Thirteen years of environmental surveillance of ESKAPE organisms and Escherichia coli in an equine hospital: Informing infection control

BACKGROUND: Bacteria from the ESKAPE group (i.e., Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species) and Escherichia coli are frequently multidrug-resistant and can be associated with healthcare-associated infections, an increasing concern for veterinary settings. OBJECTIVES: To determine the environmental prevalence of ESKAPE and E. coli on surfaces which can act as reservoirs of infection in clinical areas in equine hospitals. STUDY DESIGN: Observational study. METHODS: Routine environmental sampling was performed in one busy equine hospital with Swiffer® wipes to screen surfaces from high-risk areas (e.g., surgical theatres, intensive care unit [ICU], isolation unit), equipment (e.g., endotracheal tubes) and high-touch areas (e.g., keyboards) following selective species-specific protocols for each target organism. Monitoring hand-hygiene of hospital staff and students was by hand-plate sampling. After a pilot phase E. faecium was excluded from routine screening. RESULTS: Nine hundred and ninety-five environmental and hand-plate samples were collected from April 2010 to February 2023. The overall E. coli-SKAPE (E. coli, methicillin-resistant S. aureus [MRSA], K. pneumoniae, A. baumannii, P. aeruginosa and Enterobacter spp.) prevalence was 37.9%, where E. coli was the most (and K. pneumoniae the least) common target organism identified (18.0% and 1.7% respectively). E. coli was most prevalent in general stables and yards (37.7%) and offices (25.7%). Enterobacter spp. was the main organism in the environmental samples from ICU (24.2%) and isolation unit (22.9%, along with E. coli). Concerningly, hand-plate sampling showed that MRSA was the most common organism detected on hands (8.4%), followed by A. baumannii (5.2%) and E. cloacae (3.9%); however, E. coli, P. aeruginosa and K. pneumoniae were not found in these samples. MAIN LIMITATIONS: Inconsistent sampling limited longitudinal analysis. CONCLUSIONS: We generated baseline environmental contamination data and demonstrated high E. coli-SKAPE hospital surface and hand contamination, informing infection control to prevent environment-to-patient cross-transmission.