Despite decolonization efforts, nursing home rooms remain contaminated with resistant organisms

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Nursing home resident in wheel chair — sasirin pamai / iStock

A study conducted in three US nursing homes highlights the challenge of reducing environmental contamination with multidrug-resistant organisms (MDROs).

The study by researchers with the University of California Los Angeles Medical Center and the University of California Irvine School of Medicine, published last week in Infection Control & Hospital Epidemiology, involved implementation of routine bathing/showering with chlorhexidine and nasal iodophor to reduce MDRO colonization in residents. After a 3-month phase-in and 3-month intervention, researchers repeatedly tested for skin colonization with methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, extended-spectrum beta-lactamase producers, and carbapenem-resistant Enterobacterales. They also swabbed high-touch surfaces in the rooms of MDRO carriers.

From the 3-month baseline through the intervention period, overall resident MDRO prevalence fell from 46% (411 of 900 residents) to 29% (262/900), with each individual pathogen seeing significant declines in prevalence. In multivariable models, the intervention was associated with a 55% relative reduction in MDRO prevalence (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.37 to 0.56).

Rooms of colonized residents remain contaminated

However, in the rooms of residents who remained colonized with an MDRO despite the intervention, 87% (288/330) of high-touch objects were still colonized with one or more MDRO, and the intervention was not associated with any MDRO reduction overall (OR, 1.02; 95% CI, 0.81 to 1.27). MDRO fomite contamination in rooms of MDRO carriers was associated with antibiotic use (OR, 1.54; 95% CI, 1.19 to 1.98], wound presence (OR, 1.34; 95% CI, 1.02 to 1.77), and specific fomites such as bedside table/bedrails (OR, 12.7; 95% CI, 9.37 to 17.25).

"Although the exact reason for lack of MDRO environmental contamination reduction in rooms of residents with MDRO colonization during the decolonization period is difficult to determine, our result may suggest that those residents who failed MDRO decolonization may be more likely to shed their MDRO in the environment," the study authors wrote.

The authors added that the findings indicate environmental surfaces in the rooms of MDRO carriers may require special attention for environmental decontamination.

Maryland reports first New World screwworm infection in humans in 50 years

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Stephanie Soucheray, MA

Yesterday the US Department of Health and Human Services (HHS) confirmed the first case human case of travel-associated New World screwworm in decades in a patient who had recently returned from El Salvador.

The patient lived in Maryland, and the case represents the first human case of the flesh-eating parasitic infection caused by the Cochliomyia hominivorax fly in the United States in more than 50 years.

HHS told Reuters over the weekend that the public health risk posed by this infection is very low.

No infection in US animals

Currently, Central America is seeing a large outbreak of New World screwworm that is infecting livestock, including cows. Some experts have warned that imported cases could threaten cattle herds in the United States after cattle in Mexico suffered large outbreaks this summer. On August 15, the US Department of Agriculture announced new measures to prevent the spread of New World screwworm to US livestock.

Any warm-blooded animal can become infected by a New World screwworm, but human infection is rare. So far, US federal officials have not confirmed any cases in animals this year.

CDC: Rare Salmonella strain from bearded dragons caused 2024 US outbreak, still circulates

News brief

Mary Van Beusekom, MS

Bearded dragon on child's arm — Kent Kanouse / Flickr cc

People who live with or handle pet bearded dragons are at continued risk for Salmonella infection, conclude the authors of a study on a 2024 outbreak published last week in Morbidity and Mortality Weekly Report.

The US Centers for Disease Control and Prevention (CDC) and federal and local health authorities investigated a 27-case, 14-state outbreak in 2024 caused by reptile-transmitted Salmonella Cotham. They also referenced a 2012-14 outbreak of 160 cases in 35 states caused by a genetically related strain.

Originally imported from Australia, bearded dragons have a "beard" of spikes on the throat that inflates in response to stimuli such as stress or fear.

Most infections in young children

In the 2024 outbreak, 72% of those sickened reported contact with a bearded dragon or lizard in their household or one they visited in the 7 days before symptom onset. Children younger than 5 years, particularly infants, accounted for 65% of the 26 confirmed cases; most had bearded dragons in the home but no direct contact, although they were exposed to animal living areas or a person with contaminated hands or clothing.

Caregivers [should] prevent young children from indirect reptile contact by restricting reptiles from roaming freely, separating reptiles and supplies from food preparation areas, and washing hands and changing clothes after handling reptiles and before holding infants.

Two of six parents who were re-interviewed said their reptiles were allowed to roam freely, and two reported washing baby bottles and reptile supplies in the same sink. No parents of young children knew that reptiles can transmit Salmonella. In total, 42% of patients with confirmed illness were hospitalized; hospitalization status was unknown for two patients.

Whole-genome sequencing of two bearded dragon specimens collected in 2024 and three from 2012-14 confirmed that they were related and that the rare strain continued to circulate among commercially sold bearded dragons.

The CDC worked with pet industry representatives to disseminate information about biosecurity best practices to bearded-dragon suppliers and retailers, including a common supplier identified in the traceback investigation.

CDC officials recommended that "caregivers prevent young children from indirect reptile contact by restricting reptiles from roaming freely, separating reptiles and supplies from food preparation areas, and washing hands and changing clothes after handling reptiles and before holding infants."

Indonesia reports 17 deaths in measles outbreak, launches vaccine drive

News brief

Lisa Schnirring

A measles outbreak centered in Indonesia’s East Java has sickened more than 2,000 children, 17 of them fatally, prompting the launch of an immunization campaign today in the country’s hot spot, the Associated Press reported.

The outbreak has been under way for the past 8 months, and 16 of the patients who died are from Sumenep district, according the report, which cited data from the Sumenep District Health Agency.

Indonesia is grappling with a gap in childhood immunization, with just 72% of children younger than age 5 receiving the measles vaccine last year, well below the 95% population coverage needed to prevent outbreaks. For some provinces, the measles immunization rate is below 50%.

Indonesia experienced a large measles outbreak in 2018 in Papua province that was complicated by religious concerns that the measles, mumps, and rubella vaccine contained pork. Indonesian health officials have called on residents, community officials, and religious leaders to support immunization efforts in Sumenep, which is targeting 78,000 children ages 9 months to 6 years.

The outbreak is occurring against the backdrop of a global rise in cases, including in North America.

Transit exposures in New Jersey’s latest case

In US developments, the New Jersey Department of Health on August 22 announced a measles infection in a resident of Hudson County who had close contact with a confirmed patient who is not a resident of the state. Officials emphasized that there are no links to earlier cases and that New Jersey is not experiencing a measles outbreak.

Officials said the patient traveled on public transportation between August 13 and 15 while infectious and that they are working with local officials on contact-tracing efforts. New Jersey has reported seven cases this year.