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Patients Both Spread and Acquire Multidrug Resistant Microbes In Hospitals

Today's post expands on the problem of superbugs in hospital rooms. Superbugs are microbes that resist many antibiotics and drugs, and are called multidrug-resistant organisms (MDRO) in the medical literature. According to the Centers for Disease Protection (CDC): Each year in the U.S. at least 2 million people get an antibiotic-resistant infection, and at least 23,000 people die as a direct result of antibiotic resistant infections. Multidrug-resistant microbes are a continuing problem in hospitals and nursing homes.

The last post was on the contamination of privacy curtains around beds in hospitals and nursing homes. A recently published study (by the same Univ. of Michigan Medical School researchers) goes further in looking at microbes in hospital rooms. They looked at 3 main multidrug resistant organisms: vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA),  and resistant gram-negative bacilli (RGNB). And yes, they found them in many rooms and on some patients' hands and nostrils.

In the study, a total of 399 patients (average age 60.8 years) were followed as they entered 2 hospitals in Michigan during 2017. Fourteen percent of patients were already colonized with an MDRO when sampled within 24 hours of admission to the hospital - with 10% already having an MDRO on their hands, 7.5% in their nostrils, and 3.5% on both hands and nostrils. Room surfaces were sampled within the first 24 hours of a patient arriving at the hospital room - twenty-nine percent of rooms harbored an MDRO on the surfaces sampled. Six percent of the patients acquired an MDRO on their hands during their hospital stay. Luckily there were no deaths during the study.  

These microbes are frequently shed by patients and staff, and then they contaminate surfaces for days - which means that other people (patients, visitors, and hospital staff) are at risk of getting (acquiring) these microbes when they touch these surfaces. Surfaces that patients and staff frequently touch are: bed control and bed rail, call button, television remote, bedside tray table top, phone, toilet seat, and bathroom door knob.

The researchers stated that their study shows that patient hands are an "important reservoir" of microbes and play a "crucial role in the transmission of pathogens in acute care hospitals". Thus there is a need for "patient hand hygiene protocols" - in other words, wash the hands frequently.

From Medical Xpress: 'Superbugs' found on many hospital patients' hands and what they touch most often

For decades, hospitals have worked to get doctors, nurses and others to wash their hands and prevent the spread of germs. But a new study suggests they may want to expand those efforts to their patients, too. 

Fourteen percent of 399 hospital patients tested in the study had "superbug" antibiotic-resistant bacteria on their hands or nostrils very early in their hospital stay, the research finds. And nearly a third of tests for such bacteria on objects that patients commonly touch in their rooms, such as the nurse call button, came back positive.

Another six percent of the patients who didn't have multi-drug resistant organisms, or MDROs, on their hands at the start of their hospitalization tested positive for them on their hands later in their stay. One-fifth of the objects tested in their rooms had similar superbugs on them too.

The research team cautions that the presence of MDROs on patients or objects in their rooms does not necessarily mean that patients will get sick with antibiotic-resistant bacteria. And they note that healthcare workers' hands are still the primary mode of microbe transmission to patients.

Mody and her colleagues report in the new paper in Clinical Infectious Diseases that of the six patients in their study who developed an infection with a superbug called MRSA while in the hospital, all had positive tests for MRSA on their hands and hospital room surfaces.

In addition to MRSA, short for methicillin-resistant Staphylococcus aureus, the study looked for superbugs called VRE (vancomycin-resistant enterococcus) and a group called RGNB, for resistant Gram-negative bacteria. Because of overuse of antibiotics, these bacteria have evolved the ability to withstand attempts to treat infections with drugs that once killed them.

Mody notes that the study suggests that many of the MDROs seen on patients are also seen in their rooms early in their stay, suggesting that transmission to room surfaces is rapid. She heads the Infection Prevention in Aging research group at the U-M Medical School and VA Ann Arbor Healthcare System. Additionally, since many patients arrive at the hospital through the emergency room, and may get tests in other areas before reaching their hospital room, it will be important to study the ecology of MDROs in those areas too, she says.

"This study highlights the importance of handwashing and environmental cleaning, especially within a healthcare setting where patients' immune systems are compromised," says infectious disease physician Katherine Reyes, M.D., lead author for Henry Ford Health System researchers involved in the study. "This step is crucial not only for healthcare providers, but also for patients and their families. Germs are on our hands; you do not need to see to believe it. And they travel. When these germs are not washed off, they pass easily from person to person and objects to person and make people sick."

The team made more than 700 visits to the rooms of general medicine inpatients at two hospitals, working to enroll them in the study and take samples from their bodies and often-touched surfaces as early as possible in their stay. They were not able to test rooms before the patients arrived, and did not test patients who had had surgery, or were in intensive care or other types of units.

Using genetic fingerprinting techniques, they looked to see if the strains of MRSA bacteria on the patients' hands were the same as the ones in their rooms. They found the two matched in nearly all cases—suggesting that transfer to and from the patient was happening. The technique is not able to distinguish the direction of transfer, whether it's from patient to objects in the room, or from those objects to patients.

But the question of exactly where patients picked up the MDROs that were found on their bodies, and were transmitted to the surfaces in their rooms, is not addressed by the current study and would be an important next step based on these results.

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