1428
Dressing change Showering
Diaper change Hygiene Bathing
Transfer the patient Feeding
Glucose monitoring Physical therapy Only medication Any therapy Any medication Physical exam Any surveilance Changing linens Device care or use Toilet assistance Dressing the patient Only feeding
0 10 20 Crude transmission (%) Gloves Gowns
Fig. 1. Crude transmission risk of antibiotic-resistant Gram-negative bacteria to healthcare personnel (HCP) gloves and gowns during care interactions with resistant Gram-negative bacteria colonized residents of community nursing homes. The Y-axis details the different types of care that were identified and analyzed. The X-axis represents the percent of crude transmission detected. The blue bars represent transmission to gloves and the beige bars represent transmission to gowns.
activities for gown contamination because no transmissions occurred during these interactions (Table 2). Additionally, a random sample of 26 residents who were not colonized by RGNB in the perianal culture (183 interactions)
30 40
Natalia Blanco et al
were also analyzed. Of the 183 HCP interactions, 23 glove swabs (13%) and 16 gown swabs (9%) were RGNB positive. Of the 26 noncolonized residents, 15 (58%) had HCP interactions positive for RGNB.
Resident characteristics that increase gown and glove transmission with RGNB
We also examined whether certain resident characteristics chan- ged the risk of RGNB transmission. Having diarrhea was uncommon (3%) in this population, so we focused on stool incontinence (15%). No strong association between stool incon- tinence and transmission of RGNB was observed. Although heavy wound secretions were rare (<1%), 23% of the enrolled popula- tion had a pressure ulcer. Among colonized residents, those with a pressure ulcer were 3 times more likely to transmit RGNB to HCP gowns than those residents without a pressure ulcer (OR, 3.3; 95% CI, 1.0–11.1). A weaker association was observed for transmission to gloves (OR, 1.6; 95% CI, 0.7–3.8). High-risk types of care were also identified among residents with an unhealed pressure ulcer. Among this subpopulation, showering (OR, 14.0; P=.01), hygiene assistance (OR, 8.4; P=.03), transferring the resident (OR, 2.5; P=.01), diaper change (OR, 2.9; P=.08), and dressing (OR, 2.6; P=.09) were associated with higher RGNB transmission to HCP gowns.
Table 2. Odds Ratioa of Transmission of RGNB to Healthcare Personnel’s Gowns or Gloves by Type of Care Given to R-GNB–Colonized Residents in Community Nursing Homes
Gloves No. of
Type of Care Showering
Dressing change Bathing
Hygiene assistance Diaper change
Transfer of resident Feeding
Toilet assistance Dressing resident Only feeding
Changing linens
Any surveillance cultures Any device care or use Physical exam Any therapy
Any medications Only medications Glucose monitoring
Interactions 18
5
56 57 91
114 19 58 98 15 66 69 17 76 87
104 87 11
% Care Given With Other Care 72
40 86 96 82 76 21 64 90 0
50 3
47 36 21 16 0
64 OR
5.7 3.6 3.4 2.5 2.5 1.9 1.7 1.6 1.5 1.2 1.1 1.1
0.93 0.82 0.30 0.15 0.09
P Value <.01 .01
<.01 .07 .02 .05 .56 .27 .25 .89 .82 .88 .92 .61
<.01 <.01 <.01
No transmission OR 15.4
2.7 3.8 2.7 3.0
3.4 2.5
0.40
1.3 2.0
0.3 0.5
Gowns
P Value <.01
No transmission
.12 .08 .09
<.01 No transmission
<.01 .10
No transmission .61 No transmission
.84 .22
No transmission
.28 .40
No transmission
Note. RGNB, resistant Gram-negative bacteria. aOdds of transmission divided by odds of transmission if that type of care was not given, calculated using generalized estimating equations to account for the correlation of repeated measurements obtained from a given resident.
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