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 c ommun i t y a c q u i r e d me t h i c i l l i n r e s i s t a n t S aureus (MRSA) published in th i s i s sue o f 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 preliminarystudy.Of the35patientswhohadrecurrent 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 acquiredthesecondinfectionfromtheirhome.Thosewithcontaminatedhomesmayhave shedmorebacteria owing tomore severe infections and themore severe infectionsmayhave led to the recurrences.Most important,wedonotknow if it is possible to decontaminate a home of MRSA. It is hard enough to decontaminate a hospital room with nonporous surfaces. Thinking ofmy ownhome inhabited by 2messy 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 openmind about what can and cannot be prevented.