@article{8e1cb6bbca5c402c9d67cd2a63d9125e,
title = "Emergency Department Environmental Contamination With Methicillin-Resistant Staphylococcus aureus After Care of Colonized Patients",
abstract = "Study objective: Methicillin-resistant Staphylococcus aureus (MRSA) transmission dynamics in the emergency department (ED) are not well defined; environmental surfaces may serve as reservoirs for transmission. This study investigates the effect of patients with a history of MRSA colonization or infection on subsequent MRSA contamination of the ED environment. Methods: Adult ED patients with evidence of an MRSA-positive surveillance result or clinical microbiologic culture in the year preceding their current ED visit were enrolled. Cultures from 5 anatomic sites were obtained to detect active MRSA colonization. After patients{\textquoteright} discharge and before environmental disinfection, up to 16 prespecified surfaces in their ED rooms were cultured. Strain typing was performed by repetitive-sequence polymerase chain reaction on all recovered MRSA isolates to determine concordance with the corresponding patient strain. Results: Of 42 patients enrolled, 25 (60%) remained colonized with MRSA. Nineteen of the 25 ED rooms (76%) occupied by MRSA-colonized patients contained greater than or equal to 1 MRSA-contaminated environmental surface on patient discharge. Surfaces were more likely to be contaminated when rooms were occupied by patients colonized with MRSA at 1 body site (odds ratio 11.7; 95% confidence interval 1.5 to 91.5) and greater than or equal to 2 body sites (odds ratio 16.3; 95% confidence interval 3.1 to 86.8) compared with noncolonized patients. In 16 of the 19 ED rooms (84%) where MRSA was recovered, all environmental strains were concordant with the corresponding patient strain. Conclusion: Contamination of the ED environment with MRSA from actively colonized patients is common. Improved environmental surface disinfection may help reduce transmission of MRSA to ED health care professionals and patients during emergency care.",
author = "Liang, {Stephen Y.} and Jansson, {Daire R.} and Hogan, {Patrick G.} and Raclin, {Tyler W.} and Sullivan, {Melanie L.} and Muenks, {Carol E.} and Satish Munigala and House, {Stacey L.} and Fritz, {Stephanie A.}",
note = "Funding Information: Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Dr. Liang was supported by the KM1 Comparative Effectiveness Research Career Development Award (grant KM1CA156708-01), the Clinical and Translational Science Award program (grant UL1RR024992) of the National Center for Advancing Translational Sciences, and the Barnes-Jewish Patient Safety & Quality Career Development program, which is funded by the Foundation for Barnes-Jewish Hospital. Dr. Fritz was supported by funding from the Agency for Healthcare Research and Quality (grants R01-HS021736 and R01-HS024269). Author contributions: SYL, PGH, SLH, and SAF conceived and designed the study. SYL and SAF obtained research funding. SYL, SLH, and SAF supervised the conduct of the study, data collection, and patient recruitment. TWR, MLS, and CEM performed microbiologic culture, antibiotic susceptibility, strain typing, and managed the data, including quality control. DRJ, PGH, and SM provided statistical advice on study design and analyzed the data. SYL and DRJ drafted the manuscript, and all authors contributed substantially to its revision. SYL takes responsibility for the paper as a whole. Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Dr. Liang was supported by the KM1 Comparative Effectiveness Research Career Development Award (grant KM1CA156708-01), the Clinical and Translational Science Award program (grant UL1RR024992) of the National Center for Advancing Translational Sciences, and the Barnes-Jewish Patient Safety & Quality Career Development program, which is funded by the Foundation for Barnes-Jewish Hospital. Dr. Fritz was supported by funding from the Agency for Healthcare Research and Quality (grants R01-HS021736 and R01-HS024269). The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of data; preparation, review, or approval of the article; or decision to submit the article for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality or the National Institutes of Health. The authors acknowledge the study coordinators within the Washington University Emergency Care Research Core for participant recruitment and sample collection and Carey-Ann Burnham, PhD, of the Department of Pathology and Immunology, for assistance with molecular typing data interpretation. Author contributions: SYL, PGH, SLH, and SAF conceived and designed the study. SYL and SAF obtained research funding. SYL, SLH, and SAF supervised the conduct of the study, data collection, and patient recruitment. TWR, MLS, and CEM performed microbiologic culture, antibiotic susceptibility, strain typing, and managed the data, including quality control. DRJ, PGH, and SM provided statistical advice on study design and analyzed the data. SYL and DRJ drafted the manuscript, and all authors contributed substantially to its revision. SYL takes responsibility for the paper as a whole. Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Dr. Liang was supported by the KM1 Comparative Effectiveness Research Career Development Award (grant KM1CA156708-01), the Clinical and Translational Science Award program (grant UL1RR024992) of the National Center for Advancing Translational Sciences, and the Barnes-Jewish Patient Safety & Quality Career Development program, which is funded by the Foundation for Barnes-Jewish Hospital. Dr. Fritz was supported by funding from the Agency for Healthcare Research and Quality (grants R01-HS021736 and R01-HS024269). The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of data; preparation, review, or approval of the article; or decision to submit the article for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality or the National Institutes of Health. Publisher Copyright: {\textcopyright} 2018 American College of Emergency Physicians",
year = "2019",
month = jul,
doi = "10.1016/j.annemergmed.2018.12.014",
language = "English",
volume = "74",
pages = "50--55",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
number = "1",
}