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Transfer of multidrug-resistant bacteria to healthcare workers’ gloves and gowns after patient contact increases with environmental contamination*

Morgan, Daniel J. MD; Rogawski, Elizabeth BS; Thom, Kerri A. MD, MS; Johnson, J. Kristie PhD; Perencevich, Eli N. MD, MS; Shardell, Michelle PhD; Leekha, Surbhi MD, MPH; Harris, Anthony D. MD, MPH

doi: 10.1097/CCM.0b013e31823bc7c8
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Objective: To assess the role of environmental contamination in the transmission of multidrug-resistant bacteria to healthcare workers’ clothing.

Design: Prospective cohort.

Setting: Six intensive care units at a tertiary care hospital.

Subjects: Healthcare workers including registered nurses, patient care technicians, respiratory therapists, occupational/physical therapists, and physicians.

Interventions: None.

Measurements and Main Results: One hundred twenty of 585 (20.5%) healthcare worker/patient interactions resulted in contamination of healthcare workers’ gloves or gowns. Multidrug-resistant Acinetobacter baumannii contamination occurred most frequently, 55 of 167 observations (32.9%; 95% confidence interval [CI] 25.8% to 40.0%), followed by multidrug-resistant Pseudomonas aeruginosa, 15 of 86 (17.4%; 95% CI 9.4% to 25.4%), vancomycin-resistant Enterococcus, 25 of 180 (13.9%, 95% CI 8.9, 18.9%) and methicillin-resistant Staphylococcus aureus, 21 of 152 (13.8%; 95% CI 8.3% to 19.2%). Independent risk factors associated with healthcare worker contamination with multidrug-resistant bacteria were positive environmental cultures (odds ratio [OR] 4.2; 95% CI 2.7–6.5), duration in room for >5 mins (OR 2.0; 95% CI 1.2–3.4), performing physical examinations (OR 1.7; 95% CI 1.1–2.8), and contact with the ventilator (OR 1.8; 95% CI, 1.1–2.8). Pulsed field gel electrophoresis determined that 91% of healthcare worker isolates were related to an environmental or patient isolate.

Conclusions: The contamination of healthcare workers’ protective clothing during routine care of patients with multidrug-resistant organisms is most frequent with A. baumannii. Environmental contamination was the major determinant of transmission to healthcare workers’ gloves or gowns. Compliance with contact precautions and more aggressive environmental cleaning may decrease transmission.

From the Departments of Epidemiology and Public Health (DJM, KAT, MS, SL, ADH) and Pathology (JKJ), University of Maryland School of Medicine, Baltimore, MD; the VA Maryland Health Care System (DJM, KAT, ADH), Baltimore, MD; the Department of Epidemiology (ER), University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC; and the University of Iowa, Carver College of Medicine & Iowa City VA (ENP), Iowa City, IA.

*See also p. 1333.

This work was funded by an unrestricted research grant from Merck Pharmaceuticals. Other funding was through a 1 K08 HS18111-01 AHRQ to Dr. Morgan, 5K24AI079040-02 National Institutes of Health to Dr. Harris and a VA HSR&D Merit IIR, 05-123 to Dr. Perencevich. Dr. Perencevich has received unrestricted research grants from Merck and Pfizer. The authors have not disclosed any potential conflicts of interest.

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© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins