Please wait a minute...
Frontiers of Environmental Science & Engineering

ISSN 2095-2201

ISSN 2095-221X(Online)

CN 10-1013/X

Postal Subscription Code 80-973

2018 Impact Factor: 3.883

Front. Environ. Sci. Eng.    2021, Vol. 15 Issue (3) : 41    https://doi.org/10.1007/s11783-020-1333-y
RESEARCH ARTICLE
Occupational risk of exposure to methicillin-resistant Staphylococcus aureus (MRSA) and the quality of infection hygiene in nursing homes
Pil Uthaug Rasmussen1(), Katrine Uhrbrand1, Mette Damkjær Bartels2, Helle Neustrup2, Dorina Gabriela Karottki1,3, Ute Bültmann1,4, Anne Mette Madsen1
1. National Research Centre for the Working Environment, Lersø Parkallé 105, 2100 Copenhagen Ø, Denmark
2. Department of Clinical Microbiology, Hvidovre Hospital, Kettegård Allé 30, 2650 Hvidovre, Denmark
3. The Danish Working Environment Authority, Landskronagade 33, 2100 Copenhagen, Denmark
4. University Medical Center Groningen, Department of Health Sciences, Community & Occupational Medicine, University of Groningen, 9700 Groningen, The Netherlands
 Download: PDF(443 KB)   HTML
 Export: BibTeX | EndNote | Reference Manager | ProCite | RefWorks
Abstract

• Staff members were not colonised with MRSA.

• But staff were exposed to MRSA from air, sedimented dust and surfaces.

• MRSA was found in the rooms of MRSA-colonised residents but not in common areas.

• Staff worry about MRSA and spreading it to other residents, family, and acquaintances.

• The use of protective eyewear and facemasks could be improved.

Methicillin-resistant Staphylococcus aureus (MRSA) is an increasing health concern across the globe and is often prevalent at long-term care facilities, such as nursing homes. However, we know little of whether nursing home staff is exposed to MRSA via air and surfaces. We investigated whether staff members at nursing homes are colonised with and exposed to culturable MRSA, and assessed staff members’ self-reported knowledge of MRSA and compliance with infection hygiene guidelines. Five nursing homes with MRSA positive residents were visited in Copenhagen, Denmark. Personal bioaerosol exposure samples and environmental samples from surfaces, sedimented dust and bioaerosols were examined for MRSA and methicillin-susceptible S. aureus (MSSA) to determine occupational exposure. Swabs were taken from staffs’ nose, throat, and hands to determine whether they were colonised with MRSA. An online questionnaire about MRSA and infection control was distributed. No staff members were colonised with MRSA, but MRSA was detected in the rooms of the colonised residents in two out of the five nursing homes. MRSA was observed in air (n = 4 out of 42, ranging from 2.9–7.9 CFU/m3), sedimented dust (n = 1 out of 58, 1.1 × 103 CFU/m2/d), and on surfaces (n = 9 out of 113, 0.04–70.8 CFU/m2). The questionnaire revealed that half of the staff members worry about spreading MRSA to others. Identified aspects for improvement were improved availability and use of protective equipment, not transferring cleaning supplies (e.g., vacuum cleaners) between residents’ rooms and to reduce worry of MRSA, e.g., through education.

Keywords Antibiotic resistance      Airborne MRSA      Bioaerosols      Healthcare-associated infections      Healthcare worker      Occupational health     
Corresponding Author(s): Pil Uthaug Rasmussen   
Issue Date: 12 November 2020
 Cite this article:   
Pil Uthaug Rasmussen,Katrine Uhrbrand,Mette Damkjær Bartels, et al. Occupational risk of exposure to methicillin-resistant Staphylococcus aureus (MRSA) and the quality of infection hygiene in nursing homes[J]. Front. Environ. Sci. Eng., 2021, 15(3): 41.
 URL:  
https://academic.hep.com.cn/fese/EN/10.1007/s11783-020-1333-y
https://academic.hep.com.cn/fese/EN/Y2021/V15/I3/41
Sample group Total number of samples S. aureus positive samples MRSA positive samples
% n Concentration % n Concentration
MRSA screening of staff
Nasal swab 158 0 0
Throat swab 156 0 0
Hand swab 158 10.8 17 10–150 CFU/hand 0 0
Total of all screening samples 472 3.6% 17 0 0
Exposure to MRSA
Personal GSP air sample 79 15.2 12 7.3–201.9 CFU/m3 0 0
Stationary GSP air sample 46 6.5 3 285.7–1857.1 CFU/m3 0 0
6-stage ACI stationary air sample 42 21.4 9 2.9–173.1 CFU/m3 9.5 4 2.9–7.9 CFU/m3
EDC sedimented dust sample 58 8.6 5 91.1–1093.6 CFU/m2/d 1.7 1 1.1 × 103 CFU/m2/d
Surface sample 113 23.6 26 0.04–70.8 CFU/cm2 8.2 9 0.04–70.8 CFU/cm2
Total of all exposure samples 338 16.3% 55 4.1% 14
Stationary GSP outdoor air reference 10 0 0 0 0
Tab.1  Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) found during screening of staff members and the exposure to MRSA in air, surface and sedimented dust samples. Percentages calculated based on the total number of samples
Fig.1  Whole genome clustering of methicillin-resistant S. aureus (MRSA) isolates at the two nursing homes (a) and (b) were MRSA was detected. MRSA isolates starting with M is from the colonised residents, while isolates starting with WGS are from surface and air samples collected at the nursing home.
Work task Total number of samples S. aureus positive samples MRSA positive samples
GM (CFU/m3) Range (CFU/m3) n GM (CFU/m3) Range (CFU/m3) n
ACI
Personal care 6 21.1 8.9–56.5 2 7.9 1
Cleaning of surfaces & fomites 9 134.3 1 - 0
Cleaning of floors 6 4.8 3.5–7.9 3 5.6 3.9–7.9 2
Bed making 2 0 0
Nursing tasks 2 0 0
Background; MRSA residence 8 22.6 2.9–173.1 2 2.9 1
Background; Common area 9 3.5 1 0
GSP
Personal care 9 285.7 1 0
Cleaning of surfaces & fomites 5 0 0
Cleaning of surfaces, fomites & floor 4 1857.1 1 0
Cleaning of floors 4 0 0
Bed making 2 0 0
Nursing tasks 2 0 0
Other (marking of clothes) 1 -
Background; MRSA residence 8 571.4 1 0
Background; common area 11 0 0
Outdoor GSP reference 10 0 0
Tab.2  Potential exposure to Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) in air samples during specific work tasks conducted in the room of the MRSA-colonised resident. Shown are samples positive for S. aureus and MRSA
Sampling point Residence of MRSA-colonised individual Common area
Number of samples S. aureus positive samples MRSA positive samples Number of samples S. aureus positive samples MRSA positive samples
% n GM
(CFU/cm2)
% n GM
(CFU“/cm2)
% n GM
(CFU/cm2)
% n GM
(CFU/cm2)
Armrest 10 30 3 0.53 30 3 0.33 10 30 3 0.19 0 0
Table 10 10 1 1 0 0 10 30 3 0.37 0 0
Door handle 11 18 2 8.28 9 1 5.33 12 42 5 0.88 0 0
Light switch 10 10 1 0.24 0 0 10 0 0 0 0
TV remote 10 30 3 0.49 20 2 0.19 10 0 0 0 0
Bed rail 10 40 4 3.63 30 3 3.07 0
Tab.3  Surface samples found positive for Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) in the residences of the MRSA-colonised individuals and in the common areas of the nursing homes
Fig.2  Self-reported knowledge of methicillin-resistant S. aureus (MRSA). Shown are a) whether respondents had heard of MRSA, b) how they assess their knowledge, and c) how their average self-assessed knowledge differs among job groups. Nurses have the longest education, which requires a high school diploma, followed by social and healthcare assistants, social and healthcare helpers and nursing home assistants, and healthcare helper. Nursing home staff are unskilled workers. 1= bad, 2= less bad, 3= good, 4= very good, 5= excellent. Shown are means and standard errors.
Fig.3  Self-reported knowledge of infection hygiene. Shown are a) how respondents assess their knowledge, and b) how their average self-assessed knowledge differs among job groups. Nurses have the longest education, which requires a high school diploma, followed by social and healthcare assistants, social and healthcare helpers and nursing home assistants, and healthcare helper. Nursing home staff are unskilled workers. 1= bad, 2= less bad, 3= good, 4= very good, 5= excellent. Shown are means and standard errors.
1 W C Albrich, S Harbarth (2008). Health-care workers: Source, vector, or victim of MRSA? Lancet. Infectious Diseases, 8(5): 289–301
https://doi.org/10.1016/S1473-3099(08)70097-5
2 H Andersson, C Lindholm, A Iversen, C G Giske, Å Örtqvist, M Kalin, B Fossum (2012). Prevalence of antibiotic-resistant bacteria in residents of nursing homes in a Swedish municipality: Healthcare staff knowledge of and adherence to principles of basic infection prevention. Scandinavian Journal of Infectious Diseases, 44(9): 641–649
https://doi.org/10.3109/00365548.2012.671956
3 N S Baldwin, D F Gilpin, C M Hughes, M P Kearney, D A Gardiner, C Cardwell, M M Tunney (2009). Prevalence of methicillin-resistant Staphylococcus aureus colonization in residents and staff in nursing homes in Northern Ireland. Journal of the American Geriatrics Society, 57(4): 620–626
https://doi.org/10.1111/j.1532-5415.2009.02181.x
4 M D Bartels, H Larner-Svensson, H Meiniche, K Kristoffersen, K Schønning, J B Nielsen, S M Rohde, L B Christensen, A W Skibsted, J O Jarløv, H K Johansen, L P Andersen, I S Petersen, D W Crook, R Bowden, K Boye, P Worning, H Westh (2015). Monitoring meticillin resistant Staphylococcus aureus and its spread in Copenhagen, Denmark, 2013, through routine whole genome sequencing. Eurosurveillance, 20(17): 21112
https://doi.org/10.2807/1560-7917.ES2015.20.17.21112
5 D Bates, M Maechler, B Bolker, S Walker (2014). LME4: linear Mixed–Effects Models Using Eigen and S4
6 S Böcher, B Middendorf, H Westh, A Mellmann, K Becker, R Skov, A W Friedrich (2010). Semi-selective broth improves screening for methicillin-resistant Staphylococcus aureus. Journal of Antimicrobial Chemotherapy, 65(4): 717–720
https://doi.org/10.1093/jac/dkq001
7 S F Bradley (1999). Methicillin-resistant Staphylococcus aureus. American Journal of Medicine, 106(5 Supplement 1): 2–10
https://doi.org/10.1016/S0002-9343(98)00349-0
8 D P Calfee, L J Durbin, T P Germanson, D M Toney, E B Smith, B M Farr (2003). Spread of methicillin-resistant Staphylococcus aureus (MRSA) among household contacts of individuals with nosocomially acquired MRSA. Infection Control and Hospital Epidemiology, 24(6): 422–426
https://doi.org/10.1086/502225
9 D P Calfee, C D Salgado, A M Milstone, A D Harris, D T Kuhar, J Moody, K Aureden, S S Huang, L L Maragakis, D S Yokoe (2014). Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 Update. Infection Control and Hospital Epidemiology, 35(7): 772–796
https://doi.org/10.1086/676534
10 CDC (2013). Antibiotic Resistance Threats in the United States. Washington, DC: Centers for Disease Control
11 DANMAP (2018). Use of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from food animals, food and humans in Denmark. Copenhagen: DANMAP
12 Danmarks Statistik (2020). FOLK1A. Copenhagen: Danmarks Statistik
13 European Centre for Disease Prevention and Control (2019). Surveillance of Antimicrobial Resistance in Europe 2018. Stockholm
14 L Feld, H Bay, Ø Angen, A R Larsen, A M Madsen (2018). Survival of LA-MRSA in dust from swine farms. Annals of Work Exposures and Health, 62(2): 147–156
https://doi.org/10.1093/annweh/wxx108
15 J Fox, S Weisberg (2011). An R Companion to Applied Regression. Thousand Oaks: Sage
16 A Gandara, L C Mota, C Flores, H R Perez, C F Green, S G Gibbs (2006). Isolation of Staphylococcus aureus and antibiotic-resistant Staphylococcus aureus from residential indoor bioaerosols. Environmental Health Perspectives, 114(12): 1859–1864
https://doi.org/10.1289/ehp.9585
17 M Garazi, B Edwards, D Caccavale, C Auerbach, G Wolf-Klein (2009). Nursing homes as reservoirs of MRSA: Myth or reality? Journal of the American Medical Directors Association, 10(6): 414–418
https://doi.org/10.1016/j.jamda.2009.02.014
18 H Honda, M J Krauss, C M Coopersmith, M H Kollef, A M Richmond, V J Fraser, D K Warren (2010). Staphylococcus aureus nasal colonization and subsequent infection in intensive care unit patients: Does methicillin resistance matter? Infection Control and Hospital Epidemiology, 31(6): 584–591
https://doi.org/10.1086/652530
19 L C Kenny, R J Aitken, P E J Baldwin, G C Beaumont, A D Maynard (1999). The sampling efficiency of personal inhalable aerosol samplers in low air movement environments. Journal of Aerosol Science, 30(5): 627–638
https://doi.org/10.1016/S0021-8502(98)00752-6
20 A M Koch, H M Eriksen, P Elstrøm, P Aavitsland, S Harthug (2009). Severe consequences of healthcare-associated infections among residents of nursing homes: A cohort study. Journal of Hospital Infection, 71(3): 269–274
https://doi.org/10.1016/j.jhin.2008.10.032
21 A Kozajda, K Jeżak, A Kapsa (2019). Airborne Staphylococcus aureus in different environments: A review. Environmental Science and Pollution Research International, 26(34): 34741–34753
https://doi.org/10.1007/s11356-019-06557-1
22 A Kurup, N Chlebicka, K Y Tan, E X Chen, L Oon, T A Ling, M L Ling, J L G Hong (2010). Active surveillance testing and decontamination strategies in intensive care units to reduce methicillin-resistant Staphylococcus aureus infections. American Journal of Infection Control, 38(5): 361–367
https://doi.org/10.1016/j.ajic.2009.09.018
23 X Li, Y Qiu, A Yu, W Shi, G Chen, Z Zhang, D Liu (2015). Characteristics of airborne Staphylococcus aureus (including MRSA) in Chinese public buildings. Aerobiologia, 31(1): 11–19
https://doi.org/10.1007/s10453-014-9342-6
24 A M Madsen, S Moslehi-Jenabian, M Z Islam, M Frankel, M Spilak, M W Frederiksen (2018). Concentrations of Staphylococcus species in indoor air as associated with other bacteria, season, relative humidity, air change rate, and S. aureus-positive occupants. Environmental Research, 160: 282–291
https://doi.org/10.1016/j.envres.2017.10.001
25 A M Madsen, H U T Phan, M Laursen, J K White, K Uhrbrand (2020). Evaluation of methods for sampling of Staphylococcus aureus and other Staphylococcus species from indoor surfaces. Annals of Work Exposures and Health: wxaa080
https://doi.org/10.1093/annweh/wxaa080
26 F G Masclaux, O Sakwinska, N Charrière, E Semaani, A Oppliger (2013). Concentration of airborne Staphylococcus aureus (MRSA and MSSA), total bacteria, and endotoxins in pig farms. Annals of Occupational Hygiene, 57(5): 550–557
27 A Mitchell, M Spencer, C Jr Edmiston (2015). Role of healthcare apparel and other healthcare textiles in the transmission of pathogens: A review of the literature. Journal of Hospital Infection, 90(4): 285–292
https://doi.org/10.1016/j.jhin.2015.02.017
28 M Monaco, E Bombana, L Trezzi, L Regattin, S Brusaferro, A Pantosti, A Goglio (2009). Meticillin-resistant Staphylococcus aureus colonising residents and staff members in a nursing home in Northern Italy. Journal of Hospital Infection, 73(2): 182–184
https://doi.org/10.1016/j.jhin.2009.06.026
29 D J Morgan, E Rogawski, K A Thom, J K Johnson, E N Perencevich, M Shardell, S Leekha, A D Harris (2012). Transfer of multidrug-resistant bacteria to healthcare workers’ gloves and gowns after patient contact increases with environmental contamination. Critical Care Medicine, 40(4): 1045–1051
https://doi.org/10.1097/CCM.0b013e31823bc7c8
30 C R Murphy, V Quan, D Kim, E Peterson, M Whealon, G Tan, K Evans, H Meyers, M Cheung, B Y Lee, D B Mukamel, S S Huang (2012). Nursing home characteristics associated with methicillin-resistant Staphylococcus aureus (MRSA) Burden and Transmission. BMC Infectious Diseases, 12(1): 269
https://doi.org/10.1186/1471-2334-12-269
31 A N Neely, M P Maley (2000). Survival of enterococci and staphylococci on hospital fabrics and plastic. Journal of Clinical Microbiology, 38(2): 724–726
https://doi.org/10.1128/JCM.38.2.724-726.2000
32 C Peters, M Dulon, O Kleinmüller, A Nienhaus, A Schablon (2017). MRSA prevalence and risk factors among health personnel and residents in nursing homes in Hamburg, Germany: A cross-sectional study. PLoS One, 12(1): e0169425
https://doi.org/10.1371/journal.pone.0169425
33 R. Core Team (2019). R: A Language and Environment for Statistical Computing. Vienna: R Foundation for Statistical Computing
34 M C Roghmann, J K Johnson, J D Sorkin, P Langenberg, A Lydecker, B Sorace, L Levy, L Mody (2015). Transmission of methicillin-resistant Staphylococcus aureus (MRSA) to healthcare worker gowns and gloves during care of nursing home residents. Infection Control and Hospital Epidemiology, 36(9): 1050–1057
https://doi.org/10.1017/ice.2015.119
35 N D Stone, D R Lewis, H K Lowery, L A Darrow, C M Kroll, R P Gaynes, J A Jernigan, J E Jr Mcgowan, F C Tenover, C L Richards Jr (2008). Importance of bacterial burden among methicillin-resistant Staphylococcus aureus carriers in a long-term care facility. Infection Control and Hospital Epidemiology, 29(2): 143–148
https://doi.org/10.1086/526437
36 Sundheds- Og Ældreministeriet (2016). National Survey of the Conditions in Care Centers. København K: Sundheds- Og Ældreministeriet
37 The Danish Health Authority (2016). Guidance on preventing the spread of MRSA. København S, Denmark: The Danish Health Authority
38 M Thorstad, I Sie, B M Andersen (2011). MRSA: A challenge to Norwegian nursing home personnel. Interdisciplinary Perspectives on Infectious Diseases, 2011: 197683
https://doi.org/10.1155/2011/197683
39 D Trigg, S Timmons, C Pynegar (2008). An audit of healthcare workers’ knowledge of meticillin resistant Staphylococcus aureus (MRSA) against current infection control standards. British Journal of Infection Control, 9(1): 30–33
https://doi.org/10.1177/1469044607084970
40 J K White, J L Nielsen, C M Larsen, A M Madsen (2020). Impact of dust on airborne Staphylococcus aureus’ viability, culturability, inflammogenicity, and biofilm forming capacity. International Journal of Hygiene and Environmental Health, 230: 113608
https://doi.org/10.1016/j.ijheh.2020.113608
41 WHO (2014). Antimicrobial Resistance: Global Report on Surveillance. Geneva: World Health Organization
42 L Wibbenmeyer, I Williams, M Ward, X Xiao, T Light, B Latenser, R Lewis, G P Kealey, L Herwaldt (2010). Risk factors for acquiring vancomycin-resistant Enterococcus and methicillin-resistant Staphylococcus aureus on a burn surgery step-down unit. Journal of Burn Care & Research; Official Publication of the American Burn Association, 31(2): 269–279
https://doi.org/10.1097/BCR.0b013e3181d0f479
43 R D Wilson, S J Huang, A S Mclean (2004). The correlation between airborne methicillin-resistant Staphylococcus aureus with the presence of MRSA colonized patients in a general intensive care unit. Anaesthesia and Intensive Care, 32(2): 202–209
https://doi.org/10.1177/0310057X0403200207
[1] FSE-20147-OF-APU_suppl_1 Download
[1] Chengsong Ye, Yuming Chen, Lin Feng, Kun Wan, Jianguo Li, Mingbao Feng, Xin Yu. Effect of the ultraviolet/chlorine process on microbial community structure, typical pathogens, and antibiotic resistance genes in reclaimed water[J]. Front. Environ. Sci. Eng., 2022, 16(8): 100-.
[2] Yuwei Guo, Xian Xiao, Yuan Zhao, Jianguo Liu, Jizhong Zhou, Bo Sun, Yuting Liang. Antibiotic resistance genes in manure-amended paddy soils across eastern China: Occurrence and influencing factors[J]. Front. Environ. Sci. Eng., 2022, 16(7): 91-.
[3] Ziyan Qin, Qun Gao, Qiang Dong, Joy D. Van Nostrand, Qi Qi, Yifan Su, Suo Liu, Tianjiao Dai, Jingmin Cheng, Jizhong Zhou, Yunfeng Yang. Antibiotic resistome mostly relates to bacterial taxonomy along a suburban transmission chain[J]. Front. Environ. Sci. Eng., 2022, 16(3): 32-.
[4] Jiaheng Zhao, Bing Li, Pin Lv, Jiahui Hou, Yong Qiu, Xia Huang. Distribution of antibiotic resistance genes and their association with bacteria and viruses in decentralized sewage treatment facilities[J]. Front. Environ. Sci. Eng., 2022, 16(3): 35-.
[5] Mingyi Yang, Lin Shi, Di Zhang, Zhaohui He, Aiping Liang, Xiao Sun. Adsorption of herring sperm DNA onto pine sawdust biochar: Thermodynamics and site energy distribution[J]. Front. Environ. Sci. Eng., 2022, 16(11): 144-.
[6] Jian Lu, Jun Wu, Jianhua Wang. Metagenomic analysis on resistance genes in water and microplastics from a mariculture system[J]. Front. Environ. Sci. Eng., 2022, 16(1): 4-.
[7] Caihong Huang, Zhurui Tang, Beidou Xi, Wenbing Tan, Wei Guo, Weixia Wu, Caiyun Ma. Environmental effects and risk control of antibiotic resistance genes in the organic solid waste aerobic composting system: A review[J]. Front. Environ. Sci. Eng., 2021, 15(6): 127-.
[8] Yuan Meng, Weiyi Liu, Heidelore Fiedler, Jinlan Zhang, Xinrui Wei, Xiaohui Liu, Meng Peng, Tingting Zhang. Fate and risk assessment of emerging contaminants in reclaimed water production processes[J]. Front. Environ. Sci. Eng., 2021, 15(5): 104-.
[9] Yunping Han, Lin Li, Ying Wang, Jiawei Ma, Pengyu Li, Chao Han, Junxin Liu. Composition, dispersion, and health risks of bioaerosols in wastewater treatment plants: A review[J]. Front. Environ. Sci. Eng., 2021, 15(3): 38-.
[10] Wenwen Xie, Yanpeng Li, Wenyan Bai, Junli Hou, Tianfeng Ma, Xuelin Zeng, Liyuan Zhang, Taicheng An. The source and transport of bioaerosols in the air: A review[J]. Front. Environ. Sci. Eng., 2021, 15(3): 44-.
[11] Mariana Valdez-Castillo, Sonia Arriaga. Response of bioaerosol cells to photocatalytic inactivation with ZnO and TiO2 impregnated onto Perlite and Poraver carriers[J]. Front. Environ. Sci. Eng., 2021, 15(3): 43-.
[12] Qingkun Ji, Caihong Zhang, Dan Li. Influences and mechanisms of nanofullerene on the horizontal transfer of plasmid-encoded antibiotic resistance genes between E. coli strains[J]. Front. Environ. Sci. Eng., 2020, 14(6): 108-.
[13] Nan Wu, Weiyu Zhang, Shiyu Xie, Ming Zeng, Haixue Liu, Jinghui Yang, Xinyuan Liu, Fan Yang. Increasing prevalence of antibiotic resistance genes in manured agricultural soils in northern China[J]. Front. Environ. Sci. Eng., 2020, 14(1): 1-.
[14] Kun Wan, Wenfang Lin, Shuai Zhu, Shenghua Zhang, Xin Yu. Biofiltration and disinfection codetermine the bacterial antibiotic resistome in drinking water: A review and meta-analysis[J]. Front. Environ. Sci. Eng., 2020, 14(1): 10-.
[15] Lian Yang, Qinxue Wen, Zhiqiang Chen, Ran Duan, Pan Yang. Impacts of advanced treatment processes on elimination of antibiotic resistance genes in a municipal wastewater treatment plant[J]. Front. Environ. Sci. Eng., 2019, 13(3): 32-.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed