L M O'Hara1, M H Nguyen2, D P Calfee3, L G Miller4, L Pineles1, L S Magder1, J K Johnson1, D J Morgan1, D A Rasko5, A D Harris6. 1. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA. 2. Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. 3. Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA. 4. LA BioMed at Harbor-UCLA Medical Center, Torrance, CA, USA. 5. Institute for Genome Sciences, University of Maryland, Baltimore, MD, USA. 6. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: aharris@som.umaryland.edu.
Abstract
BACKGROUND: Hospitals are sources for acquisition of carbapenem-resistant Entero-bacterales (CRE), and it is believed that the contamination of healthcare personnel (HCP) hands and clothing play a major role in patient-to-patient transmission of antibiotic-resistant bacteria. AIM: The aim of this study was to determine which HCP types, HCP-patient interactions, and patient characteristics are associated with greater transmission of CRE to HCP gloves and gowns in the hospital. METHODS: This was a prospective observational cohort study that enrolled patients with recent surveillance or clinical cultures positive for CRE at five hospitals in four states in the USA. HCP gloves and gown were cultured after patient care. Samples were also obtained from patients' stool, perianal area, and skin of the chest and arm to assess bacterial burden. FINDINGS: Among 313 CRE-colonized patients and 3070 glove and gown cultures obtained after patient care, HCP gloves and gowns were found to be contaminated with CRE 7.9% and 4.3% of the time, respectively. Contamination of either gloves or gowns occurred in 10.0% of interactions. Contamination was highest (15.3%) among respiratory therapists (odds ratio: 3.79; 95% confidence interval: 1.61-8.94) and when any HCP touched the patient (1.52; 1.10-2.12). Associations were also found between CRE transmission to HCP gloves or gown and: being in the intensive care unit, having a positive clinical culture, and increasing bacterial burden on the patient. CONCLUSION: CRE transmission to HCP gloves and gown occurred frequently. These findings may inform evidence-based policies about what situations and for which patients contact precautions are most important.
BACKGROUND: Hospitals are sources for acquisition of carbapenem-resistant Entero-bacterales (CRE), and it is believed that the contamination of healthcare personnel (HCP) hands and clothing play a major role in patient-to-patient transmission of antibiotic-resistant bacteria. AIM: The aim of this study was to determine which HCP types, HCP-patient interactions, and patient characteristics are associated with greater transmission of CRE to HCP gloves and gowns in the hospital. METHODS: This was a prospective observational cohort study that enrolled patients with recent surveillance or clinical cultures positive for CRE at five hospitals in four states in the USA. HCP gloves and gown were cultured after patient care. Samples were also obtained from patients' stool, perianal area, and skin of the chest and arm to assess bacterial burden. FINDINGS: Among 313 CRE-colonized patients and 3070 glove and gown cultures obtained after patient care, HCP gloves and gowns were found to be contaminated with CRE 7.9% and 4.3% of the time, respectively. Contamination of either gloves or gowns occurred in 10.0% of interactions. Contamination was highest (15.3%) among respiratory therapists (odds ratio: 3.79; 95% confidence interval: 1.61-8.94) and when any HCP touched the patient (1.52; 1.10-2.12). Associations were also found between CRE transmission to HCP gloves or gown and: being in the intensive care unit, having a positive clinical culture, and increasing bacterial burden on the patient. CONCLUSION: CRE transmission to HCP gloves and gown occurred frequently. These findings may inform evidence-based policies about what situations and for which patients contact precautions are most important.
Authors: Sarah S Jackson; Anthony D Harris; Laurence S Magder; Kristen A Stafford; J Kristie Johnson; Loren G Miller; David P Calfee; Kerri A Thom Journal: Am J Infect Control Date: 2018-09-26 Impact factor: 2.918
Authors: Sarah S Jackson; Kerri A Thom; Laurence S Magder; Kristen A Stafford; J Kristie Johnson; Loren G Miller; David P Calfee; Anthony D Harris Journal: Infect Control Hosp Epidemiol Date: 2018-07-27 Impact factor: 3.254
Authors: Melanie D Spencer; Kathryn Winglee; Catherine Passaretti; Ashlee M Earl; Abigail L Manson; Holly P Mulder; Robert L Sautter; Anthony A Fodor Journal: J Infect Date: 2018-11-29 Impact factor: 6.072
Authors: Timileyin Adediran; Anthony D Harris; J Kristie Johnson; David P Calfee; Loren G Miller; M Hong Nguyen; Daniel J Morgan; Katherine E Goodman; Stephanie Hitchcock; Lisa Pineles; Lyndsay M O'Hara Journal: Open Forum Infect Dis Date: 2020-08-27 Impact factor: 3.835