Cleaning House—Environmental Contamination in the Home

Recurrent Staphylococcus aureus infections are a major problem. In their report on an intensive environmental investigation of the homes of persons diagnosed with community-acquired methicillin-resistant S aureus (MRSA) published in this issue of JAMA Internal Medicine, Knox and colleagues¹ found that the clinical isolate that caused the initial infection could be cultured from the surfaces of 24.4% of the homes, including television remotes, door knobs, computers, and couches. Of greater importance, patients from houses where MRSA could be cultured were twice as likely to develop a recurrent infection.

However, before we instruct our patients with MRSA to decontaminate their houses, remember this is a small preliminary study. Of the 35 patients who had recurrent infection, only 13 (37%) had contaminated homes. Of the 20 with contaminated homes, 7 (35%) did not develop a recurrent infection. We do not know that those who developed recurrences acquired the second infection from their home. Those with contaminated homes may have shed more bacteria owing to more severe infections and the more severe infections may have led to the recurrences. Most important, we do not know if it is possible to decontaminate a home of MRSA. It is hard enough to decontaminate a hospital room with nonporous surfaces. Thinking of my own home inhabited by 2 messy children and 2 not-so-neat adults, I cannot imagine how we would even begin to decontaminate the couch. Still, we should understand the potential sources of recurrent infections and keep an open mind about what can and cannot be prevented.

Conflict of Interest Disclosures: None reported.