Tracking Pathogen Contamination in a New Children’s Outpatient Pulmonary Clinic

Pathogens causing health care-associated infections (HAIs) can be transmitted from environmental surfaces via direct contact by patients and visitors. There's limited research on pathogen contamination in newly constructed outpatient clinics. A study presented at The 2024 Association for Professionals in Infection Control and Epidemiology (APIC) Annual Conference & Exposition held from June 3 to 5 in San Antonio, Texas, aimed to observe methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas species contamination on surfaces in a newly built children’s outpatient pulmonary clinic during construction and after it began accepting patients.

Before the conference, to learn more about their presentation, Infection Control Today^® (ICT^®) spoke with Henry Spratt, PhD, senior microbiologist and professor in the Department of Biology, Geology, and Environmental Science in the University of Tennessee at Chattanooga, Tennessee, and an ICT Editorial Advisory Board member; David Levine, PhD, PT, DPT, MPH, CCRP, FAPTA, board-certified clinical specialist in orthopedic physical therapy emeritus, in the University of Tennessee at Chattanooga, Tennessee, and an ICT Editorial Advisory Board member; and Caitlin Crews-Stowe, PhD, MPH, assistant professor in public health and health science at the University of Tennessee at Chattanooga.

ICT also spoke with Crews-Stowe at the conference in the video above.

“While we were working at the local hospital in their inpatient clinics, they had constructed a new facility,” Spratt told ICT, “It was going to be for outpatient clinics on their campus. It was right across the street from their main building, and through discussions with our colleagues who were physicians there, we managed to get permission to go in and start a study in several areas of that new building while it was still under construction.”

The study highlighted on the poster tracked bacterial contamination in a children's pulmonary outpatient clinic for at least 6 months post-patient visits. Researchers investigated Pseudomonas, especially Pseudomonas argininosis, due to its impact on cystic fibrosis patients. They also monitored staphylococci, Clostridium difficile, and other cultures throughout the building. This study is part of a broader investigation into bacterial presence in different areas of the facility before, during, and after patient visits. The focus of the APIC poster was on staff and Pseudomonas bacteria.

“What we found was that MRSA presence increased from about 3% on surfaces during the construction phase to 37% of surfaces 3 months after the patients were introduced into the facility, and then they found that Pseudomonas species,” Crewes-Stowe said. “The presence there was none during the construction, and it jumped to again to 37% on surfaces after patient introduction. Both of those were statistically significant, and we had many sampling opportunities, so we saw that it was up and that it was also maintained during the sampling period. This highlights the importance of and the interesting fact that patients contaminate everything that they touch.”

She continued with a memorable image. “I like to think of them as Pig Pen from Peanuts, with the little cloud of dust leading everywhere they go. That's how I used to tell my nurses in the hospital to treat them as if they're little Pig Pens, and we don't want to catch anything. [The study] highlights and drives home the fact the importance of environmental disinfection. Because this study was able to show that even during construction, which is very obviously dirty, it wasn't until the patients were introduced that we saw this marked increase in these pathogens that can be very significant for these patients that have immunocompromised systems.”

When asked what inspired the research, Levine said, “I think it goes back to the same thing that inspires most things related to prevention of infectious disease and treatment in that we are trying to help eliminate some of the sources and to prevent as many patients as possible from getting sick. And I think that's the bottom line. We don't know how to clean things appropriately if we don't know where they are. That is probably a common thread that you hear in every podcast, but that's why people in infection prevention and control do what they do.”