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Burden of perianal Staphylococcus aureus colonization in nursing home residents increases transmission to healthcare worker gowns and gloves

Published online by Cambridge University Press:  07 August 2020

Justin J. Kim*
Affiliation:
Division of Infectious Diseases, University of Maryland Medical Center, Baltimore, Maryland
J. Kristie Johnson
Affiliation:
Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
Emily M. Stucke
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
John D. Sorkin
Affiliation:
Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland Geriatrics Research Education and Clinical Center, Veterans’ Affairs Maryland Health Care System, Baltimore, Maryland
LiCheng Zhao
Affiliation:
Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
Alison Lydecker
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Lona Mody
Affiliation:
Division of Geriatric and Palliative Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan Geriatrics Research Education and Clinical Center, Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
Mary-Claire Roghmann
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland Geriatrics Research Education and Clinical Center, Veterans’ Affairs Maryland Health Care System, Baltimore, Maryland
*
Author for correspondence: Justin J. Kim, E-mail: justin.kim@som.umaryland.edu

Abstract

Objective:

To evaluate the effect of the burden of Staphylococcus aureus colonization of nursing home residents on the risk of S. aureus transmission to healthcare worker (HCW) gowns and gloves.

Design:

Multicenter prospective cohort study.

Setting and participants:

Residents and HCWs from 13 community-based nursing homes in Maryland and Michigan.

Methods:

Residents were cultured for S. aureus at the anterior nares and perianal skin. The S. aureus burden was estimated by quantitative polymerase chain reaction detecting the nuc gene. HCWs wore gowns and gloves during usual care activities; gowns and gloves were swabbed and then cultured for the presence of S. aureus.

Results:

In total, 403 residents were enrolled; 169 were colonized with methicillin-resistant S. aureus (MRSA) or methicillin-sensitive S. aureus (MSSA) and comprised the study population; 232 were not colonized and thus were excluded from this analysis; and 2 were withdrawn prior to being swabbed. After multivariable analysis, perianal colonization with S. aureus conferred the greatest odds for transmission to HCW gowns and gloves, and the odds increased with increasing burden of colonization: adjusted odds ratio (aOR), 2.1 (95% CI, 1.3–3.5) for low-level colonization and aOR 5.2 (95% CI, 3.1–8.7) for high level colonization.

Conclusions:

Among nursing home patients colonized with S. aureus, the risk of transmission to HCW gowns and gloves was greater from those colonized with greater quantities of S. aureus on the perianal skin. Our findings inform future infection control practices for both MRSA and MSSA in nursing homes.

Type
Original Article
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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