Infection Control & Hospital Epidemiology (2018), 39, 1425–1430 doi:10.1017/ice.2018.247
Original Article
Transmission of resistant Gram-negative bacteria to healthcare personnel gowns and gloves during care of residents in community-based nursing facilities
Natalia Blanco PhD1, J. Kristie Johnson PhD2, John D. Sorkin MD, PhD3,4, Alison D. Lydecker MPH1,
Lauren Levy JD, MPH1, Lona Mody MD, MSc5,6 and Mary-Claire Roghmann MD, MS1 1Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, 2Department of Pathology, University of
Maryland School of Medicine, Baltimore, Maryland, 3Baltimore VA Medical Center Geriatric Research, Education and Clinical Center, Baltimore, Maryland, 4Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, 5Division of Geriatric and Palliative Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan and 6Geriatrics Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
Abstract
Objective: To estimate the risk of transmission of antibiotic-resistant Gram-negative bacteria (RGNB) to gowns and gloves worn by healthcare personnel (HCP) when providing care to residents of community-based nursing facilities to identify the types of care and resident characteristics associated with transmission. Design: Prospective observational study. Settings and participants: Residents and HCP from 13 community-based nursing facilities in Maryland and Michigan. Methods: Perianal swabs were collected from residents and cultured to detect RGNB. HCP wore gowns and gloves during usual care activities, and at the end of each interaction, these were swabbed in a standardized manner. Transmission of RGNB from a colonized resident to gowns and gloves was estimated. Odds ratios (ORs) of transmission associated with type of care or resident characteristic were calculated. Results: We enrolled 403 residents and their HCP in this study. Overall, 19% of enrolled residents with a perianal swab (n=399) were colonized with at least 1 RGNB. RGNB transmission to either gloves or gowns occurred during 11% of the 584 interactions. Showering the resident, hygiene or toilet assistance, and wound dressing changes were associated with a high risk of transmission. Glucose monitoring and assistance with feeding or medication were associated with a low risk of transmission. Residents with a pressure ulcer were 3 times more likely to transmit RGNB than residents without one (OR, 3.3; 95% confidence interval [CI], 1.0–11.1). Conclusions: Gown and glove use in community nursing facilities should be prioritized for certain residents and care interactions that are deemed a high risk for transmission.
(Received 15 June 2018; accepted 4 September 2018; electronically published October 8, 2018)
More than half (57%) of nursing home residents are colonized with multidrug-resistant organisms (MDROs).1 Methicillin- resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and multidrug-resistant Gram-negative bac- teria (RGNB) are among the most common MDROs in nursing facilities.1,2 Between 11% and 59% of nursing home residents are colonized with RGNB.1,3 Furthermore, these bacteria have been shown to spread from patient-to-patient by healthcare personnel (HCP).4–6 Contact precautions are used for MDRO-colonized patients in acute-care hospitals, while in nursing homes only standard
Author for correspondence: Mary-Claire Roghmann, MD, MS, University of
Maryland School of Medicine, 10 South Pine Street, MTSF Room 336, Baltimore, MD 21201. E-mail:
Mroghmann@som.umaryland.edu
Cite this article: Blanco N, et al. (2018). Transmission of resistant gram-negative
bacteria to healthcare personnel gowns and gloves during care of residents in community-based nursing facilities. Infection Control & Hospital Epidemiology 2018, 39, 1425–1430. doi: 10.1017/ice.2018.247
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
precautions are used.7–9 Few evidence-based guidelines describe best practices for the prevention of the transmission of MDROs in nursing homes. Our group recently reported that transmission of RGNB from
colonized residents to HCP gloves and gowns occurs during specific high-risk care activities in Veterans Affairs (VA) nursing homes.10 However, most nursing homes in the United States are not part of the VA system and are known as community nursing facilities. In contrast to VA nursing homes, residents living here are older and more likely to be women. They are less likely to be affiliated with acute-care hospitals responsible for the nursing homes’ infection prevention program.11 Therefore, it is important to determine whether the same risk factors are also observed in this related but different population. In this study, we examined care-specific transmission of
RGNB to HCP gowns and gloves in community nursing homes. In addition, we aimed to identify resident characteristics asso- ciated with transmission of RGNB.
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