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Patient Room Floors Often Overlooked as Pathogen Sources

CLEVELAND – If you’re concerned about overlooking sources of infection in patient rooms, try looking down.

That’s the advice of a new study published in the American Journal of Infection Control, which suggests that floors in hospital rooms could be an overlooked source of infection.

An investigation led by researchers from the Cleveland Clinic and Case Western Reserve University School of Medicine Hospital points out that ground surface pathogens can easily reach hands and high-touch surfaces because numerous items touch the floors of patient rooms.

"Understanding gaps in infection prevention is critically important for institutions seeking to improve the quality of care offered to patients," explained Linda Greene, RN, MPS, CIC, FAPIC, the 2017 president of the Association for Professionals in Infection Control and Epidemiology (APIC), which publishes the journal. "Even though most facilities believe they are taking the proper precautions, this study points out the importance of ensuring cleanliness of the hospital environment and the need for education of both staff and patients on this issue."

For the study, researchers cultured 318 floor sites — two sites per room — from 159 patient rooms in five Cleveland-area hospitals, including C. difficile infection (CDI) isolation rooms and non-CDI rooms. Also cultured were hands, gloved and bare, as well as high-touch surfaces such as clothing, call buttons, medical devices, linens, and medical supplies.

C. difficile was the most frequently identified pathogen found in both CDI isolation rooms and non-CDI rooms, but contamination with methicillin-resistant Staphylococcus aureus (MRSA) and VRE also was found in patient areas.

The problem, according to the researchers, is that so many of the spaces — 41 of 100 occupied rooms — had high-touch items in contact with the floor. Those included personal items, medical devices, and supplies. The result? MRSA was recovered from 18%, VRE from 6%, and C. difficile from 1% of bare or gloved hands that handled the items.

"Efforts to improve disinfection in the hospital environment usually focus on surfaces that are frequently touched by the hands of healthcare workers or patients," the study authors explained. "Although healthcare facility floors are often heavily contaminated, limited attention has been paid to disinfection of floors because they are not frequently touched. The results of our study suggest that floors in hospital rooms could be an underappreciated source for dissemination of pathogens and are an important area for additional research."