Brief report
Evaluation of patients' skin, environmental surfaces, and urinary catheters as sources for transmission of urinary pathogens

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In hospitalized patients with urinary tract infection or asymptomatic bacteriuria, urinary pathogens frequently contaminate skin, high-touch environmental surfaces, and urinary catheters. Contamination is more common in patients with a urinary catheter in place and with gram-positive pathogens. Patients' skin and environmental surfaces may provide an important source for transmission of urinary pathogens.

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Methods

The Cleveland VA Medical Center Institutional Review Board approved the study protocol. During a 4-month period (July through October 2010), we conducted a prospective study of consecutive inpatients with bacteriuria (>105 colony-forming units of a urinary pathogen per mL of urine) identified in the microbiology laboratory. Medical records review was performed to obtain demographic data and information on medications, signs and symptoms of UTI, and laboratory tests. Patients were considered to

Results

Of the 54 patients with bacteriuria enrolled in this study, 31 (57%) had skin and/or environmental contamination with pathogens concordant with the organism in urine, including 29 (54%) with skin contamination and 19 (35%) with contamination of 1 or more environmental sites. There was no difference in the frequency of skin and/or environmental contamination between patients with UTI (n = 30) and those with ASB (n = 24) (data not shown). Of the 31 patients with a urinary catheter (29 with an

Discussion

In our hospitalized patients with UTI or ASB, urinary pathogens frequently contaminated skin, high-touch environmental surfaces, and urinary catheters. Contamination was significantly more common in patients with urinary catheters and with gram-positive pathogens in urine, and there was a trend toward increased contamination in patients with decreased mobility. These findings provide support for the hypothesis that skin and environmental surfaces of patients with bacteriuria represent an

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This work was supported by the Department of Veterans Affairs, United States Government and by the Centers for Disease Control and Prevention (Grant R01 C100614-02, to C.J.D.).

Conflict of interest: C.J.D has received research grants from STERIS, Pfizer, and GOJO, and has served on scientific advisory boards for 3M, EcoLab, and GOJO. There are no other conflicts of interest to report.

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