comparison of two glove-sampling methods 885
used to compare the median distribution of CFUs recovered. The differences between the categories of presence of bacteria were analyzed using a Fisher exact test for each method.
results
A total of 42 HCP were enrolled in the study. During each patient encounter, HCP reached a median of 3 WHO hand hygienemoments before their gloveswere sampled. The average timespent sampling for sponge stickwas 20 seconds, and for the TSA plate it was 13 seconds.When comparing the intervention versus usual care using the direct imprint method, the median CFU values were 2 and 31, respectively (P<.01). For the sponge-stick method, the median CFU values were 1 and 6, respectively (P=.25). When comparing the number of gloves positive for bacteria in each of the arms, the direct agar method detected bacteria on 16 of 25 gloves (64%) in the intervention and 17 of 17 gloves (100%) in the usual care arm (P<.05). Using the sponge stick method, bacteria was detected on 16 of 25 gloves (64%) in the intervention and 15 of 17 gloves (88%)in the usual care arm (P=.15).
discussion
In this study, in the absence of a gold standard, we compared two glove-sampling methodologies, direct imprint and sponge stick, to detect a difference between two arms in our study relative to CFUs and the presence of bacteria. With the direct-imprint method, we detected a significant difference in both outcomes between the intervention and usual care groups. With the sponge-stick method, we did not detect a significant difference. Prior to this study, few data were available on microbial
sampling of gloved hands, and no gold standard exists. The glove-juice method is recognized as a standard for microbial sampling of hands, but not for sampling gloved hands.3–5 In the glove-juice method, the participant places a hand in a sterile glove and sampling solution is added. The hand is vigorously massaged for 1 minute. The broth is then cultured for bacteria. The glove-juice method cannot be employed for sampling gloves during patient care because itwould not only sample the glove but also bacteria on theHCP’s
hands.The use of this method wouldalsobemoredisruptivetopatient care and likely not tolerated by clinicians during a clinical study. This study is limited by its small sample size. Possibly, with a
larger sample, a difference between the 2 study arms would also be detected using the sponge-stick method. However, the direct imprint method has a shorter sampling time and a shorter laboratory processing time. It is also a less expensive method, making it preferable overall. Our data also support the use of the direct imprint method for the culturing of gloved hands.
acknowledgments
Financial support: K.A.T. and G.L.R. were supported by the Agency for Health- care Research and Quality (grant no. 1RO1HS024108-01). K.A.T., A.D.H., G.L.R., and J.K.J. were supported by the Center for Disease Control and Prevention (CDC) Prevention Epicenters Program (grant no. 1U54CK000450-01). Potential conflicts of interest: All authors report no conflicts of interest
relevant to this article. CDC Disclaimer: The findings and conclusions in this report are those of
the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry.
Gwen L. Robinson, MPH;1 Linda Otieno, MPH;1
J. Kristie Johnson, PhD;1,2 Laura J. Rose, MS;2
Anthony D. Harris, MD, MPH;1 Judith Noble-Wang, PhD;2
Kerri A. Thom, MD, MS1 for the CDC Epicenter Prevention Program
Affiliations: 1. Department of Epidemiology, University ofMaryland School of Medicine, Baltimore, Maryland; 2. Department of Pathology, University of Mary- land School of Medicine, Baltimore, Maryland; 3. Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Cen- ters for Disease Control and Prevention, Atlanta, Georgia.
Address correspondence to Kerri A. Thom, MD, MS, Department of Epi-
demiology and Public Health, University of Maryland School of Medicine, 685 WBaltimore Street, Bressler Research Building, M021B, Baltimore,MD21201 (
kthom@som.umaryland.edu).
Received December 13, 2017; accepted March 1, 2018; electronically published May 7, 2018 Infect Control Hosp Epidemiol 2018;39:884–885 © 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2018/3907-0022. DOI: 10.1017/ice.2018.91
references
1. Clean care is safer care. World Health Organization website.
http://www.who.int/gpsc/5may/background/5moments/en/. Accessed November 20, 2017.
2. Rose LJ, Hodges L, O’Connell H, Noble-Wang J. National validation study of a cellulose sponge wipe-processing method for use after sampling Bacillus anthracis spores from surfaces. Appl Environ Microbiol 2011;77:8355–8359.
3. Lingaas E, Fagernes M. Development of a method to measure bacterial transfer from hands. J Hosp Infect 2009;72:43–49.
4. Rosenthal M, Aiello AE, Chenoweth C, et al. Impact of technical sources of variation on the hand microbiome dynamics of healthcare workers. PLoS One 2014;9:e88999.
5. Visalachy S, Palraj KK, Kopula SS, Sekar U. Carriage of multidrug resistant bacteria on frequently contacted surfaces and hands of health care workers. J Clin Diagn Res 2016;10: DC18–DC20.
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