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Table 1 Key Studies that Examine the Role of Environment in Patient Infectious Disease Outcomes

From: One Health in hospitals: how understanding the dynamics of people, animals, and the hospital built-environment can be used to better inform interventions for antimicrobial-resistant gram-positive infections

Relation Organism Comments Reference
Increased Acquisition
 ENV - > Patient MRSA Outbreak of MRSA in hospital that lasted 2 years was found in hospital dust with the same genotype. [22]
 ENV - > Patient Not specific Patients assigned to shared bay rooms had a 21% greater relative risk of a central line infection (p = 0.005), compared with patients assigned to private rooms. At the hospital level, a 10% increase in private rooms was associated with an 8.6% decrease in central line infections (p < 0.001), regardless of individual patients’ room assignment. [23]
 ENV - > Patient MRSA Three of 26 patients who acquired MRSA while in the intensive care unit acquired MRSA from the environment, strains from the patients and their immediate environment were indistinguishable [24]
 ENV- > HCW VRE Contact with contaminated surfaces in the rooms of colonized patients results in transfer of VRE to gloved hands, despite cleaning with disinfectants [25]
 ENV - > HCW C. difficile Increasing levels of environmental contamination was positively associated with increasing amounts of C. difficile on the hands of healthcare workers, particularly for environmental sites that patients touch [26]
 Patient - > ENV C. difficile Surfaces in rooms exposed to a C. difficile patient had significantly increased odds of being contaminated with C. difficile, compared to surfaces in unexposed patient rooms [27]
 Patient - > HCW MRSA Two-thirds of staff enter a room containing an MRSA patient will acquire the patient’s strain on gloved hands or apron, even without touching patient directly (40%) [28]
 Patient - > Patient MRSA, VRE Admission to a room previously occupied by an MRSA-positive patient or a VRE-positive patient significantly increased the odds of acquisition for MRSA and VRE. [29]
 Patient - > Patient C. difficile Prior room occupant with CDI was a positive risk factor for new patient CDI acquisition, hazard ratio 2.35 p = .01 [30]
 Patient - > Patient Several (MRSA, C. difficile, VRE) Pooled acquisition odds ratio of 2.14 (95% confidence interval (CI), 1.65e2.77) for several bacteria from prior occupants, Gram positive 1.89 (95% CI: 1.62–2.21) [31]
 Patient - > ENV - > HCW MRSA In the colonized patient’s room, HCW exposure occurred more predominantly through the indirect (patient to surfaces to HCW) mode compared to the direct (patient to HCW) mode. [32]
Cleaning/Removal Reduces Human Acquisition
 ENV - > Patient MRSA Enhanced cleaning during an outbreak decreased the number of new affected patients, stopped outbreak, and saved an estimated £28,000. [22]
 ENV - > Patient General Lower infection rates associated with routine disinfection of surfaces (mainly floors) [33]
 ENV - > Patient C. difficile Daily disinfectant high touch surfaces and dedicated cleaning staff reduced CDI positive cultures by 60% [34]
 ENV - > Patient C. difficile Hydrogen peroxide vapor decontamination reduced CDI rate by 37% [35]
 ENV - > Patient VRE Hydrogen peroxide vapor reduced VRE by 80% [36]
 ENV - > Patient MRSA Reduction in acquired MRSA infections with enhanced targeted cleaning compared to routine cleaning, despite higher MRSA patient-days and bed occupancy rates during enhanced cleaning periods (P = 0.032: 95% CI 7.7, 92.3%). Genotyping identified indistinguishable strains from both hand-touch sites and patients [37]
 ENV - > HCW VRE Decreasing VRE contamination of environmental surfaces decreases hand colonization of VRE and VRE acquisition rates [38]
  1. MRSA methicillin-resistant Staphylococcus aureus, CDI C. difficile infection, VRE vancomycin-resistant Enterococcus, ENV hospital environment, HCW healthcare worker