B104-17 Pathogen Prevalence on Paper-Packaged Supplies in Pediatric ICU Bedside Supply Carts: The Path-Prev Study

Rationale Single-use sterile supplies used in intensive care units (ICUs) are often stored in bedside supply carts. Supplies with paper packaging cannot be wiped with disinfectants and carry an unknown risk of transmitting hospital-acquired infection (HAI) to subsequent patients. Discarding these supplies between patient admissions has financial and environmental costs. We aimed to determine the prevalence of pathogens on these supplies in bedside supply carts at the time of patient discharge from pediatric ICU (PICU). Methods Over 7 weeks, during research coordinator hours, 840 paper-packaged supply items from 70 consecutive bedside carts were swabbed after patient discharge from two pediatric ICUs [PICU=50, Pediatric Cardiac ICU=20]. One swab was used to swab three supply items with paper packaging contained in a single drawer in a room’s bedside cart. Carts had two drawers sampled, each with a swab sent for bacterial culture and respiratory viral nucleic acid amplification testing (NAAT). Rooms on isolation for spore-related infection (Clostridioides difficile) were excluded. Pathogens were pre-specified to include Staphylococcus aureus, Enterococcus sp., gram-negative bacilli (GNB) including Pseudomonas sp., Enterobacter sp., Serratia sp., and Stenotrophomonas sp., and Candida sp. These organisms were considered pathogens because they are not commensal organisms, and each can develop multiple resistance mechanisms to become multi-drug resistant organisms. For example, methicillin-resistant Staphylococcus aureus (MRSA), carbapenemase-producing GNB, and piperacillin-tazobactam resistant GNB. Common and commensal skin and oral flora that might be cultured were pre-specified as non-pathogens as they colonize all patients and staff. Results All bacterial swabs had no growth of a pathogen [0/140 (0%)]. Non-pathogens were cultured from 8/140 (5.7%) swabs [7/70 (10.0%) carts], most with scant growth [7/8 (87.5%) with growth of only one colony]. Non-pathogens included coagulase-negative staphylococci (n = 5), Actinomyces oris (n = 1), aerobic spore-forming Bacillus [not Bacillus anthracis] (n = 1), and viridans group streptococcus [non-anginosus] (n = 1). Of viral swabs, 3/140 (2.1%, enterovirus/rhinovirus n = 2, parainfluenza n = 1) were NAAT positive [3/70 (4.3%) carts, 2/50 from rooms not on vs. 1/20 from rooms on isolation], with most [2/3 (66.7%)] only weakly positive [relative light units <100]. Room isolation status, length of stay, and ICU were not associated with a positive bacterial or viral swab. Conclusions Risk of transmission of bacterial HAI was extremely low. Viral NAAT detection exaggerates the risk of fomite transmission, as whether there was viable virus at sufficient concentration to cause an infection is unknown. The risk of viral HAI was likely very low.