Shedding of Enterococci and environment contamination

in patients with nosocomial diarrhoea

M.Röttig (1, 2), E-M. Zeitlberger (3), O. Janata (3, 4), R. Bliem (1)
(1) FH Campus Wien, (2) Laboratorium für Betriebshygiene, Wien, (3) Donauspital, Wien, (4) Al Ain Hospital, Abu Dhabi VAE

Introduction
Vancomycin-resistant Enterococci (VRE) are bacterial pathogens that pose an increasing threat to hospitalized patients. It is critical that their dissemination
thoughout the hospital be prevented as far as possible. Enterococci (EC) are shed with the stool and can contaminate the patient bedside environment. However,
the degree to which diarrhoea patients shed ECs and thereby contribute to the spread of nosocomial pathogens is as yet unclear. The aim of this study was to
determine the degree to which nosocomial (i.e. hospitial-aquired) diarrhoea patients shed these pathogens and whether patient mobility plays a role.

Method Results
The relative EC-burden at the bedside environment We defined a minimum of 2 cfu as the threshold level to exclude
was determined with 81 patients, 46 with and 35 contaminations. Thus we observed shedding of Enterococci (at least 2
without diarrhoea, using sedimentation-plates, 2 plates cfu per plate) in 21 surroundings of 46 patients with diarrhoea (46%), but
per bed, with selective media. The exposure time was only in 7 of 35 patients without (20%).
2 hours; plates were then incubated at 37°C for 5
days. Colonies were counted and defined as colony Furthermore, 57% of the bedridden non-mobile patients showed elevated
forming units (cfu). EC levels, compared to only 27% of patients which were mobile and
The collected patient data included the degree of could use the toilets and in 43% of the partially mobile patients.
patient mobility (ability to use toilet facilities), duration Conclusion
of hospitalization and the presence or absence of In the control group (without diarrhoea) 36 % of the bedridden patients Nosocomial, enterococcal
diarrhoea. Diarrhoea was defined as nosocomial if showed a EC-positive environment, compared to only 17 % of the mobile diarrhoea represents a significant
symptoms started later then 72 hours after admission patients. 4 of 7 EC-positive patients without diarrhoea were located next risk factor in the dissemination of
to EC-positive Patients with diarrhoea. nosocomial pathogens and may
. serve as a new hygiene indicator
in monitoring the dissemination of
Patients diarrhea associated organisms.
Patients
without diarrhoea Furthermore, patient assistance in
with diarrhoea
using toilet facilities, i.e. mobility
Degree of EC positiv EC negativ EC positiv EC negativ was shown to reduce the level of
mobility environment environment environment Environment dissemination of nosocomial
3 of 11 patients 8 of 11 patients 2 of 12 patients 10 of 12 patients
Mobile patients diarrhoea pathogens. In conclusion
(27%) (73%) (17%) (83%)
the study suggests that the
11 of 12 patients
Partially mobile 6 of 14 patients 8 of 14 patients 1 of 12 patients segregation non-mobile diarrhea
(92%)
patients (43%) (57%) (8%) patients will reduce the transfer of
diarrheal Enteroccoci to other
Bedridden 12 of 21 9 of 21 patients 4 of 11 patients 7 of 11 patients
Sedimentations-plates with selective media for enterococci patients patients (57%) (43%) (36%) (64%)
patients.
were placed behind and beside patients‘ bed.
 Patients
Patients
without diarrhoea
with diarrhoea

Mobility EC positiv EC negativ EC positiv EC negativ

Status environment environment environment Environment

3 of 11 8 of 11 2 of 12 10 of 12
Mobile patients
patients patients patients
patients
(27%) (73%) (17%) (83%)

11 of 12
Partially 6 of 14 8 of 14 1 of 12 patients
mobile patients patients patients
(92%)
patients (43%) (57%) (8%)

12 of 21 9 of 21 4 of 11 7 of 11
Bedridden
patients patients patients patients
patients
(57%) (43%) (36%) (64%)