Table 1. Summary of Best Quality Evidence by transmission Pathway
First Author, Year
Morgan DJ et al 20128
Title 1. Transmission from patient to HCW
Transfer of multidrug-resistant bacteria to HCW gloves and gowns after patient contact increases with environmental contamination.
Morgan DJ et al 20109
Frequent MDR A. baumannii contamination of gloves, gowns, and hands of HCWs
Prospective cohort study
27 HCW–patient interactions: 256 patient samples, 1,572 environmental sites, 131 pairs of HCW hands from the MICU of Rush University Medical Center
Prospective cohort study
199 patient–HCW interactions in 48 ICUs at University of Maryland Medical Center
To estimate the level of hand or glove contamination with VRE among HCWs when interacting with the patient or environment
To determine the incidence of transmission of MDR A. baumannii and P. aeruginosa from patients to HCWs during routine care
Hayden, M.K. et al 200816
Risk of hand or glove contamination after contact with patients colonized with VRE or the colonized patients’ environment
Schweizer M et al 201217
The epidemiology of MRSA on a burn trauma unit
2. Transmission from patient to environment
Munoz-Price LS et al 201311
Thom KA et al 201112
A. baumannii: association between environmental contamination of patient rooms and occupant status
Environmental contamination because of multidrug-resistant A. baumannii surrounding colonized or infected patients.
Yakupogullari Y et al 200618
Is airborne transmission of A. baumannii possible? A prospective molecular epidemiologic study in a tertiary- care hospital
Wilson AP et al 200719
Importance of the environment for patient acquisition of MRSA in the ICU: a baseline study
Prospective cohort study
Randomized sequential sampling of bed areas
Prospective cohort study
186 air samples and 82 clinical specimens from Turgut Ozal Medical Center
2,436 environmental samples around 114 patients; 349 samples from HCWs hands and phones from ICUs from 2 London teaching hospitals
479 environmental samples from 50 unique patient rooms in 4 ICUs at University of Maryland Medical Center
Prospective cohort study
628 ICU rooms at a county teaching hospital
To understand the dynamics of Acinetobacter spread in air
To assess the degree of environmental contamination with MRSA in critical care and the likelihood of subsequent new patient acquisition
To determine how frequently the environment surrounding the patient becomes contaminated
To determine the association between room contamination and the status of the occupants
PCR-typing (DiversLab) PFGE
Phage typing
The Acinetobacter concentration was the highest in bedside sampling areas of infected patients. Air isolates were clonally related to clinical strains.
Of 52 patients colonized with MRSA, 34 (65%) had similar strains found consequently in their environment.
PGFE
48% (24/50) of the rooms were positive for MDR A. baumannii. In 17 of 20 instances (85%) (among patients with MDR A. baumannii history), environmental isolates were genetically similar to the patient isolate.
PFGE
39% of rooms with A. baumannii positive patients were contaminated. 10% of rooms with A. baumannii–negative patients were contaminated as well. 6 of 7 instances (86%), environmental isolates were genetically similar to the patient isolate.
Prospective cohort study
603 patient–HCW interactions in 6 different ICUs at University of Maryland Medical Center
To assess the role of environmental contamination in the transmission of MDROs to HCW clothing
Prospective cohort study
144 patients, 67 HCWs and 50 environmental samples from the burn trauma unit at a midwestern academic medical center
To determine whether HCW, environment, or admitted patients could be reservoirs for MRSA
PFGE
Of 103 HCWs whose hand samples were negative for VRE when they entered the room, 70% contaminated their hands/gloves after interacting with the patient and the environment.
PFGE
39% of patient–HCW interactions resulted in HCW G&G contamination with A. baumannii. 9 (5%) episodes resulted in hand contamination after G&G removal; isolates were identical to the G&G strain. 8% of patient–HCW interactions resulted in HCW G&G contamination with MDR P. aeuroginosa (imipenem resistant).
PFGE
33% of P-HCW interactions led to transmission of MDR A. baumannii to HCW G&G. Carbapenem- resistant P. aeruginosa was transmitted 17% of the time. MRSA and VRE were transmitted 14% of time. Of 22 cases (selected for PFGE), 82% of HCW had a strain related to the patient.
PFGE
The USA100 subtype was shared by 3 patients and 1 HCW. In these cases, at least 1 patient was positive before the HCW was.
Study Design Population Relevant Objective
Related Molecular Analysis
Related Finding
450
Natalia Blanco et al
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