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      The role of hospital environment in transmissions of multidrug-resistant gram-negative organisms

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          Abstract

          Infections by multidrug-resistant (MDR) Gram-negative organisms (GN) are associated with a high mortality rate and present an increasing challenge to the healthcare system worldwide. In recent years, increasing evidence supports the association between the healthcare environment and transmission of MDRGN to patients and healthcare workers. To better understand the role of the environment in transmission and acquisition of MDRGN, we conducted a utilitarian review based on literature published from 2014 until 2019.

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          Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings.

          Saber Yezli, Simon Otter, James A G Salkeld … (2013)
          Evidence that contaminated surfaces contribute to the transmission of hospital pathogens comes from studies modeling transmission routes, microbiologic studies, observational epidemiologic studies, intervention studies, and outbreak reports. This review presents evidence that contaminated surfaces contribute to transmission and discusses the various strategies currently available to address environmental contamination in hospitals. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
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            The crisis of no new antibiotics--what is the way forward?

            Laura Piddock (2012)
            Antibiotic use not only underpins modern medicine, but has brought huge changes to the world, especially in expectations of survival of children into adulthood. The theme of World Health Day, 2011, was "antimicrobial resistance: no action today and no cure tomorrow". The demise of antibacterial drug discovery brings the spectre of untreatable infections. To prevent this crisis immediate action is needed and a new initiative, Antibiotic Action, has been launched. By bringing together communities who need these drugs with academia, health-care professionals, and pharmaceutical companies, this initiative aims to strengthen and enhance academic-industrial partnerships, bring about revision of costly and laborious processes of licensing and regulation of new antibiotics, and address the economics of antimicrobial drugs (cost of use vs profit). A global alliance for antibiotic drug discovery and development would provide a platform for these initiatives. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              Transfer of multidrug-resistant bacteria to healthcare workers' gloves and gowns after patient contact increases with environmental contamination.

              Daniel J Morgan, Elizabeth Rogawski, Kerri A Thom … (2012)
              To assess the role of environmental contamination in the transmission of multidrug-resistant bacteria to healthcare workers' clothing. Prospective cohort. Six intensive care units at a tertiary care hospital. Healthcare workers including registered nurses, patient care technicians, respiratory therapists, occupational/physical therapists, and physicians. None. One hundred twenty of 585 (20.5%) healthcare worker/patient interactions resulted in contamination of healthcare workers' gloves or gowns. Multidrug-resistant Acinetobacter baumannii contamination occurred most frequently, 55 of 167 observations (32.9%; 95% confidence interval [CI] 25.8% to 40.0%), followed by multidrug-resistant Pseudomonas aeruginosa, 15 of 86 (17.4%; 95% CI 9.4% to 25.4%), vancomycin-resistant Enterococcus, 25 of 180 (13.9%, 95% CI 8.9, 18.9%) and methicillin-resistant Staphylococcus aureus, 21 of 152 (13.8%; 95% CI 8.3% to 19.2%). Independent risk factors associated with healthcare worker contamination with multidrug-resistant bacteria were positive environmental cultures (odds ratio [OR] 4.2; 95% CI 2.7-6.5), duration in room for >5 mins (OR 2.0; 95% CI 1.2-3.4), performing physical examinations (OR 1.7; 95% CI 1.1-2.8), and contact with the ventilator (OR 1.8; 95% CI, 1.1-2.8). Pulsed field gel electrophoresis determined that 91% of healthcare worker isolates were related to an environmental or patient isolate. The contamination of healthcare workers' protective clothing during routine care of patients with multidrug-resistant organisms is most frequent with A. baumannii. Environmental contamination was the major determinant of transmission to healthcare workers' gloves or gowns. Compliance with contact precautions and more aggressive environmental cleaning may decrease transmission.
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                Author and article information

                Contributors
                Kalisvar Marimuthu: kalisvar_marimuthu@ttsh.com.sg
                Journal
                Journal ID (nlm-ta): Antimicrob Resist Infect Control
                Journal ID (iso-abbrev): Antimicrob Resist Infect Control
                Title: Antimicrobial Resistance and Infection Control
                Publisher: BioMed Central (London )
                ISSN (Electronic): 2047-2994
                Publication date (Electronic): 11 February 2020
                Publication date PMC-release: 11 February 2020
                Publication date Collection: 2020
                Volume: 9
                Electronic Location Identifier: 29
                Affiliations
                [1 ]National Centre for Infectious Diseases, Jln Tan Tock Seng, Singapore
                [2 ]GRID grid.240988.f, Department of Infectious Diseases, , Tan Tock Seng Hospital, ; Block H, CHI Level 3, 18, Jalan Tan Tock Seng, 308442 Singapore
                [3 ]ISNI 0000 0001 2224 0361, GRID grid.59025.3b, Lee Kong Chian School of Medicine, , Nanyang Technological University, ; Nanyang, Singapore
                [4 ]ISNI 0000 0000 8963 3111, GRID grid.413018.f, University Malaya Medical Centre, ; Kuala Lumpur, Malaysia
                [5 ]ISNI 0000 0001 2180 6431, GRID grid.4280.e, Yong Loo Lin School of Medicine, , National University of Singapore, ; Kent Ridge Rd, Singapore
                Article
                Publisher ID: 685
                DOI: 10.1186/s13756-020-0685-1
                PMC ID: 7014667
                PubMed ID: 32046775
                SO-VID: 325a574f-3389-4fa2-ac8b-360f9d611747
                Copyright © © The Author(s). 2020
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 28 July 2019
                Date accepted : 23 January 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001349, National Medical Research Council;
                Award ID: NMRC/Fellowship/0056/2018
                Award ID: NMRC/CSA-INV/0002/2016
                Award Recipient :
                Funded by: National Medical Research Council (SG)
                Award ID: CIRG18Nov-0034
                Award Recipient :
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: multidrug-resistant gram-negative organisms,environment,transmission,cre,crab,carbapenem-resistant acinetobacter baumannii
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: multidrug-resistant gram-negative organisms, environment, transmission, cre, crab, carbapenem-resistant acinetobacter baumannii

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