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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.
Prospective cohort study.
Medical and surgical intensive care units at a tertiary-care academic institution.
VRE-colonized patients on Contact Precautions and their HCWs.
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.
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).
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.
Two of the most iconic photos of the 1956 Hungarian revolution involve a colossal statue of Stalin, erected in 1951 and toppled on the first day of the anti-Soviet uprising. One of these pictures shows Stalin's decapitated head, abandoned in the street as curious pedestrians amble by. The other shows a tall stone pedestal with nothing on it but a lonely pair of bronze boots. Situated near Heroes' Square, Hungary's national pantheon, the Stalin statue had served as a symbol of Hungary's subjugation to the Soviet Union; and its ceremonious and deliberate destruction provided a poignant symbol for the fall of Stalinism.
Children with specific language impairment (SLI) have well-documented problems in the use of tense-related grammatical morphemes. However, in English, tense often overlaps with aspect and modality. In this study, 15 children with SLI (mean age 5;2) and two groups of 15 typically developing children (mean ages 3;6 and 5;3) were compared in terms of their use of previously studied morphemes in contexts that more clearly assessed the role of aspect. The children's use of less frequently studied morphemes tied to modality or tense was also examined. The children with SLI were found to use -ing to mark progressive aspect in past as well as present contexts, even though they were relatively poor in using the tense morphemes (auxiliary was, were) that should accompany the progressive inflection. These children were inconsistent in their use of third person singular -s to describe habitual actions that were not occurring during the time of their utterance. However, the pattern of the children's use suggested that the source of the problem was the formal tense feature of the inflection, not the habitual action context. The children's use of modal can was comparable to that of the typically developing children, raising the possibility that the modality function of possibility had been learned without necessarily acquiring the tense feature of this morpheme. These children's proficiency with can suggests that their bare verb stem productions should probably not be re-interpreted as cases of missing modals. Together these findings suggest that the more serious tense-related problems seen in English-speaking children with SLI co-occur with a less impaired ability to express temporal relations through aspect and modality.