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Transmission of resistant Gram-negative bacteria to healthcare personnel gowns and gloves during care of residents in community-based nursing facilities

Published online by Cambridge University Press:  08 October 2018

Natalia Blanco ,
J. Kristie Johnson ,
John D. Sorkin ,
Alison D. Lydecker ,
Lauren Levy ,
Lona Mody  and
Mary-Claire Roghmann
Natalia Blanco
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
J. Kristie Johnson
Affiliation:
Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
John D. Sorkin
Affiliation:
Baltimore VA Medical Center Geriatric Research, Education and Clinical Center, Baltimore, Maryland Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Alison D. Lydecker
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Lauren Levy
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, VA 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
*
Author for correspondence: Mary-Claire Roghmann, MD, MS, University of Maryland School of Medicine, 10 South Pine Street, MTSF Room 336, Baltimore, MD 21201. E-mail: Mroghmann@som.umaryland.edu
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Abstract

Objective

To estimate the risk of transmission of antibiotic-resistant Gram-negative bacteria (RGNB) to gowns and gloves worn by healthcare personnel (HCP) when providing care to residents of community-based nursing facilities to identify the types of care and resident characteristics associated with transmission.

Design

Prospective observational study.

Settings and participants

Residents and HCP from 13 community-based nursing facilities in Maryland and Michigan.

Methods

Perianal swabs were collected from residents and cultured to detect RGNB. HCP wore gowns and gloves during usual care activities, and at the end of each interaction, these were swabbed in a standardized manner. Transmission of RGNB from a colonized resident to gowns and gloves was estimated. Odds ratios (ORs) of transmission associated with type of care or resident characteristic were calculated.

Results

We enrolled 403 residents and their HCP in this study. Overall, 19% of enrolled residents with a perianal swab (n=399) were colonized with at least 1 RGNB. RGNB transmission to either gloves or gowns occurred during 11% of the 584 interactions. Showering the resident, hygiene or toilet assistance, and wound dressing changes were associated with a high risk of transmission. Glucose monitoring and assistance with feeding or medication were associated with a low risk of transmission. Residents with a pressure ulcer were 3 times more likely to transmit RGNB than residents without one (OR, 3.3; 95% confidence interval [CI], 1.0–11.1).

Conclusions

Gown and glove use in community nursing facilities should be prioritized for certain residents and care interactions that are deemed a high risk for transmission.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 12 , December 2018 , pp. 1425 - 1430
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

Cite this article: Blanco N, et al. (2018). Transmission of resistant gram-negative bacteria to healthcare personnel gowns and gloves during care of residents in community-based nursing facilities. Infection Control & Hospital Epidemiology 2018, 39, 1425–1430. doi: 10.1017/ice.2018.247

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