{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T06:28:25Z","timestamp":1791872905050,"version":"4.3.4"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T00:00:00Z","timestamp":1731024000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Hospital surfaces are known to contribute to the spread of healthcare-associated antimicrobial pathogens. Environmental sampling can help locate reservoirs and determine intervention strategies, although sampling and detection can be labor intensive. Composite approaches may help reduce time and costs associated with sampling and detection. We investigated optimum surface areas for sampling antimicrobial-resistant organisms (AROs) with a single side of cellulose sponge, created theoretical composites (TC) by adding recovery results from multiple optimum areas, then compared the TC to the standard Centers for Disease Control and Prevention sampling method (one sponge using all sides, whole tool; (WT)). Five AROs were evaluated: carbapenemase-producing KPC+ <jats:italic>Klebsiella pneumoniae<\/jats:italic> (KPC), <jats:italic>Acinetobacter baumannii<\/jats:italic> (AB), methicillin-resistant <jats:italic>Staphylococcus aureus<\/jats:italic> (MRSA), vancomycin-resistant <jats:italic>Enterococcus faecalis<\/jats:italic> (VRE) <jats:italic>and Clostridioides difficile<\/jats:italic> spores (CD). Steel coupons comprising four surface areas (323; 645; 1,290 and 2,258 cm<jats:sup>2<\/jats:sup>) were inoculated, dried, and sampled with one sampling pass using the larger side (face) or the smaller side (edge) of a pre-moistened cellulose sponge tool. Based on the optimum areas determined for each organism, composite areas were 1,290 cm<jats:sup>2<\/jats:sup> for MRSA and VRE, 1,936 cm<jats:sup>2<\/jats:sup> for AB, 2,580 cm<jats:sup>2<\/jats:sup> for CD spores and 3,870 cm<jats:sup>2<\/jats:sup> for KPC. Total colony forming units (CFU) recovered using a composite approach was greater or comparable than using multiple WT samplings (over the same area as the composite) for MRSA, VRE and AB (130%; 144% and 95%) yet less than if using multiple WT samplings for KP and CD (47% and 66%). We propose a conservative composite sampling strategy if the target organism is unknown; 323 cm<jats:sup>2<\/jats:sup> sampling area for each of the four sides of the sponge, (1290 cm<jats:sup>2<\/jats:sup> total). The conservative composite sampling strategy improved the recovery of KP (from 47% to 85% of multiple WT samplings), while MRSA, VRE, AB and CD (131%; 144%; 97% and 66%) remained within 5% to that of the optimum area TC.<\/jats:p>","DOI":"10.1371\/journal.pone.0310283","type":"journal-article","created":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T18:34:09Z","timestamp":1731090849000},"page":"e0310283","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Investigating surface area and recovery efficiency of healthcare-associated pathogens to optimize composite environmental sampling"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4884-0183","authenticated-orcid":true,"given":"Monica Y.","family":"Chan-Riley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan R.","family":"Edwards","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Noble-Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Rose","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,11,8]]},"reference":[{"key":"pone.0310283.ref001","volume-title":"HAI and Antimicrobial Use Prevalence Surveys","author":"CDC","year":"2024"},{"issue":"12","key":"pone.0310283.ref002","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1017\/ice.2016.198","article-title":"Assessment of the Overall and Multidrug-Resistant Organism Bioburden on Environmental Surfaces in Healthcare Facilities.","volume":"37","author":"AM Shams","year":"2016","journal-title":"Infection Control & Hospital Epidemiology."},{"issue":"18","key":"pone.0310283.ref003","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1056\/NEJMoa1801550","article-title":"Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals","volume":"379","author":"SS Magill","year":"2018","journal-title":"N Engl J Med"},{"issue":"3","key":"pone.0310283.ref004","first-page":"1266","article-title":"The role of the hospital environment in the healthcare-associated infections: a general review of the literature.","volume":"23","author":"A Facciola","year":"2019","journal-title":"Eur Rev Med Pharmacol Sci"},{"issue":"4","key":"pone.0310283.ref005","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.ajic.2004.04.197","article-title":"The benefits of surface disinfection.","volume":"32","author":"WA Rutala","year":"2004","journal-title":"Am J Infect Control"},{"issue":"SUPPL. 2","key":"pone.0310283.ref006","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/S0195-6701(07)60015-2","article-title":"Environmental contamination makes an important contribution to hospital infection.","volume":"2","author":"JM Boyce","year":"2007","journal-title":"J Hosp Infect"},{"issue":"1","key":"pone.0310283.ref007","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.jmii.2018.02.001","article-title":"Predominance of methicillin-resistant Staphylococcus aureus in the residents and environments of long-term care facilities in Taiwan.","volume":"52","author":"CY Liu","year":"2019","journal-title":"J Microbiol Immunol Infect"},{"issue":"3","key":"pone.0310283.ref008","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1007\/BF00456662","article-title":"Editorial: Composite sampling.","volume":"2","author":"GP Patil","year":"1995","journal-title":"Environmental and Ecological Statistics"},{"issue":"2","key":"pone.0310283.ref009","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/s10651-011-0174-z","article-title":"Composite sampling: A novel method to accomplish observational economy in environmental studies: A monograph introduction.","volume":"18","author":"GP Patil","year":"2011","journal-title":"Environmental and Ecological Statistics"},{"issue":"4","key":"pone.0310283.ref010","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.jhin.2019.07.015","article-title":"How to carry out microbiological sampling of healthcare environment surfaces? 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