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Patient contact is the main risk factor for vancomycin-resistant Enterococcus contamination of healthcare workers’ gloves and gowns in the intensive care unit

Published online by Cambridge University Press:  27 July 2018

Sarah S. Jackson ,
Kerri A. Thom ,
Laurence S. Magder ,
Kristen A. Stafford ,
J. Kristie Johnson ,
Loren G. Miller ,
David P. Calfee ,
Anthony D. Harris  and
for the CDC Prevention Epicenters Program
Sarah S. Jackson*
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Kerri A. Thom
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Laurence S. Magder
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Kristen A. Stafford
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
J. Kristie Johnson
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Loren G. Miller
Affiliation:
LA BioMed at Harbor-UCLA Medical Center, Torrance, California
David P. Calfee
Affiliation:
Weill Cornell Medicine, New York, New York
Anthony D. Harris
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
*
Author for correspondence: Sarah S. Jackson, 685 West Baltimore Street, Baltimore, MD 21201. E-mail:[email protected]
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Abstract

Objective

To determine which healthcare worker (HCW) roles and patient care activities are associated with acquisition of vancomycin-resistant Enterococcus (VRE) on HCW gloves or gowns after patient care, as a surrogate for transmission to other patients.

Design

Prospective cohort study.

Setting

Medical and surgical intensive care units at a tertiary-care academic institution.

Participants

VRE-colonized patients on Contact Precautions and their HCWs.

Methods

Overall, 94 VRE-colonized patients and 469 HCW–patient interactions were observed. Research staff recorded patient care activities and cultured HCW gloves and gowns for VRE before doffing and exiting patient room.

Results

VRE were isolated from 71 of 469 HCWs’ gloves or gowns (15%) following patient care. Occupational/physical therapists, patient care technicians, nurses, and physicians were more likely than environmental services workers and other HCWs to have contaminated gloves or gowns. Compared to touching the environment alone, the odds ratio (OR) for VRE contamination associated with touching both the patient (or objects in the immediate vicinity of the patient) and environment was 2.78 (95% confidence interval [CI], 0.99–0.77) and the OR associated with touching only the patient (or objects in the immediate vicinity) was 3.65 (95% CI, 1.17–11.41). Independent risk factors for transmission of VRE to HCWs were touching the patient’s skin (OR, 2.18; 95% CI, 1.15–4.13) and transferring the patient into or out of bed (OR, 2.66; 95% CI, 1.15–6.43).

Conclusion

Patient contact is a major risk factor for HCW contamination and subsequent transmission. Interventions should prioritize contact precautions and hand hygiene for HCWs whose activities involve touching the patient.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 9 , September 2018 , pp. 1063 - 1067
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION. Presented in part to the Society for Healthcare Epidemiology Annual Meeting, Portland, Oregon, on April XX, 2018 (abstract no. 10453).

Cite this article: Jackson SS, et al. (2018) Patient contact is the main risk factor for vancomycin-resistant Enterococcus contamination of healthcare workers’ glove and gowns in the intensive care unit. Infection Control & Hospital Epidemiology 2018, 39, 1063–1067. doi: 10.1017/ice.2018.160

References

1. Antibiotic resistance threats in the United States. 2013. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugresistance/threat-report-2013/index.html. Accessed June 16, 2018.Google Scholar
2. Weiner, LM, Webb, AK, Walters, MS, Dudeck, MA, Kallen, AJ. Policies for controlling multidrug-resistant organisms in US healthcare facilities reporting to the national healthcare safety network, 2014. Infect Control Hosp Epidemiol 2016;37:1105–1108.Google Scholar
3. Seibert, DJ, Speroni, KG, Oh, KM, DeVoe, MC, Jacobsen, KH. Knowledge, perceptions, and practices of methicillin-resistant Staphylococcus aureus transmission prevention among health care workers in acute-care settings. Am J Infect Control 2014;42:254–259.Google Scholar
4. Ziakas, PD, Thapa, R, Rice, LB, Mylonakis, E. Trends and significance of VRE colonization in the ICU: a meta-analysis of published studies. PLoS ONE 2013;8:e75658.Google Scholar
5. DiazGranados, CA, Zimmer, SM, Klein, M, Jernigan, JA. Comparison of mortality associated with vancomycin-resistant and vancomycin-susceptible enterococcal bloodstream infections: a meta-analysis. Clin Infect Dis 2005;41:327–333.Google Scholar
6. Perugini, MR, Nomi, SM, Lopes, GK, et al. Impact of the reduction of environmental and equipment contamination on vancomycin-resistant Enterococcus rates. Infection 2011;39:587–593.Google Scholar
7. Morgan, DJ, Rogawski, E, Thom, KA, et al. Transfer of multidrug-resistant bacteria to healthcare workers’ gloves and gowns after patient contact increases with environmental contamination. Crit Care Med 2012;40:1045–1051.Google Scholar
8. Drees, M, Snydman, DR, Schmid, CH, et al. Antibiotic exposure and room contamination among patients colonized with vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 2008;29:709–715.Google Scholar
9. 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
10. Duckro, AN, Blom, DW, Lyle, EA, Weinstein, RA, Hayden, MK. Transfer of vancomycin-resistant enterococci via health care worker hands. Arch Intern Med 2005;165:302–307.Google Scholar
11. Furuno, JP, Perencevich, EN, Johnson, JA, et al. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci co-colonization. Emerg Infect Dis 2005;11:1539–1544.Google Scholar
12. Roghmann, MC, Johnson, JK, Sorkin, JD, et al. Transmission of methicillin-resistant Staphylococcus aureus (MRSA) to healthcare worker gowns and gloves during care of nursing home residents. Infect Control Hosp Epidemiol 2015;36:1050–1057.Google Scholar
13. Pineles, L, Morgan, DJ, Lydecker, A, et al. Transmission of methicillin-resistant Staphylococcus aureus to health care worker gowns and gloves during care of residents in veterans affairs nursing homes. Am J Infect Control 2017;45:947–953.Google Scholar
14. Elixhauser, A, Steiner, C, Harris, DR, Coffey, RM. Comorbidity measures for use with administrative data. Med Care 1998;36:8–27.Google Scholar
15. Quan, H, Sundararajan, V, Halfon, P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005;43:1130–1139.Google Scholar
16. 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
17. McDermott, H, Skally, M, O’Rourke, J, Humphreys, H, Fitzgerald-Hughes, D. Vancomycin-resistant enterococci (VRE) in the intensive care unit in a nonoutbreak setting: identification of potential reservoirs and epidemiological associations between patient and environmental VRE. Infect Control Hosp Epidemiol 2018;39:40–45.Google Scholar
18. Franck, JN, Behan, AZ, Herath, PS, Mueller, AC, Marhoefer, KA. The red box strategy: an innovative method to improve isolation precaution compliance and reduce costs. Am J Infect Control 2011;39:E208.Google Scholar
19. Blomberg, D. Safe zone: taking the red box to the next step. Am J Infect Control 2014;42:S80–S81.Google Scholar
20. Russell, D, Beekmann, SE, Polgreen, PM, Rubin, Z, Uslan, DZ. Routine use of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: Which way is the pendulum swinging? Infect Control Hosp Epidemiol 2016;37:36–40.Google Scholar
21. Morgan, DJ, Murthy, R, Munoz-Price, LS, et al. Reconsidering contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus . Infect Control Hosp Epidemiol 2015;36:1163–1172.Google Scholar
22. Rubin, MA, Samore, MH, Harris, AD. The importance of contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. JAMA 2018;319:863–864.Google Scholar
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