884 infection control & hospital epidemiology july 2018, vol. 39, no. 7 PREVIOUS PRESENTATION. These data were presented in part at IDWeek
2017 on October 7, 2017, in San Diego, California, in the following poster (2170): Voskertchian A, Akinboyo I, Johnson J, Colantuoni E, Sick-Samuels A, Aucott SW, Milstone AM. Association of Active Surveillance and Decolonization Program on Incidence of Clinical Cultures Growing Staphylococcus aureus in the Neonatal Intensive Care Unit.
Received December 15, 2017; accepted February 26, 2018; electronically published April 20, 2018. Infect Control Hosp Epidemiol 2018;39:882–884 © 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2018/3907-0021. DOI: 10.1017/ice.2018.81
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2. Huang YC, Lien RI, Su LH, Chou YH, Lin TY. Successful control of methicillin-resistant Staphylococcus aureus in endemic neonatal intensive care units—a7-yearcampaign. PloS One 2011;6:e23001.
3. Ericson JE, Popoola VO, Smith PB, et al. Burden of invasive Staphylococcus aureus infections in hospitalized infants. JAMA Pediatr 2015;169:1105–1111.
4. Popoola VO, Colantuoni E, Suwantarat N, et al. Active surveillance cultures and decolonization to reduce Staphylococcus aureus infections in the neonatal intensive care unit. Infect Control Hosp Epidemiol 2016;37:381–387.
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MelishM.Comprehensive strategy including prophylactic mupirocin to reduce Staphylococcus aureus colonization and infection in high-risk neonates. J Perinatol 2013;33:313–318.
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sampling methods to identify an effective glove-sampling method with the ability to detect a difference between the 2 study arms (Figure 1).
methods
This study, approved by the University of Maryland, Baltimore Institutional Review Board, was performed in 2 units at the University of Maryland Medical Center in Baltimore, Mary- land. This study is imbedded in a randomized trial in which healthcare personnel (HCP) entering contact precaution rooms are randomized to either intervention or usual care. Intervention participants are directed by research staff to cleanse gloves with alcohol-based hand rub (ABHR) at each World Health Organization (WHO) hand hygiene opportu- nity.1 For usual care, HCP behavior at each WHO hand hygiene opportunity is silently recorded. We excluded HCP if they were providing care for patients with Clostridium difficile or if they previously participated. The primary outcomes were (1) total colony-forming units (CFUs) and (2) presence of pathogenic bacteria. In both study arms, at the last hand hygiene opportunity
before exiting the room or after the HCP had completed 7 opportunities, gloved hands were sampled to assess bacterial contamination. One hand of each HCP was sampled using the sponge-stickmethod (3M, St Paul,MN), and the other handwas sampled by direct imprint of the glove onto a 150-mm tryptic soy agar (TSA) plate (Teknova, Hollister, CA), with the right hand being randomized to receive one or the other method. In the sponge-stick method, the large flat side of the sponge
was used to make vertical overlapping “S” strokes and then flipped to make horizontal overlapping “S” strokes along the
palmar side of the hands, fingers, and thumb. Next, each finger and thumb were sampled using 3 upward strokes per digit and then 3 downward strokes using the opposite thin edge of the sponge. Last, using the tip of the sponge, the fingertips were sampled 3 times each. In the direct imprint method, the research team instructed the HCP to imprint for 5 seconds their gloved fingertips, thumb, and palm. Direct agar imprint samples were incubated overnight, and
Comparison of Two Glove-Sampling Methods to Discriminate Between Study Arms of a Hand Hygiene and Glove-Use Study
In the absence of a gold standard for sampling gloved hands, we aimed to compare direct-imprint versus sponge-stick
colony counts were performed. Sponge-stick samples were processed as previously described.2 From the eluent, 1/10 dilutions were made. Each dilution was plated on TSA in triplicate for quantitative culturing. Plates were incubated overnight, colonies were counted, and the number of CFUs per milliliter was then calculated. For each sampling method, CFUs and presence of bacteria
were compared across study arms to detect differences between the intervention and the usual care arm (Figure 1). The results from each sampling method were then compared to detect a difference among the differences. For example, we assessed for a difference in total colony counts between inter- vention and usual care using the sponge-stick sampling method and then assessed for a difference using the direct imprint sampling method. The Wilcoxon rank-sum test was
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