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Frequent Multidrug-Resistant Acinetobacter baumannii Contamination of Gloves, Gowns, and Hands of Healthcare Workers

Published online by Cambridge University Press:  02 January 2015

Daniel J. Morgan ,
Stephen Y. Liang ,
Catherine L. Smith ,
J. Kristie Johnson ,
Anthony D. Harris ,
Jon P. Furuno ,
Kerri A. Thorn ,
Graham M. Snyder ,
Hannah R. Day  and
Eli N. Perencevich
Daniel J. Morgan*
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore
Stephen Y. Liang
Affiliation:
Department of Medicine, University of Maryland, Baltimore
Catherine L. Smith
Affiliation:
Department of Medicine, University of Maryland, Baltimore
J. Kristie Johnson
Affiliation:
Department of Pathology, University of Maryland, Baltimore
Anthony D. Harris
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore
Jon P. Furuno
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore
Kerri A. Thorn
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore
Graham M. Snyder
Affiliation:
Department of Medicine, University of Maryland, Baltimore
Hannah R. Day
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore
Eli N. Perencevich
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore
*
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, 685 West Baltimore Street, MSTF 334D, Baltimore, MD 21201 ([email protected])
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Extract

Background.

Multidrug-resistant (MDR) gram-negative bacilli are important nosocomial pathogens.

Objective.

To determine the incidence of transmission of MDR Acinetobacter baumannii and Pseudomonas aeruginosa from patients to healthcare workers (HCWs) during routine patient care.

Design.

Prospective cohort study.

Setting.

Medical and surgical intensive care units.

Methods.

We observed HCWs who entered the rooms of patients colonized with MDR A. baumannii or colonized with both MDR A. baumannii and MDR P. aeruginosa. We examined their hands before room entry, their disposable gloves and/or gowns upon completion of patient care, and their hands after removal of gloves and/or gowns and before hand hygiene.

Results.

Sixty-five interactions occurred with patients colonized with MDR A. baumannii and 134 with patients colonized with both MDR A. baumannii and MDR P. aeruginosa. Of 199 interactions between HCWs and patients colonized with MDR A. baumannii, 77 (38.7% [95% confidence interval {CI}, 31.9%–45.5%]) resulted in HCW contamination of gloves and/or gowns, and 9 (4.5% [95% CI, 1.6%–7.4%]) resulted in contamination of HCW hands after glove removal before hand hygiene. Of 134 interactions with patients colonized with MDR P. aeruginosa, 11 (8.2% [95% CI, 3.6%–12.9%]) resulted in HCW contamination of gloves and/or gowns, and 1 resulted in HCW contamination of hands. Independent risk factors for contamination with MDR A. baumannii were manipulation of wound dressing (adjusted odds ratio [aQR], 25.9 [95% CI, 3.1–208.8]), manipulation of artificial airway (aOR, 2.1 [95% CI, 1.1–4.0]), time in room longer than 5 minutes (aOR, 4.3 [95% CI, 2.0–9.1]), being a physician or nurse practitioner (aOR, 7.4 [95% CI, 1.6–35.2]), and being a nurse (aOR, 2.3 [95% CI, 1.1–4.8]).

Conclusions.

Gowns, gloves, and unwashed hands of HCWs were frequently contaminated with MDR A. baumannii. MDR A. baumannii appears to be more easily transmitted than MDR P. aeruginosa and perhaps more easily transmitted than previously studied methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus. This ease of transmission may help explain the emergence of MDR A. baumannii.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 7 , July 2010 , pp. 716 - 721
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.Peleg, AY, Seifert, H, Paterson, DL. Acinetobacter baumannii: emergence of a successful pathogen. Clin Microbiol Rev 2008;21:538–582.Google Scholar
2.Gaynes, R, Edwards, JR; National Nosocomial Infections Surveillance System. Overview of nosocomial infections caused by gram-negative bacilli. Clin Infect Dis 2005;41:848–854.Google ScholarPubMed
3.Boucher, HW, Talbot, GH, Bradley, JS, et al. Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis 2009;48:1–12.Google Scholar
4.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Health Care Infection Control Practices Advisory Committee. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35:S65–S164.Google Scholar
5.Harbarth, S, Fankhauser, C, Schrenzel, J, et al. Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 2008;299:1149–1157.CrossRefGoogle ScholarPubMed
6.Robicsek, A, Beaumont, JL, Paule, SM, et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148:409–418.CrossRefGoogle ScholarPubMed
7.Barbolla, RE, Centron, D, Maimone, S, et al. Molecular epidemiology of Acinetobacter baumannii spread in an adult intensive care unit under an endemic setting. Am J Infect Control 2008;36:444–452.CrossRefGoogle Scholar
8.Gbaguidi-Haore, H, Legast, S, Thouverez, M, Bertrand, X, Talon, D. Ecological study of the effectiveness of isolation precautions in the management of hospitalized patients colonized or infected with Acinetobacter baumannii. Infect Control Hosp Epidemiol 2008;29:1118–1123.CrossRefGoogle ScholarPubMed
9.Olsen, R, Lynch, P, Coyle, M, Cummings, J, Bokete, T, Stamm, W. Examination gloves as barriers to hand contamination in clinical practice. JAMA 1993;270:350–353.Google Scholar
10.Snyder, GM, Thom, KA, Furuno, JP, et al. Detection of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on the gowns and gloves of healthcare workers. Infect Control Hosp Epidemiol 2008;29:583–589.Google Scholar
11.Centers for Disease Control and Prevention. Protocols CDC PulseNet. http://www.cdc.gov/pulsenet/protocols.htm. May 13,2009. Accessed May 5, 2010.Google Scholar
12.Ecker, JA, Massire, C, Hall, TA, et al. Identification of Acinetobacter species and genotyping of Acinetobacter baumannii by multilocus PCR and mass spectrometry. J Clin Microbiol 2006;44:2921.Google Scholar
13.Tenover, F, Arbeit, R, Goering, R, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
14.Evans, HL, Shaffer, MM, Hughes, MG, et al. Contact isolation in surgical patients: a barrier to care? Surgery 2003;134:180–188.Google Scholar
15.Chai, LYA, Ng, TM, Habib, AG, Singh, K, Kumarasinghe, G, Tambyah, PA. Paradoxical increase in methicillin-resistant Staphylococcus aureus acquisition rates despite barrier precautions and increased hand washing compliance during an outbreak of severe acute respiratory syndrome. Clin Infect Dis 2005;40:632–633.Google Scholar
16.Stelfox, HT, Bates, DW, Redelmeier, DA. Safety of patients isolated for infection control. JAMA 2003;290:1899–1905.Google Scholar
17.Furuno, JP, Hebden, JN, Standiford, HC, et al. Prevalence of methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii in a long-term acute care facility. Am J Infect Control 2008;36:468–471.CrossRefGoogle Scholar
18.Pittet, D, Hugonnet, S, Harbarth, S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356: 1307–1312.Google Scholar
19.Hayden, MK, Blom, DW, Lyle, EA, Moore, CG, Weinstein, RA. Risk of hand or glove contamination after contact with patients colonized with vancomycin-resistant Enterococcus or the colonized patients' environment. Infect Control Hosp Epidemiol 2008;29:149–154.Google Scholar
20.Boyce, JM, Potter-Bynoe, G, Chenevert, C, King, T. Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications. Infect Control Hosp Epidemiol 1997; 18: 622–627.CrossRefGoogle ScholarPubMed