Methicillin-resistant Staphylococcus aureus in air and surfaces of hospital wards

a comparison between new and old buildings

Authors

  • Ahmad Nikpey Department of Occupational Health, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran

Keywords:

Hospital, Cross Infection, Methicillin-Resistant Staphylococcus aureus, Air Pollution, Environmental Microbiology

Abstract

Background: Airborne particles that contain Methicillin resistant Staphylococcus aureus (MRSA) can be transferred from hospital air and environmental surfaces. It presents special risks of infections to patients and personnel and imposes exorbitant financial costs and human losses.  Objective: This research has been done to determine the prevalence of MRSA in the air and on surfaces of different hospitals wards. Methods: In this cross-sectional study, surfaces and air samples were collected from 12 wards of new and old-building hospitals, following identification of MRSA by detection of pvl, mecA and vanA genes using Polymerase chain reaction (PCR) assay in 2017. Both hospitals are located in the north of Qazvin city (population: 596,932), Iran, with 255 and 230 patients’ beds respectively. Also, some environmental properties of the sampling areas were measured. The data were analyzed using IBM-SPSS version 23, parametric tests and Pearson product-moment correlation. Results: S. aureus and Gram-negative bacteria were detected in 59.6 and 80% of the samples. The Intensive care unit (ICU) with 7.5% MRSA prevalence was the most contaminated ward. S. aureus was detected in 20% of the surface samples while MRSA was isolated in 16.7%. There are positive correlations between bacterial contamination levels of the air, surfaces and the CO2 concentration of the sampling spaces (p<0.0001). Conclusion: According to the findings of this study, air and surfaces of hospitals are contaminated with MRSA. Because of significant correlation between bioaerosol concentration and fomites, to reduce and control prevalence of MRSA, using air cleaning systems as well as decontamination of surfaces is suggested.

References

Khan HA, Baig FK, Mehboob R. Nosocomial infections: Epidemiology, prevention, control and

surveillance. Asian Pac J Trop Biomed. 2017;7(5):478-82. DOI: 10.1016/j.apjtb.2017.01.019

Kourtis AP, Hatfield K, Baggs J, Mu Y, See I, Epson E, et al. Vital Signs: Epidemiology and Recent

Trends in Methicillin-Resistant and in Methicillin-Susceptible Staphylococcus aureus Bloodstream

Infections—United States. MMWR Morb Mortal Wkly Rep. 2019;68(9):214-22. DOI:

15585/mmwr.mm6809e1. PMid: 30845118, PMCid: PMC6421967

Tong SY, Davis JS, Eichenberger E, Holland TL, Fowler VG. Staphylococcus aureus infections:

epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev.

;28(3):603-61. DOI: 10.1128/CMR.00134-14. PMid: 26016486, PMCid: PMC4451395

Lee AS, de Lencastre H, Garau J, Kluytmans J, Malhotra-Kumar S, Peschel A, et al. Methicillin-resistant

Staphylococcus aureus. Nat Rev Dis Primers. 2018;4:18033. DOI: 10.1038/nrdp.2018.33. PMid: 29849094

Lakhundi S, Zhang K. Methicillin-resistant Staphylococcus aureus: molecular characterization, evolution,

and epidemiology. Clin Microbiol Rev. 2018;31(4):e00020-18. DOI: 10.1128/CMR.00020-18. PMid:

, PMCid: PMC6148192

Yaren H, Saygin O, Turaclar N, Vural H, Turhan A, Tuncer E, et al. Investigation of PVL and MecA Gene

Locies in Methicillin-Resistant Staphylococcus aureus (MRSA) Strains Isolated from Nosocomial Samples

of Hospital Patients and Hospital Staff. Genomics and Appl Biol. 2015;6(10):1-6. DOI:

5376/gab.2015.06.0010

Lei H, Jones RM, Li Y. Exploring surface cleaning strategies in hospital to prevent contact transmission of

methicillin-resistant Staphylococcus aureus. BMC Infect Dis. 2017;17(1):85-90. DOI: 10.1186/s12879-

-2120-z. PMid: 28100179, PMCid: PMC5242018

Yuen J, Chung T, Loke A. Methicillin-resistant Staphylococcus aureus (MRSA) contamination in bedside

surfaces of a hospital ward and the potential effectiveness of enhanced disinfection with an antimicrobial

polymer surfactant. Int J Environ Res Public Health. 2015;12(3):3026-41. DOI: 10.3390/ijerph120303026.

PMid: 25768241, PMCid: PMC4377950

Loftus RW, Dexter F, Robinson AD. Methicillin-resistant Staphylococcus aureus has greater risk of

transmission in the operating room than methicillin-sensitive S aureus. Am J Infect Control.

;46(5):520-5. DOI: 10.1016/j.ajic.2017.11.002

Mirzaii M, Emaneini M, Jabalameli F, Halimi S, Taherikalani M. Molecular investigation of

Staphylococcus aureus isolated from the patients, personnel, air and environment of an ICU in a hospital in

Tehran. J Infect Public. 2015;8(2):202-6. DOI: 10.1016/j.jiph.2014.09.002. PMid: 25458916

Leylabadlo HE, Pourlak T, Aghazadeh M, Asgharzadeh M, Kafil HS. Extended-spectrum beta-lactamase

producing gram negative bacteria In Iran: A review. Afr J Infect Dis. 2017;11(2):39-53. DOI:

21010/ajid.v11i2.6. PMid: 28670639, PMCid: PMC5476812

Taromian M, Peymani A, Aslanimehr M. Frequency of Fibronectin Binding Protein A and Panton-

Valentine Leukocidin in Methicillin-Resistant Staphylococcus aureus Collected From Educational

Hospitals in Qazvin, Iran. Biotech Health Sci. 2016;3(1): e35939. DOI: 10.17795/bhs-35939

Nazemsadati SS, Allami A, Haj Manoochehri F. Staphylococcus aureus colonization in Qazvin university

hospitals healthcare workers. J Qazvin Univ Med Sci. 2018;22(2):8-19.

Azimi A, Moosavi ME, Peymani A. Phenotypic and Genotypic Characterization of Methicillin and

Erythromycin Resistance in Staphylococcus aureus Collected from Nasal Samples in Qazvin Medical

Students. Iranian Journal of Infectious Diseases And Tropical Medicine. 2019;23(83):55-65.

Alimanesh N, Taheri M, Sadeghi A. Selection from the results of the general population and housing

census of the year 2016. Qazvin: Management and Planning Organization of Qazvin province; 2017 Aug.

p.

Health, Prevention, Dept HS. Niosh Criteria for a Recommended Standard: Occupational Exposure to Heat

and Hot Environments: National Institute on Drug Abuse; 2018.

Holmes NE, Turnidge JD, Munckhof WJ, Robinson JO, Korman TM, O’Sullivan MV, et al. Antibiotic

choice may not explain poorer outcomes in patients with Staphylococcus aureus bacteremia and high

vancomycin minimum inhibitory concentrations. J Infect Dis. 2011;204(3):340-7. DOI:

1093/infdis/jir270, PMid: 21742831

Ghahremani M, Jazani NH, Sharifi Y. Emergence of vancomycin-intermediate and-resistant

Staphylococcus aureus among methicillin-resistant S. aureus isolated from clinical specimens in the

northwest of Iran. J Glob Antimicrob Resist. 2018;14:4-9. DOI: 10.1016/j.jgar.2018.01.017. PMid:

Azarian T, Cook RL, Johnson JA, Guzman N, McCarter YS, Gomez N, et al. Whole-genome sequencing

for outbreak investigations of methicillin-resistant Staphylococcus aureus in the neonatal intensive care

unit: time for routine practice? Infect Control Hosp Epidemiol. 2015;36(7):777-85. DOI:

1017/ice.2015.73. PMid: 25998499, PMCid: PMC4507300

de la Gandara MP, Curry M, Berger J, Burstein D, Della-Latta P, Kopetz V, et al. MRSA causing infections

in hospitals in greater metropolitan New York: major shift in the dominant clonal type between 1996 and

PloS one. 2016;11(6):e0156924. DOI: 10.1371/journal.pone.0156924. PMid: 27272665, PMCid:

PMC4896443

Mukhiya R, Shrestha A, Rai S, Pant K, Rai G, Singh R. Methicillin-resistant Staphylococcus aureus in

clinical samples of hospital located in kathmandu valley, Nepal. Res J Pharm Biolo Chem Sci.

;4(2):617-21.

Creamer E, Shore AC, Deasy EC, Galvin S, Dolan A, Walley N, et al. Air and surface contamination

patterns of meticillin-resistant Staphylococcus aureus on eight acute hospital wards. J Hosp Infect.

;86(3):201-8. DOI: 10.1016/j.jhin.2013.12.005. PMid: 24529449

Wagenvoort J, Toenbreker H, Nurmohamed A, Davies B. Transmission of methicillin-

resistantStaphylococcus aureus within a household. Eur J Clin Microbiol Infect Dis. 1997;16(5):399-400.

DOI: 10.1007/BF01726373. PMid: 9228485

Lax S, Gilbert JA. Hospital-associated microbiota and implications for nosocomial infections. Trends Mol

Med. 2015;21(7):427-32. PMID: 25907678 DOI: 10.1016/j.molmed.2015.03.005

Mirhoseini SH, Nikaeen M, Shamsizadeh Z, Khanahmad H. Hospital air: A potential route for transmission

of infections caused by β-lactam–resistant bacteria. Am J Infect Control. 2016;44(8):898-904. DOI:

1016/j.ajic.2016.01.041. PMid: 27021512

van de Sande-Bruinsma N, van Hall MAL, Janssen M, Nagtzaam N, Leenders S, de Greeff SC, et al.

Impact of livestock-associated MRSA in a hospital setting. Antimicrob Resist Infect Control. 2015;4(1):11.

DOI: 10.1186/s13756-015-0053-8. PMID: 25908965, PMCid: PMC4407377

Getchell-White SI, Donowitz LG, Groschel DH. The inanimate environment of an intensive care unit as a

potential source of nosocomial bacteria evidence for long survival of Acinetobacter calcoaceticus. Infect

Control Hosp Epidemiol. 1989;10(9):402-7. DOI: 10.1086/646061. PMid: 2794465

Falagas ME, Skalidis T, Vardakas KZ, Legakis NJ. Activity of cefiderocol (S-649266) against carbapenem-

resistant Gram-negative bacteria collected from inpatients in Greek hospitals. J Antimicrob Chemother.

;72(6):1704-8. DOI: 10.1093/jac/dkx049. PMid: 28369471

Denton M, Wilcox M, Parnell P, Green D, Keer V, Hawkey P, et al. Role of environmental cleaning in

controlling an outbreak of Acinetobacter baumannii on a neurosurgical intensive care unit. J Hosp Infect.

;56(2):106-10. DOI: 10.1016/j.jhin.2003.10.017. PMid: 15019221

Zanetti G, Blanc DS, Federli I, Raffoul W, Petignat C, Maravic P, et al. Importation of Acinetobacter

baumannii into a burn unit: a recurrent outbreak of infection associated with widespread environmental

contamination. Infect Control Hosp Epidemiol. 2007;28(6):723-5. DOI: 10.1086/517956. PMid: 17520548

Hardy KJ, Oppenheim BA, Gossain S, Gao F, Hawkey PM. A study of the relationship between

environmental contamination with methicillin-resistant Staphylococcus aureus (MRSA) and patients'

acquisition of MRSA. Infect Control Hosp Epidemiol. 2006;27(2):127-32. DOI: 10.1086/500622. PMid:

Ho C-M, Li C-Y, Ho M-W, Lin C-Y, Liu S-H, Lu J-J. High rate of qacA-and qacB-positive methicillin-

resistant Staphylococcus aureus isolates from chlorhexidine-impregnated catheter-related bloodstream

infections. Antimicrob Agents Chemother. 2012;56(11):5693-7. DOI: 10.1128/AAC.00761-12. PMid:

, PMCid: PMC3486537

Nandalal P, Somashekar R. Prevalence of Staphylococcus aureus and Pseudomonas aeruginosa in indoor

air flora of a district hospital, Mandya, Karnataka. J Environ Biol. 2007;28(2):197-200. PMid: 17915750

Hwang SH, Roh J, Park WM. Evaluation of PM10, CO2, airborne bacteria, TVOCs, and formaldehyde in

facilities for susceptible populations in South Korea. Environ Pollut. 2018;242:700-8. doi:

1016/j.envpol.2018.07.013. PMid: 30029169.

Chaivisit P, Fontana A, Galindo S, Strub C, Choosong T, Kantachote D, et al. Airborne Bacteria and Fungi

Distribution Characteristics in Natural Ventilation System of a University Hospital in Thailand.

EnvironmentAsia. 2018;11(2):53-66. DOI: 10.14456/ea.2018.22

Barbut F, Yezli S, Mimoun M, Pham J, Chaouat M, Otter JA. Reducing the spread of Acinetobacter

baumannii and methicillin-resistant Staphylococcus aureus on a burns unit through the intervention of an

infection control bundle. Burns.2013;39(3):395-403. DOI: 10.1016/j.burns.2012.07.007. PMid: 22884127

Aliabadi AA, Rogak SN, Bartlett KH, Green SI. Preventing airborne disease transmission: review of

methods for ventilation design in health care facilities. Adv Prev Med. 2011;2011:1-21. DOI:

4061/2011/124064. PMid: 22162813. PMCid: PMC3226423

Stawicki SP, Brisendine C, Levicoff L, Ford F, Snyder B, Eid S, et al. Comprehensive and Live Air

Purification as a Key Environmental, Clinical, and Patient Safety Factor: A Prospective Evaluation. In:

Stawicki SP, MS Firstenberg, editors. Vignettes in Patient Safety. 2019. vol. 4. P.138-153. DOI:

5772/intechopen.84530

Sexton T, Clarke P, O'neill E, Dillane T, Humphreys H. Environmental reservoirs of methicillin-resistant

Staphylococcus aureus in isolation rooms: correlation with patient isolates and implications for hospital

hygiene. J Hosp Infect. 2006;62(2):187-94. DOI: 10.1016/j.jhin.2005.07.017. PMid: 16290319.

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Published

2021-12-07