Significance of Airborne Transmission of Methicillin-Resistant Staphylococcus aureus in an Otolaryngology–Head and Neck Surgery Unit | Facial Plastic Surgery | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Gottlieb  RDShah  MKPerlman  DCKimmelman  CP Community-acquired methicillin-resistant Staphylococcus aureus infections in otolaryngology.  Otolaryngol Head Neck Surg.1992;107:434-437.Google Scholar
Suh  HKJeon  YHSong  JSHwang  SJCheong  HJ A molecular epidemiologic study of methicillin-resistant Staphylococcus aureus infection in patients undergoing middle ear surgery.  Eur Arch Otorhinolaryngol.1998;255:347-351.Google Scholar
Parton  MBeasley  NJHarvey  GHoughton  DJones  AS Four cases of aggressive MRSA wound infection following head and neck surgery.  J Laryngol Otol.1997;111:874-876.Google Scholar
Boyce  JMPotter-Bynoe  GChenevert  CKing  T Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications.  Infect Control Hosp Epidemiol.1997;18:622-627.Google Scholar
Kumari  DNHaji  TCKeer  VHawkey  PMDuncanson  VFlower  E Ventilation grilles as a potential source of methicillin-resistant Staphylococcus aureus causing an outbreak in an orthopaedic ward at a district general hospital.  J Hosp Infect.1998;39:127-133.Google Scholar
Silas  JCHarrison  MACarpenter  JARoth  IL Airborne aflatoxin in corn processing facilities in Georgia.  Am Ind Hyg Assoc J.1987;48:198-201.Google Scholar
Shiomori  TYoshida  SMiyamoto  HMakishima  K Relationship of nasal carriage of Staphylococcus aureus to pathogenesis of perennial allergic rhinitis.  J Allergy Clin Immunol.2000;105:449-454.Google Scholar
Murakami  KMinamide  WWada  KNakamura  ETeraoka  HWatanabe  S Identification of methicillin-resistant strains of staphylococci by polymerase chain reaction.  J Clin Microbiol.1991;29:2240-2244.Google Scholar
National Committee for Clinical Laboratory Standards Performance Standards for Antimicrobial Susceptibility Testing.  Villanova, Pa: National Committee for Clinical Laboratory Standards1994;14:204-205.
Oie  SKamiya  A Survival of methicillin-resistant Staphylococcus aureus (MRSA) on naturally contaminated dry mops.  J Hosp Infect.1996;34:145-149.Google Scholar
Jorgensen  MGivney  RPegler  MVickery  AFunnell  G Typing multidrug-resistant Staphylococcus aureus: conflicting epidemiological data produced by genotypic and phenotypic methods clarified by phylogenetic analysis.  J Clin Microbiol.1996;34:398-403.Google Scholar
Struelens  MJDeplano  AGodard  CMaes  NSerruys  E Epidemiologic typing and delineation of genetic relatedness of methicillin-resistant Staphylococcus aureus by macrorestriction analysis of genomic DNA by using pulsed-field gel electrophoresis.  J Clin Microbiol.1992;30:2599-2605.Google Scholar
Andersen  AA New sampler for the collection, sizing, and enumeration of viable airborne particles.  J Bacteriol.1958;76:471-484.Google Scholar
Simard  CTrudel  MPaquette  GPayment  P Microbial investigation of the air in an apartment building.  J Hyg Lond.1983;91:277-286.Google Scholar
Hartstein  AILeMonte  AMIwamoto  PK DNA typing and control of methicillin-resistant Staphylococcus aureus at two affiliated hospitals.  Infect Control Hosp Epidemiol.1997;18:42-48.Google Scholar
Dominguez  MAde Lencastre  HLinares  JTomasz  A Spread and maintenance of a dominant methicillin-resistant Staphylococcus aureus (MRSA) clone during an outbreak of MRSA disease in a Spanish hospital of methicillin-resistant Staphylococcus aureus by macrorestriction analysis of genomic DNA by using pulsed-field gel electrophoresis.  J Clin Microbiol.1994;32:2081-2087.Google Scholar
van Belkum  Avan Leeuwen  WVerkooyen  RSacilik  SCCokmus  CVerbrugh  H Dissemination of a single clone of methicillin-resistant Staphylococcus aureus among Turkish hospitals.  J Clin Microbiol.1997;35:978-981.Google Scholar
Pritchard  VGSanders  N Universal precautions: how effective are they against methicillin-resistant Staphylococcus aureus J Gerontol Nurs.1991;17:6-11.Google Scholar
Sheretz  RJReagan  DRHampton  KD  et al A cloud adult: the Staphylococcus aureus–virus interaction revisited.  Ann Intern Med.1996;124:539-547.Google Scholar
Original Article
June 2001

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

Author Affiliations

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

Arch Otolaryngol Head Neck Surg. 2001;127(6):644-648. doi:10.1001/archotol.127.6.644

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.