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Patient contact is the main risk factor for vancomycin-resistant Enterococcus contamination of healthcare workers’ gloves and gowns in the intensive care unit

Published online by Cambridge University Press:  27 July 2018

Sarah S. Jackson
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Kerri A. Thom
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Laurence S. Magder
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Kristen A. Stafford
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
J. Kristie Johnson
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Loren G. Miller
Affiliation:
LA BioMed at Harbor-UCLA Medical Center, Torrance, California
David P. Calfee
Affiliation:
Weill Cornell Medicine, New York, New York
Anthony D. Harris
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Corresponding
E-mail address:

Abstract

Objective

To determine which healthcare worker (HCW) roles and patient care activities are associated with acquisition of vancomycin-resistant Enterococcus (VRE) on HCW gloves or gowns after patient care, as a surrogate for transmission to other patients.

Design

Prospective cohort study.

Setting

Medical and surgical intensive care units at a tertiary-care academic institution.

Participants

VRE-colonized patients on Contact Precautions and their HCWs.

Methods

Overall, 94 VRE-colonized patients and 469 HCW–patient interactions were observed. Research staff recorded patient care activities and cultured HCW gloves and gowns for VRE before doffing and exiting patient room.

Results

VRE were isolated from 71 of 469 HCWs’ gloves or gowns (15%) following patient care. Occupational/physical therapists, patient care technicians, nurses, and physicians were more likely than environmental services workers and other HCWs to have contaminated gloves or gowns. Compared to touching the environment alone, the odds ratio (OR) for VRE contamination associated with touching both the patient (or objects in the immediate vicinity of the patient) and environment was 2.78 (95% confidence interval [CI], 0.99–0.77) and the OR associated with touching only the patient (or objects in the immediate vicinity) was 3.65 (95% CI, 1.17–11.41). Independent risk factors for transmission of VRE to HCWs were touching the patient’s skin (OR, 2.18; 95% CI, 1.15–4.13) and transferring the patient into or out of bed (OR, 2.66; 95% CI, 1.15–6.43).

Conclusion

Patient contact is a major risk factor for HCW contamination and subsequent transmission. Interventions should prioritize contact precautions and hand hygiene for HCWs whose activities involve touching the patient.

Type
Original Article
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION. Presented in part to the Society for Healthcare Epidemiology Annual Meeting, Portland, Oregon, on April XX, 2018 (abstract no. 10453).

Cite this article: Jackson SS, et al. (2018) Patient contact is the main risk factor for vancomycin-resistant Enterococcus contamination of healthcare workers’ glove and gowns in the intensive care unit. Infection Control & Hospital Epidemiology 2018, 39, 1063–1067. doi: 10.1017/ice.2018.160

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