Fig. 5: A representative interactive visit that resulted in a transmission event.

This participant, who was colonized with VRE at the hand, visited the rehabilitation gym for physical and occupational therapy. The first piece of equipment used by the participant was a hand weight; the hand weight was negative for any MDRO prior to use and was contaminated with VRE after approximately 6 minutes of participant contact. This change in surface contamination is an example of a transmission event, with the source being the participant’s hand and the destination surface being the weight. The participant’s hand remained colonized with VRE during the session. The walker was used next by the participant -- it was negative for any MDRO prior to use and after two minutes of use, no transmission occurred. The last item of contact, the blood pressure cuff, was not swabbed before use, but was negative for any MDRO after being on the participant’s arm for five minutes. The bare hand of the physical therapist was negative for any MDRO after taking the participant’s blood pressure. The occupational therapist’s gloved hand was positive for VRE at the end of the session, following several touches to the participant and walker. Because we only swabbed the occupational therapist’s hand one time, we cannot conclusively say a transmission occurred (as we do not know if their hand was negative at the session start). The participant’s hand remained colonized with VRE at the end of the session. “Nurse” icon by Llisole from https://thenounproject.com/browse/icons/term/nurse/ CC BY 3.0. All other icons downloaded from thenounproject.com via a paid subscription (no attribution required).