MRSA Contamination of Hospital Privacy Curtains Common

Troy Brown, RN

October 03, 2018

Two weeks after being hung, 87.5% of hospital privacy curtains were contaminated with methicillin-resistant Staphylococcus aureus (MRSA), even though none of the patients in those rooms had the infection, a small study found.

"We know that privacy curtains pose a high risk for cross-contamination because they are frequently touched but infrequently changed," lead author Kevin Shek, BSc, said in a news release. "The high rate of contamination that we saw by the fourteenth day may represent an opportune time to intervene, either by cleaning or replacing the curtains."

Shek, from the BSc Med Research Program, Max Rady College of Medicine at the University of Manitoba, Winnipeg, Canada; Rakesh Patidar, PhD, from the Department of Microbiology at the University of Manitoba, and colleagues published their findings in the September issue of the American Journal of Infection Control.

Although person-to-person contact is the main route of transmission for healthcare-associated infections, environmental surfaces are also known to be an important factor, the authors note. Previous studies have shown that hospital curtains are often contaminated, but the rate of contamination has been unknown.

Therefore, the researchers conducted a longitudinal prospective pilot study in which surveillance cultures were obtained from privacy curtains in a regional burn/plastic unit during a 21-day period. The study included 10 standard, freshly laundered privacy curtains: four in a four-bed room, four in two double rooms, and two control curtains in rooms with no direct patient or caregiver contact. No patients with MRSA occupied any of the rooms, and the curtains were placed approximately 30 cm from hospital beds. Curtains were changed if they became visibly soiled or for reasons of patient turnover before day 21.

Cultures were obtained on days 1, 3, 7, 10, 14, 17, and 21. On each day, two samples were obtained from each curtain, using one culture plate per curtain. Curtain samples were taken from the side of the curtain facing the patient, close to the edge hem; one sample was obtained from above shoulder height, and the second sample was obtained from below shoulder height. On subsequent days, samples were taken at the same heights but lateral to earlier sample locations, to avoid contamination from earlier sample sites.

Overall Microbial Contamination

Control curtains showed relatively little microbial contamination during the 21 days, going from 0.10 mean colony-forming units (CFU)/cm2 at day 1 to 0.60 mean CFU/2 at day 21. Test curtains became increasingly contaminated, with 0.20, 1.17, 1.57, 1.80, 1.69, and 1.86 mean CFU/2 at days 1, 3, 7, 10, 14, and 17, respectively. Microbial contamination of test curtains then rose sharply to 5.11 mean CFU/2 on day 21.

"To our knowledge, no set of standards exists for assessing hospital surface hygiene. However, it has been proposed that hospitals should be at least as clean as food preparation environments. For example, the United Kingdom has specified that food processing equipment should be <2.5 CFU/2; by day 21, 75% of remaining curtains exceeded this safety threshold," the researchers write.

MRSA Contamination

By day 10, four of the eight test curtains were positive for MRSA, and by day 14, seven (87.5%) of the eight test curtains were positive for MRSA.

The researchers were surprised by their findings, senior author Sarvesh Logsetty, MD, told Medscape Medical News. They knew there would likely be contamination on the curtains, as people were touching them, he said. "[B]ut the level of what it is, and more surprisingly, the number [of curtains] that actually had MRSA on there...surprised us," he explained.

Unanswered Questions

"The presence of MRSA and the number of CFUs suggest that curtains are a source of cross-contamination in hospitals," the authors write. "These data suggest that interventions to clean or routinely replace curtains should occur approximately 14 days after the curtains are hung."

However, Logsetty cautions that more needs to be known about patient outcomes before hospitals start spending large amounts of money cleaning curtains. "[D]oes having a dirty curtain change the rate of infection on somebody's wounds or the risk that the person becomes MRSA-positive when they weren't MRSA-positive before?"

The other question is, "Can we do something cheap, like cleaning them every week or 2 weeks, or do we need to actually wash them?" he added.

One of the researchers, Song Liu, PhD, from the Department of Biosystems Engineering, Faculty of Agricultural and Food Sciences at the University of Manitoba, is a surface chemistry expert, Logsetty explained. The group hopes to evaluate techniques for the use of self-cleaning surfaces and privacy curtains, he said, emphasizing that this study was a multidisciplinary collaborative effort between clinical, microbiology, and surface chemistry experts. "[T]his is what the future of healthcare research should be, this collaborative model of different people with different expertises. No one person can do everything anymore," he noted.

The study was supported by the Firefighters Burn Fund (Manitoba), a Natural Sciences and Engineering Research Council of Canada Discovery grant, and a Collaborative Health Research Projects Operating grant. The authors have disclosed no relevant financial relationships.

Am J Infect Control. 2018;46:1019-1021. Full text

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