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Significance of Airborne Transmission of Methicillin-Resistant Staphylococcus aureus in an Otolaryngology–Head and Neck Surgery Unit
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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