Transmission of health care-associated infections from roommates and prior room occupants: a systematic review

Abstract

Pathogens that cause health care-associated infections (HAIs) are known to survive on surfaces and equipment in health care environments despite routine cleaning. As a result, the infection status of prior room occupants and roommates may play a role in HAI transmission. We performed a systematic review of the literature evaluating the association between patients' exposure to infected/colonized hospital roommates or prior room occupants and their risk of infection/colonization with the same organism. A PubMed search for English articles published in 1990-2014 yielded 330 studies, which were screened by three reviewers. Eighteen articles met our inclusion criteria. Multiple studies reported positive associations between infection and exposure to roommates with influenza and group A streptococcus, but no associations were found for Clostridium difficile, methicillin-resistant Staphylococcus aureus, Cryptosporidium parvum, or Pseudomonas cepacia; findings were mixed for vancomycin-resistant enterococci (VRE). Positive associations were found between infection/colonization and exposure to rooms previously occupied by patients with Pseudomonas aeruginosa and Acinetobacter baumannii, but no associations were found for resistant Gram-negative organisms; findings were mixed for C. difficile, methicillin-resistant S. aureus, and VRE. Although the majority of studies suggest a link between exposure to infected/colonized roommates and prior room occupants, methodological improvements such as increasing the statistical power and conducting universal screening for colonization would provide more definitive evidence needed to establish causality.

Keywords: health care-associated infections; hospital roommates; multidrug-resistant organisms; prior room occupants.

Figure 1

Identification, screening, eligibility, and inclusion of articles according to the PRISMA guidelines. Notes: Three hundred and thirty articles were identified by database search and no additional records were identified from other sources. No duplicates were identified. Abbreviation: PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2

Findings of studies investigating the association between health care-associated infection or colonization and exposure to infected or colonized roommates. Notes: Studies reporting significant positive associations are represented in black circles and those reporting significant negative associations are represented in white circles. Studies that did not find statistically significant associations are represented in gray circles. Circles display study authors, setting, investigation of endemic versus epidemic pathogen, and quality score.

Figure 3

Findings of studies investigating the association between health care-associated infection or colonization and exposure to infected or colonized prior room occupants. Notes: Studies reporting significant positive associations are represented in black circles. Studies that did not find statistically significant associations are represented in gray circles. No studies reported a significant negative association. Circles display study authors, setting, investigation of endemic versus epidemic pathogen, and quality score.