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Teruo Shiomori, MD, PhD; Hiroshi Miyamoto, MD, PhD; Kazumi Makishima, MD, PhD

Arch Otolaryngol Head Neck Surg. 2001;127:644-648.

Objectives  To quantitatively investigate the existence of airborne methicillin-resistant Staphylococcus aureus (MRSA) in a hospital environment and to perform phenotyping and genotyping of MRSA isolates to study MRSA epidemiology.

Design  Prospective surveillance of patients with MRSA infections or colonizations was performed, as was an observational study of environmental airAirborne samples were taken by an air sampler; samples were obtained from object surfaces by stamping or swabbing. Epidemiological study of MRSA isolates was performed with an antibiotic susceptibility test, coagulase typing, and pulsed-field gel electrophoresis.

Setting  Three single-patient rooms in a 37-bed otolaryngology–head and neck surgery unit.

Patients  Three patients with squamous cell head and neck cancer were observed to have been colonized or infected with MRSA after surgery.

Results  The MRSA samples were collected from the air in single-patient rooms during both a period of rest and when bedsheets were being changed. Isolates of MRSA were detected in all stages (from stage 1 [>7 µm] to stage 6 [0.65-1.1 µm]). About 20% of the MRSA particles were within a respirable range of less than 4 µm. Methicillin-resistant S aureus was also isolated from inanimate environments, such as sinks, floors, and bedsheets, in the rooms of the patients with MRSA infections as well as from the patients' hands. An epidemiological study demonstrated that clinical isolates of MRSA in our ward were of one origin and that the isolates from the air and from inanimate environments were identical to the MRSA strains that caused infection or colonization in the inpatients.

Conclusions  Methicillin-resistant S aureus was recirculated among the patients, the air, and the inamimate environments, especially when there was movement in the rooms. Airborne MRSA may play a role in MRSA colonization in the nasal cavity or in respiratory tract MRSA infections. Measures should be taken to prevent the spread of airborne MRSA to control nosocomial MRSA infection in hospitals.

From the Departments of Otorhinolaryngology (Drs Shiomori and Makishima) and Microbiology (Dr Miyamoto), University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.

Corresponding author and reprints: Teruo Shiomori, MD, PhD, Department of Otorhinolaryngology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu 807-8555, Japan.

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