To measure directly the rate of contamination, during routine patient examination, of gowns, gloves, and stethoscopes with vancomycin-resistant enterococci (VRE).
A large, academic, tertiary-care hospital.
Between January 1997 and December 1998, 49 patients colonized or infected with VRE were entered in the study.
After routine examination, the examiner's glove fingertips, gown (the umbilical region and the cuffs), and stethoscope diaphragm were pressed onto Columbia colistin-nalidixic acid (CNA) agar plates with 5% sheep blood plus vancomycin 6 ug/mL. The stethoscope diaphragm was sampled again after cleaning with a 70% isopropanol wipe.
VRE were isolated from at least 1 examiner site (gloves, gowns, or stethoscope) in 33 (67%) of 49 cases. Gloves were contaminated in 63%, gowns in 37%, and stethoscopes in 31%. All three items were positive for VRE in 24%. One case each had stethoscope and gown contamination without glove contamination. Only 1 (2%) of 49 stethoscopes was positive after wiping with an alcohol swab. Contamination at any site was more likely when the patient had a colostomy or ileostomy. Patients identified by rectal-swab culture alone were as likely to contaminate their examiners as were those identified by clinical specimens.
Our study revealed a high rate of examiner contamination with VRE. The similar risk of contamination identified by surveillance and clinical cases reinforces concerns that patients not known to be colonized with VRE could serve as sources for dissemination. Wiping with alcohol is effective in decontaminating stethoscopes.