Contamination of Common Area and Rehabilitation Gym Environment with Multidrug-Resistant Organisms

Abstract

Objectives: To quantify the multidrug-resistant organism (MDRO) burden of high-touch common area and rehabilitation gym surfaces, and to assess microorganism transfer potential during rehabilitation sessions.

Design: Prospective study of environmental contamination.

Setting: Nursing home (NH).

Participants: Six Michigan NHs.

Measurements: Monthly samples from common area surfaces (eg, living room), rehabilitation equipment, and rehabilitation personnel hands were screened for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and resistant gram-negative bacilli (R-GNB). To assess microorganism transfer potential, we conducted an in-depth assessment of microorganism transfer during 10 rehabilitation sessions. Microorganism transfer was defined as the identification of a microorganism on a destination surface that was uncontaminated before the rehabilitation session. Patient frequency of common area usage was also assessed qualitatively.

Results: We obtained 1338 common area specimens from 180 monthly facility visits, of which 13.4% (179/1338) were MDRO positive: MRSA, 3.8%; VRE, 5.8%; and R-GNB, 5.1%. A total of 64% (116/180) of sampling visits had at least one MDRO-positive common area specimen. Within rehabilitation gyms, we obtained 521 equipment and 190 personnel hand specimens during 60 monthly visits. Of the equipment specimens collected, 7.7% (40/521) were MDRO positive: MRSA, 2.5%; VRE, 4.0%; and R-GNB, 1.9%. Of the 190 rehabilitation personnel hand specimens collected, 3.7% (7/190) were MDRO positive. Overall, 55% (33/60) of rehabilitation gym visits had at least one MDRO-positive specimen. Microorganism transfer assessment during 10 rehabilitation sessions revealed 35 opportunities for transfer during which microorganism transfer occurred in 17.1% (6/35) of opportunities.

Conclusion: NH common areas and rehabilitation gyms are MDRO reservoirs that may contribute to the transmission of healthcare-associated pathogens. Because NHs accommodate the increasing short-stay patient population, developing effective interventions that reduce MDRO transmission in the common area and rehabilitation gym environment should be considered an infection prevention priority. J Am Geriatr Soc 68:478-485, 2020.

Keywords: environmental contamination; multidrug-resistant organisms; nursing home; rehabilitation; transmission.

Figure 1.. Example of Microorganism Transfer During a Rehabilitation Session.

Step 1: Patient and rehabilitation personnel (physical or occupational therapy) hand specimens were collected before initiation of the rehabilitation session. Step 2: Equipment surface swabs were collected before and after patient utilization. Step 3: Patient and rehabilitation personnel hand specimens were collected after the conclusion of the rehabilitation session. Microorganism transfer was defined as the identification of microorganisms on destination surfaces that were not contaminated prior to source interaction. Here, the patient successively interacts with the weights, walker, and stationary bike during their rehabilitation session. Transfer of methicillin-susceptible Staphylococcus aureus (MSSA) from the patient hands to the stationary bike handle was identified.

Figure 2.. Assessment of Microorganism Transfer Potential During Ten Rehabilitation Sessions.

Abbreviations: MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillin-susceptible S. aureus.

Figure 3.. Six Microorganism Transfer Events Identified During Transfer Potential Assessment.

Non-resistant Escherichia vulneris was classified as GNB. Abbreviations: MRSA, methicillin-resistant Staphylococcus aureus; VRE, vancomycin-resistant enterococci; GNB, gram-negative bacilli.