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Rate of contamination of hospital privacy curtains in a burns/plastic ward: A longitudinal study

Kevin Shek BSc a,1, Rakesh Patidar PhD b,1, Zeenib Kohja BSc a, Song Liu PhD c, Justin P. Gawaziuk MSc d, Monika Gawthrop BN d, Ayush Kumar PhD b, Sarvesh Logsetty MD d,e,*

a College of Medicine, BSc Med Research Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
b Department of Microbiology, University of Manitoba, Winnipeg, MB, Canada
c Department of Biosystems Engineering, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB, Canada
d Manitoba Firefighters’ Burn Unit, Health Sciences Centre, Winnipeg, MB, Canada
e Department of Surgery and Children’s Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

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Background: Since hospital patient privacy curtains can harbor bacteria, are high-touch surfaces, and are cleaned infrequently, they may be involved in pathogen transmission. The aim of this longitudinal prospective study was to understand curtain contamination to inform curtain hygiene protocols, thereby minimizing the role of curtains in pathogen transmission.

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Methods: Over 21 days, cultures of 10 freshly laundered curtains (8 test curtains surrounding patient beds and 2 controls in an unoccupied staff room) were taken in the Regional Burns/Plastics Unit. Contact plates were used to sample the curtains near the edge hem where they are most frequently touched. Mi-crobial contamination and the presence of methicillin-resistant Staphylococcus aureus (MRSA) were determined.
Results: By day 3, test curtains showed increased microbial contamination (mean colony-forming units [CFU]/cm2 = 1.17) compared to control curtains (mean CFU/cm2 = 0.19). Test curtains became increasing-ly contaminated over time, with mean CFU/cm2 for days 17 and 21 of 1.86 and 5.11, respectively. By day 10, 1/8 test curtains tested positive for MRSA, and 5/8 were positive by day 14.

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Conclusions: Patient privacy curtains became progressively contaminated with bacteria, including MRSA. Between days 10 and 14 after being hung, curtains showed increased MRSA positivity. This may repre-sent an opportune time to intervene, either by cleaning or replacing the curtains.

© 2018 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.

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BACKGROUND

Healthcare-associated infections contribute to unnecessary patient suffering and to increased healthcare costs.1,2 While person-to-person contact is the primary pathway, studies show that environmental surfaces can serve as important routes of transmis-sion as well.3

Hospital privacy curtains surrounding patient beds are at a high risk for cross-contamination for several reasons: 1) they are fre-quently touched;4 2) they are infrequently cleaned or changed; and 3) people may be less likely to disinfect their hands after contact with inanimate objects.5 Furthermore, a recent cross-sectional study found that curtains were contaminated with up to 13.3 colony-forming units (CFU)/cm2 of bacteria, and 31% of the curtains grew methicillin-resistant Staphylococcus aureus (MRSA).6

Unfortunately, cleaning budgets and staffing have been cut across Canada.7 Therefore, it is important to know the rate and extent of contamination to optimize curtain cleaning/changing protocols.

* Address correspondence to Sarvesh Logsetty, MD, GF431 - 820 Sherbrook St., Winnipeg, MB R3A 1R9, Canada. E-mail address: logsetty@umanitoba.ca (S. Logsetty).Funding source: Support from for this work comes from the Firefighters Burn Fund (Manitoba), Natural Sciences and Engineering Research Council of Canada (NSERC) Discovery grant (Grant no.: RGPIN/04922-2014) and Collaborative Health Research Projects (CHRP) Operating grant (Grant no.: CHRP 413713-2012). Conflicts of interest: The authors report no conflict of interest relevant to this manuscript. 1-Both authors contributed equally to this manuscript. 0196-6553/© 2018 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc. https://doi.org/10.1016/j.ajic.2018.03.004

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The objectives of this study were to determine the level and tra-jectory of contamination of curtains, including with MRSA. We hypothesized that patient privacy curtains become increasingly con-taminated over time.

METHODS

In this longitudinal prospective pilot study in the Regional Burn/Plastic Unit, Health Sciences Center, in Winnipeg, Canada, surveillance cultures of curtains were taken over a 21-day period.

Ten standard, identical polyester/cotton curtains were freshly laundered by a commercial company and packed in plastic nonsterile bags. Four curtains were placed in a 4-bed room, 4 were placed in 2 double rooms, and 2 controls were placed in areas without direct patient or caregiver contact. No rooms were occupied by patients with MRSA. The curtains were located approximately 30 cm from the bed and could be moved for privacy needs. Curtains were changed prior to day 21 if they became visibly soiled.

Contact testing was done with Dey/Engley Neutralizing Agar Rodac Contact Plates (Oxoid catalogue #RE111103). This plate can neutralize antimicrobial chemicals for environmental sampling. Two sites were sampled from each curtain. The sample sites were on the side of the curtain facing the patient, near the edge hem, with 1 sample taken from above shoulder height and the other sample taken from below shoulder height. For every sample, the same Rodac plate was pressed against the curtain for 30 seconds. Curtain cultures taken on subsequent days were taken at the same vertical height on the curtain but lateral to the prior sample location to avoid contami-nation from previous sites. One culture plate was used for each curtain on days 1, 3, 7, 10, 14, 17, and 21.

Bacterial isolation and genotypic analysis

Contact plates were incubated at 37°C for 48 hours, and swab samples were streaked on Lysogeny Broth (LB) agar (Bacto LB Agar, Lennox, BD, France). CFUs were counted from each plate. Initially, phenotypic identification of MRSA strains was confirmed by growth on MSA-Oxacillin agar. SA003 (CA-MRSA #40065) was used as a ref-erence strain throughout the study.

All MSA-Oxacillin-positive strains were further screened by nucle-ase (nuc) and mecA gene by the colony polymerase chain reaction method.

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