carriage of extended-spectrum ß-lactamase-producing enterobacteria (ESBL-PE) in a healthcare facility. METHODS: In 2016 a serial cross-sectional survey of ESBL-PE carriage in a French university hospital was conducted. All patients present on the day of the survey were screened for ESBL-PE carriage. Demographic characteristics and risk factors for ESBL-PE carriage were collected. RESULTS: In all, 146/844 patients (17%) were digestive carriers of ESBL-PE; of these, 96 (66%) had not previously been identified. Among patients carrying ESBL-PE, Escherichia coli (62%) and CTX-M type (94%) predominated. Greater age, recent travel abroad, receipt of antibiotic, and prolonged hospitalization were associated with ESBL-PE carriage. CONCLUSION: Given the high prevalence of ESBL-PE and the high proportion of unknown carriers, our results strongly suggest reinforcing standard precautions rather than contact precautions for controlling the spread of ESBL-PE.