Environmental Screening Effective Proxy for Evaluating MRSA and VRE Rate in Nursing Facilities

Environmental screening may be an effective proxy for defining the burden of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) in nursing facilities, according to new research published in Clinical Infectious Diseases.

Prevention and surveillance programs that rely on screening patients are rarely implemented in settings such as nursing facilities for a variety of reasons, including lack of resources, high rate of patient refusal, and cost.

In this study, the authors investigated the idea of using environmental screening of high-touch surfaces in patient rooms as a method of circumventing challenges to direct screening and as a proxy for patient colonization.

A MRSA panel was identified and validated, and consisted of the bed controls, nurse call button, bed rail, and television remote control, while a VRE panel included the toilet seat, bed controls, bed rail, television remote control, and top of the side table. Overall panel performance was tested at 4 facilities, and 2 facilities were used for validation.

A total of 14,450 environmental samples obtained from 6 nursing facilities and 7413 body samples were collected from 651 patients.  The prevalence of patient colonization was 17% for MRSA and 32% for VRE.

For MRSA, a strain type that was isolated from the patient exhibited a matching typing group with a strain isolated from 1 or more sites in the environmental panel 98% of the time (43 out of 44 times).  For VRE, the same was true 91% of the time, for 41 out of 45 times.

“With this study, we provide a proof of concept and a real-life example that carefully selected environmental colonization panels correlate with patient MRSA and VRE colonization,” say the authors.

Reference

Cassone M, Mantey J, Perri MB,  et al. Environmental panels as a proxy for nursing facility patients with methicillin-resistant Staphylococcus aure and vancomycin-resistant Enterococcus colonization [published online May 2, 2018]. Clin Infect Dis. doi: 10.1093/cid/ciy115