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Background Environmental contamination is an important source of hospital multidrug-resistant organism (MDRO) transmission. Factors such as patient MDRO contact precautions (CP) status, patient proximity to surfaces, and unit type likely influence MDRO contamination and bacterial bioburden levels on patient room surfaces. Identifying factors associated with environmental contamination in patient rooms and on shared unit surfaces could help identify important environmental MDRO transmission routes. Methods Surfaces were sampled from MDRO CP and non-CP rooms, nursing stations, and mobile equipment in acute care, intensive care, and transplant units within 6 acute care hospitals using a convenience sampling approach blinded to cleaning events. Precaution rooms had patients with clinical or surveillance tests positive for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, carbapenem-resistant Enterobacteriaceae or Acinetobacter within the previous 6 months, or Clostridioides difficile toxin within the past 30 days. Rooms not meeting this definition were considered non-CP rooms. Samples were cultured for the above MDROs and total bioburden. Results Overall, an estimated 13% of rooms were contaminated with at least 1 MDRO. MDROs were detected more frequently in CP rooms (32% of 209 room-sample events) than non-CP rooms (12% of 234 room-sample events). Surface bioburden did not differ significantly between CP and non-CP rooms or MDRO-positive and MDRO-negative rooms. Conclusions CP room surfaces are contaminated more frequently than non-CP room surfaces; however, contamination of non-CP room surfaces is not uncommon and may be an important reservoir for ongoing MDRO transmission. MDRO contamination of non-CP rooms may indicate asymptomatic patient MDRO carriage, inadequate terminal cleaning, or cross-contamination of room surfaces via healthcare personnel hands.

Background Environmental contamination may play a critical role in ARO (antibiotic-resistant organism) transmission. The objective of this study was to estimate facility-unit contamination in 6 healthcare facilities and determine if differences existed among facilities, unit types, and room contact precautions status. Methods In each facility, two units with patients with a recent positive test of a target ARO (MRSA, VRE, or carbapenem-resistant Gram-negatives in the previous 6 months or C. difficile in the previous 30 days) were randomly selected every 2 weeks for 8 cycles. Within units, surfaces were sampled in all contact precautions rooms of patients with a target ARO, 1–2 randomly selected non-contact precautions rooms per contact precautions room, and the nursing station. Multilevel logistic regression was used to model the association of facility, unit type and room type with risk of contamination. The inverse of sampling probability was used as weights in the regression. Results A total of 196 ARO contact precautions rooms and 221 non-precautions rooms were sampled from 24 units (9 ICUs; 13 acute care medicine/surgical units; 2 transplant units) totaling 1,448 specimens. Of 417 rooms sampled, 23% were positive for one or more of the target AROs. Fourteen percent of non-precautions rooms were positive for target AROs, and 17% of ARO precautions rooms were positive for AROs other than the known target ARO. In general, prevalence of environmental ARO contamination did not differ between facilities sampled. Compared with ICUs, odds of contamination on transplant and acute care units were 5.86 and 3.85 times higher, respectively. Non-precautions rooms and nursing stations were significantly less likely to be contaminated with AROs compared with contact precautions rooms (OR = 0.24, P < 0.001) and (OR = 0.34, P = 0.009), respectively. Conclusion Detection of target AROs in non-precautions rooms and at nursing stations suggests colonized patients may be going undetected, cleaning is not sufficiently removing contamination from prior ARO patients, or AROs are being transferred from infected patients to other locations within the unit. Additional intensive sampling may further illuminate priority areas for interventions within acute care facilities. Disclosures All authors: No reported disclosures.