ICP finds MRSA survives on surfaces, glove boxes

Editor: The article in the July 1998 issue of Hospital Infection Control is helpful in considering actions to be taken if/when we encounter vancomycin intermediate-resistant Staphylococcus aureus (VISA). (See "Resistant staph case sets off public fears for hospital," pp. 108-109.)

I would, however, like to comment regarding the survival of methicillin-resistant S. aureus (MRSA) in the environment. We have been treating burns since 1964, and have had three infection control episodes with MRSA. During the last (in 1983), we monitored a large number of environmental areas to try to find reservoirs. We found that MRSA survived for over two weeks on a vinyl floor area (that we purposely did not disinfect) and on the pages of a book that was read by a child with MRSA. We also found that MRSA survived for several days on the knobs of a television set and on the plastic surfaces of some packages, which had been contacted by personnel who were wearing gloves that had been used in treating a patient.

^{Looking at survival sites}

Recently, after seeing a slight increase in our infection rate, we have looked at several areas in the hospital to determine where organisms might survive. We noticed a possible link between multi-glove boxes of gloves and dissemination of gram-positive cocci to patients in our ICU rooms. Wet-swab cultures of the surface of the glove box, at the opening, yielded coagulase-negative Staphylococcus (CNS), S. aureus, common skin flora, a few molds, Bacillus spp., and MRSA. Cultures of the gloves in these boxes yielded basically the same flora, including MRSA. These "contaminated" boxes were sent to the lab and it was found that CNS, S. aureus, and in one case MRSA were still present on the surface of the box after eight to 10 days.

Many of these organisms, including MRSA, were surviving on the glove boxes and possibly on gloves after a patient with these organisms was discharged. Then a subsequent patient admitted to the room may have been contaminated with the organisms on the box or on the gloves. This prompted us to transfer all glove boxes with the patient when they were transferred to another room and to collect and remove all glove boxes at patient discharge. We introduced these control measures on March 5 of this year. While we have cultured MRSA from boxes of gloves from rooms where patients with MRSA were treated, we have not had evidence of any additional glove box-to-patient transmission.

The skin flora of personnel may be transferred to gloves in a box when the personnel change gloves, without washing, during a dressing change. One factor that seems to be very important relative to the prevention of glove box and glove contamination with organisms brought from outside a patient's room is that personnel should not use gloves as a substitute for hand washing. They should wash their hands just prior to reaching into the glove box.

Submitted by: Matthew P. Maley, MS, Risk Management/Infection Control, Shriners Hospital for Children, Cincinnati.

(Editor's note: Infection control professionals are encouraged to send letters to the editor at this address: Hospital Infection Control, P.0. Box 740059, Atlanta, GA 30374. Letters should be no more than 500 words long, and are subject to editing for length and clarity.)