1887

Abstract

is a spore-forming pathogen responsible for antibiotic-associated diarrhoea. In the USA high incidence of infection (CDI) in clinical environments has led to interest in spore transmission.

Single use hospital surgical gown ties act as a reservoir for spores.

This study sought to examine whether single-use hospital surgical gown ties used in surgery, from an acute healthcare facility, harboured spores.

Used surgical gowns ties worn by clinicians in the healthcare facility were examined for spore presence via spread plate and anaerobic culture. The colonies isolated from each gown tie were subcultured on selective agar for phenotypic confirmation. Presumptive colonies were examined using Quik Check Complete, 16–23S PCR Ribotyping and MALDI-TOF analysis.

In total 17 suspected colonies were isolated from 15 gown ties via culture. Quik Check Complete found two isolates as possible . MALDI-TOF and PCR Ribotyping confirmed one isolate as PCR ribotype 027 associated with clinical outbreaks.

Our study revealed the presence of hypervirulent ribotype 027 spores on single-use gown ties. This highlights the potential of gown ties as a vector of spore transmission across clinical environments, especially when gowns are not worn appropriately.

Appropriate compliance to infection control procedures by healthcare workers is essential to prevent spore dissemination across clinical facilities and reduce CDI rates.

  • This is an open-access article distributed under the terms of the Creative Commons Attribution License. This article was made open access via a Publish and Read agreement between the Microbiology Society and the corresponding author’s institution.
Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.001550
2022-06-08
2022-07-06
Loading full text...

Full text loading...

/deliver/fulltext/jmm/71/6/jmm001550.html?itemId=/content/journal/jmm/10.1099/jmm.0.001550&mimeType=html&fmt=ahah

References

  1. Guh AY, Mu Y, Winston LG, Johnston H, Olson D et al. Trends in US burden of Clostridioides difficile infection and outcomes. N Engl J Med 20201320–1330 [View Article]
    [Google Scholar]
  2. Louh IK, Greendyke WG, Hermann EA, Davidson KW, Falzon L et al. Clostridium difficile infection in acute care hospitals: systematic review and best practices for prevention. Infect Control Hosp Epidemiol 2017; 38:476–482 [View Article] [PubMed]
    [Google Scholar]
  3. McDonald LC, Killgore GE, Thompson A, Owens RC Jr, Kazakova SV et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005; 353:2433–2441 [View Article] [PubMed]
    [Google Scholar]
  4. Stabler RA, Dawson LF, Phua LTH, Wren BW. Comparative analysis of BI/NAP1/027 hypervirulent strains reveals novel toxin B-encoding gene (tcdB) sequences. J Med Microbiol 2008; 57:771–775 [View Article] [PubMed]
    [Google Scholar]
  5. Jones IA, Joshi LT. Biocide use in the antimicrobial era: a review. Molecules 2021; 26:2276 [View Article] [PubMed]
    [Google Scholar]
  6. Jencson AL, Cadnum JL, Wilson BM, Donskey CJ. Spores on wheels: wheelchairs are a potential vector for dissemination of pathogens in healthcare facilities. Am J Infect Control 2019; 47:459–461 [View Article] [PubMed]
    [Google Scholar]
  7. Dyer C, Hutt LP, Burky R, Joshi LT, Nojiri H. Biocide resistance and transmission of Clostridium difficile spores spiked onto clinical surfaces from an American health care facility. Appl Environ Microbiol 2019; 85:e01090–19 [View Article] [PubMed]
    [Google Scholar]
  8. Tarrant J, Jenkins RO, Laird KT. From ward to washer: the survival of Clostridium difficile spores on hospital bed sheets through a commercial UK NHS healthcare laundry process. Infect Control Hosp Epidemiol 2018; 39:1406–1411 [View Article]
    [Google Scholar]
  9. Reveles KR, Pugh MJV, Lawson KA, Mortensen EM, Koeller JM et al. Shift to community-onset Clostridium difficile infection in the National Veterans Health Administration, 2003-2014. Am J Infect Control 2018; 46:431–435 [View Article] [PubMed]
    [Google Scholar]
  10. Owen L, Laird K. The role of textiles as fomites in the healthcare environment: a review of the infection control risk. PeerJ 2020; 8:e9790 [View Article] [PubMed]
    [Google Scholar]
  11. Reddy SC, Valderrama AL, Kuhar DT. Improving the use of personal protective equipment: applying lessons learned. Clin Infect Dis 2019; 69:S165–S170 [View Article] [PubMed]
    [Google Scholar]
  12. Kilinc FS. A review of isolation gowns in healthcare: fabric and gown properties. Journal of Engineered Fibers and Fabrics 2015; 10:155892501501000 [View Article]
    [Google Scholar]
  13. Kilinc Balci FS. Isolation gowns in health care settings: laboratory studies, regulations and standards, and potential barriers of gown selection and use. Am J Infect Control 2016; 44:104–111 [View Article] [PubMed]
    [Google Scholar]
  14. Mitchell A, Spencer M, Edmiston C Jr. Role of healthcare apparel and other healthcare textiles in the transmission of pathogens: a review of the literature. J Hosp Infect 2015; 90:285–292 [View Article] [PubMed]
    [Google Scholar]
  15. Joshi LT, Phillips DS, Williams CF, Alyousef A, Baillie L. Contribution of spores to the ability of Clostridium difficile to adhere to surfaces. Appl Environ Microbiol 2012; 78:7671–7679 [View Article] [PubMed]
    [Google Scholar]
  16. Weese JS, Reid-Smith RJ, Avery BP, Rousseau J. Detection and characterization of Clostridium difficile in retail chicken. Lett Appl Microbiol 2010; 50:362–365 [View Article] [PubMed]
    [Google Scholar]
  17. Edwards AN, Karim ST, Pascual RA, Jowhar LM, Anderson SE et al. Chemical and stress resistances of Clostridium difficile spores and vegetative cells. Front Microbiol 2016; 7:1698 [View Article] [PubMed]
    [Google Scholar]
  18. Quinn CD, Sefers SE, Babiker W, He Y, Alcabasa R et al. C. diff quik chek complete enzyme immunoassay provides a reliable first-line method for detection of Clostridium difficile in stool specimens. J Clin Microbiol 2010; 48:603–605 [View Article] [PubMed]
    [Google Scholar]
  19. Joshi LT, Mali BL, Geddes CD, Baillie L. Extraction and sensitive detection of toxins A and B from the human pathogen Clostridium difficile in 40 seconds using microwave-accelerated metal-enhanced fluorescence. PLoS One 2014; 9:e104334 [View Article] [PubMed]
    [Google Scholar]
  20. Stubbs SLJ, Brazier JS, O’Neill GL, Duerden BI. PCR targeted to the 16S-23S rRNA gene intergenic spacer region of gene intergenic spacer region of Clostridium difficile and construction of a library consisting of 116 different PCR ribotypes. J Clin Microbiol 1999; 37:461–463 [View Article]
    [Google Scholar]
  21. Lemee L, Dhalluin A, Testelin S, Mattrat MA, Maillard K et al. Multiplex PCR targeting tpi (triose phosphate isomerase), tcdA (Toxin A), and tcdB (Toxin B) genes for toxigenic culture of Clostridium difficile. J Clin Microbiol 2004; 42:5710–5714 [View Article] [PubMed]
    [Google Scholar]
  22. Veloo ACM, Jean-Pierre H, Justesen US, Morris T, Urban E et al. An overview of the data obtained during the validation of an optimized MALDI-TOF MS Biotyper database for the identification of anaerobic bacteria. Data Brief 2018; 18:1484–1496 [View Article] [PubMed]
    [Google Scholar]
  23. Glasset B, Herbin S, Granier SA, Cavalié L, Lafeuille E et al. Bacillus cereus, a serious cause of nosocomial infections: epidemiologic and genetic survey. PLoS One 2018; 13:e0194346 [View Article] [PubMed]
    [Google Scholar]
  24. Wazir M, Jain AG, Nadeem M, Ur Rahman A, Everett G. Clostridium tertium bacteremia in a non-neutropenic patient with liver cirrhosis. Cureus 2019; 11:e4432 [View Article] [PubMed]
    [Google Scholar]
  25. Tyrrell KL, Citron DM, Leoncio ES, Merriam CV, Goldstein EJC. Evaluation of cycloserine-cefoxitin fructose agar (CCFA), CCFA with horse blood and taurocholate, and cycloserine-cefoxitin mannitol broth with taurocholate and lysozyme for recovery of Clostridium difficile isolates from fecal samples. J Clin Microbiol 2013; 51:3094–3096 [View Article] [PubMed]
    [Google Scholar]
  26. Barrie D, Hoffman PN, Wilson JA, Kramer JM. Contamination of hospital linen by Bacillus cereus. Epidemiol Infect 1994; 113:297–306 [View Article] [PubMed]
    [Google Scholar]
  27. Vongsavath T, Salvo R. S2657 Clostridium tertium liver abscess: a case report on bacteremia following prolonged common bile stent. Am J Gastroenterol 2021; 116:S1114–S1115 [View Article]
    [Google Scholar]
  28. Bulla LA, St Julian G, Rhodes RA, Hesseltine CW. Scanning electron and phase-contrast microscopy of bacterial spores. Appl Microbiol 1969; 18:490–495 [View Article] [PubMed]
    [Google Scholar]
  29. Panessa-Warren BJ, Tortora GT, Warren JB. High resolution FESEM and TEM reveal bacterial spore attachment. Microsc Microanal 2007; 13:251–266 [View Article] [PubMed]
    [Google Scholar]
  30. Hota B. Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection?. Clin Infect Dis 2004; 39:1182–1189 [View Article] [PubMed]
    [Google Scholar]
  31. Wilson GM, Jackson VB, Boyken LD, Schweizer ML, Diekema DJ et al. Bioaerosols generated from toilet flushing in rooms of patients with Clostridioides difficile infection. Infect Control Hosp Epidemiol 2020; 41:517–521 [View Article] [PubMed]
    [Google Scholar]
  32. Redmond SN, Pearlmutter BS, Ng-Wong YK, Alhmidi H, Cadnum JL et al. Timing and route of contamination of hospitalized patient rooms with healthcare-associated pathogens. Infect Control Hosp Epidemiol 2021; 42:1076–1081 [View Article] [PubMed]
    [Google Scholar]
  33. Deshpande A, Cadnum JL, Fertelli D, Sitzlar B, Thota P et al. Are hospital floors an underappreciated reservoir for transmission of health care-associated pathogens?. Am J Infect Control 2017; 45:336–338 [View Article] [PubMed]
    [Google Scholar]
  34. Koganti S, Alhmidi H, Tomas ME, Cadnum JL, Jencson A et al. Evaluation of hospital floors as a potential source of pathogen dissemination using a nonpathogenic virus as a surrogate marker. Infect Control Hosp Epidemiol 2016; 37:1374–1377 [View Article] [PubMed]
    [Google Scholar]
  35. Katoh I, Tanabe F, Kasai H, Moriishi K, Shimasaki N et al. Potential risk of virus carryover by fabrics of personal protective gowns. Front Public Health 2019; 7:121 [View Article] [PubMed]
    [Google Scholar]
  36. Hicks A, Temizel-Sekeryan S, Kontar W, Ghamkhar R, Rodríguez Morris M. Personal respiratory protection and resiliency in a pandemic, the evolving disposable versus reusable debate and its effect on waste generation. Resour Conserv Recycl 2021; 168:105262 [View Article] [PubMed]
    [Google Scholar]
  37. Singh N, Tang Y, Ogunseitan OA. Environmentally sustainable management of used personal protective equipment. Environ Sci Technol 2020; 54:8500–8502 [View Article] [PubMed]
    [Google Scholar]
  38. Prechter F, Katzer K, Bauer M, Stallmach A. Sleeping with the enemy: Clostridium difficile infection in the intensive care unit. Crit Care 2017; 21:260 [View Article] [PubMed]
    [Google Scholar]
  39. Crobach MJT, Vernon JJ, Loo VG, Kong LY, Péchiné S et al. Understanding Clostridium difficile colonization. Clin Microbiol Rev 2018; 31:9 [View Article] [PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.001550
Loading
/content/journal/jmm/10.1099/jmm.0.001550
Loading

Data & Media loading...

Most cited this month Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error