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Frequent Multidrug-Resistant Acinetobacter baumannii Contamination of Gloves, Gowns, and Hands of Healthcare Workers

Published online by Cambridge University Press:  02 January 2015

Daniel J. Morgan ,
Stephen Y. Liang ,
Catherine L. Smith ,
J. Kristie Johnson ,
Anthony D. Harris ,
Jon P. Furuno ,
Kerri A. Thorn ,
Graham M. Snyder ,
Hannah R. Day  and
Eli N. Perencevich
Daniel J. Morgan*
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore
Stephen Y. Liang
Affiliation:
Department of Medicine, University of Maryland, Baltimore
Catherine L. Smith
Affiliation:
Department of Medicine, University of Maryland, Baltimore
J. Kristie Johnson
Affiliation:
Department of Pathology, University of Maryland, Baltimore
Anthony D. Harris
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore
Jon P. Furuno
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore
Kerri A. Thorn
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore
Graham M. Snyder
Affiliation:
Department of Medicine, University of Maryland, Baltimore
Hannah R. Day
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore
Eli N. Perencevich
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore
*
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, 685 West Baltimore Street, MSTF 334D, Baltimore, MD 21201 (dmorgan@epi.umaryland.edu)
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Extract

Background.

Multidrug-resistant (MDR) gram-negative bacilli are important nosocomial pathogens.

Objective.

To determine the incidence of transmission of MDR Acinetobacter baumannii and Pseudomonas aeruginosa from patients to healthcare workers (HCWs) during routine patient care.

Design.

Prospective cohort study.

Setting.

Medical and surgical intensive care units.

Methods.

We observed HCWs who entered the rooms of patients colonized with MDR A. baumannii or colonized with both MDR A. baumannii and MDR P. aeruginosa. We examined their hands before room entry, their disposable gloves and/or gowns upon completion of patient care, and their hands after removal of gloves and/or gowns and before hand hygiene.

Results.

Sixty-five interactions occurred with patients colonized with MDR A. baumannii and 134 with patients colonized with both MDR A. baumannii and MDR P. aeruginosa. Of 199 interactions between HCWs and patients colonized with MDR A. baumannii, 77 (38.7% [95% confidence interval {CI}, 31.9%–45.5%]) resulted in HCW contamination of gloves and/or gowns, and 9 (4.5% [95% CI, 1.6%–7.4%]) resulted in contamination of HCW hands after glove removal before hand hygiene. Of 134 interactions with patients colonized with MDR P. aeruginosa, 11 (8.2% [95% CI, 3.6%–12.9%]) resulted in HCW contamination of gloves and/or gowns, and 1 resulted in HCW contamination of hands. Independent risk factors for contamination with MDR A. baumannii were manipulation of wound dressing (adjusted odds ratio [aQR], 25.9 [95% CI, 3.1–208.8]), manipulation of artificial airway (aOR, 2.1 [95% CI, 1.1–4.0]), time in room longer than 5 minutes (aOR, 4.3 [95% CI, 2.0–9.1]), being a physician or nurse practitioner (aOR, 7.4 [95% CI, 1.6–35.2]), and being a nurse (aOR, 2.3 [95% CI, 1.1–4.8]).

Conclusions.

Gowns, gloves, and unwashed hands of HCWs were frequently contaminated with MDR A. baumannii. MDR A. baumannii appears to be more easily transmitted than MDR P. aeruginosa and perhaps more easily transmitted than previously studied methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus. This ease of transmission may help explain the emergence of MDR A. baumannii.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 7 , July 2010 , pp. 716 - 721
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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