Abstract & Commentary

ICU Privacy Curtains are Contaminated with Potentially Pathogenic Bacteria

By David J. Pierson, MD, Editor, Professor Emeritus, Pulmonary and Critical Care Medicine, University of Washington, Seattle, is Editor for Critical Care Alert.

Synopsis: When routinely cultured, essentially all ICU privacy curtains were found to be contaminated with potential pathogens at least some of the time. Recovered organisms included methicillin-resistant staphylococci and vancomycin-resistant enterococci.

Source: Ohl M, et al. Hospital privacy curtains are frequently and rapidly contaminated with potentially pathogenic bacteria. Am J Infect Control 2012; Mar 29. [Epub ahead of print.]

Investigators at the University of Iowa hospital collected culture samples from vinyl privacy curtains at 30 inpatient locations, half of them in the medical and surgical ICUs. Curtains at each location were sampled twice weekly. Each curtain's leading edge was swabbed vertically for 100 cm, starting 90 cm above the floor, to a depth of 4 cm. Standard culture techniques were used, and methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) were typed in order to distinguish recontamination from persistence of previous contamination.

Over the 3-week study period, 43 separate curtains were cultured a total of 180 times. In the 30 sites, 13 new curtains were placed during this period. Cultures from 41 of the 43 curtains (95%) demonstrated contamination on at least one occasion. The mean number of colonies resulting from direct plating of the swabs on culture medium was 13.2. Two-thirds of all cultures grew either S. aureus, enterococcus species, or a gram-negative species. S. aureus was present in 26%, and of these 44% were MRSA; VRE was recovered in 17%. Aerobic gram-negative bacteria grew in 22% of cultures, including two Klebsiella isolates with extended-spectrum beta-lactamase phenotype. Two curtains grew MRSA on two separate occasions, in each case of different phenotypes. Of the 18 curtains that grew VRE, eight were positive at more than one time point, seven with different phenotypes over time. Of the 13 new curtains hung during the study period, 12 became contaminated with at least one class of organisms within 1 week.

Commentary

The findings of this study are not surprising. Potentially pathogenic organisms have been recovered from patients' gowns, personal effects, bed rails, and television remotes; from their clinicians' ties, white coats, stethoscopes, and cellular phones; from bedside medical equipment of all kinds; and from computer keyboards and monitors in the room. Privacy curtains are touched by patients, visitors, clinicians, and many others, so they could be expected to be contaminated by organisms potentially passing both toward and from the patient. The authors call for additional studies of interventions for reducing bacterial contamination of curtains and the potential for the contaminating organisms to be transferred to patients. While such studies would undoubtedly be helpful, the findings reinforce the need for appropriate hand hygiene and other infection control measures now — by everyone both coming and going — when interacting with each patient or that patient's immediate environment.