N9. MRSA, MSSA and other gram positive pathogens
Oral Abstract Submission
Lyndsay M. O'Hara, PhD, MPH
Assistant Professor
University of Maryland
Baltimore, MD
Disclosure: Nothing to disclose
David P. Calfee, NRP, MD, MS
Chief Hospital Epidemiologist
Weill Cornell Medicine
New York, NY
Disclosure: Nothing to disclose
Loren G. Miller, MD, MPH
Associate Chief
Harbor UCLA
Torrance, California
Disclosure: Nothing to disclose
Laurence S. Magder, PhD MPH
Professor
University of Maryland
Baltimore, MD
Disclosure: Nothing to disclose
J. Kristie Johnson, PhD, D(ABMM)
Professor
University of Maryland
Baltimore, MD
Disclosure: GenMark Diagnostics, Inc: Material support (testing system and cartridges)
Daniel Morgan, MD, MS
Associate Professor of Epidemiology and Public Health and Medicine
University of Maryland
Baltimore, Maryland
Disclosure: Nothing to disclose
Anthony Harris, MD, MPH
Professor
University of Maryland
Baltimore, MD
Disclosure: Entasis: Advisory Board
UpToDate: Infection control section editor. Author., Other Financial or Material Support
Background :
Healthcare personnel’s (HCP) gloves and gowns are frequently contaminated with antibiotic-resistant bacteria in the intensive care unit (ICU). Guidelines recommend contact precautions for patients with methicillin-resistant Staphylococcus aureus (MRSA), however, this approach remains controversial. This study aimed to identify which patients are more likely to transfer MRSA to HCP gloves or gowns and to identify HCP interactions more likely to lead to glove or gown contamination.
Methods :
In a multicenter cohort study of MRSA colonized patients, we observed HCP-patient interactions and cultured HCP’s gloves and gowns before doffing. We also assessed the association between bacterial burden and contamination by sampling patients' anterior nares, perianal area, chest and arm.
Results :
We enrolled 402 MRSA-colonized patients and observed 3,982 HCP interactions. MRSA contamination of HCP gloves and gown occurred in 14.3% and 5.9% of interactions, respectively. Contamination of either gloves or gown occurred in 16.2% of interactions. Occupational/physical therapists had the highest rates of contamination (OR: 6.96 [95% CI: 3.51-13.79]), followed by respiratory therapists (OR: 5.34 [95% CI: 3.04-9.39]) when compared to the “Other” category. Touching the patient was associated with higher contamination (OR: 2.59 [95% CI: 1.04-6.51]) when compared to touching nothing in the room. Touching only the environment was not associated with glove or gown contamination (OR: 1.13 [95% CI: 0.43, 3.00]) when compared to touching nothing. Touching the endotracheal tube (OR: 1.75 [95% CI: 1.38-2.19]), bedding (OR: 1.43 [95% CI: 1.20-1.70]) and bathing a patient (OR: 1.32 [95% CI: 1.01-1.75]) increased odds of contamination when compared to not having such contacts (Figures 1 and 2). We found an association between increasing bacterial burden in the patient’s nares, perianal area, and chest skin and glove or gown contamination.
Conclusion : Contamination of HCP gloves and gowns with MRSA occurs frequently when caring for ICU patients. We identified interactions that are high-risk for transmission. Hospitals may consider optimizing contact precautions by using less precautions for low-risk interactions and more precautions for high-risk interactions.
