Transfer of multidrug-resistant bacteria to healthcare workers' gloves and gowns after patient contact increases with environmental contamination.
OBJECTIVE
To assess the role of environmental contamination in the transmission of multidrug-resistant bacteria to healthcare workers' clothing.


METHODS
Prospective cohort.


METHODS
Six intensive care units at a tertiary care hospital.


METHODS
Healthcare workers including registered nurses, patient care technicians, respiratory therapists, occupational/physical therapists, and physicians.


METHODS
None.


RESULTS
One hundred twenty of 585 (20.5%) healthcare worker/patient interactions resulted in contamination of healthcare workers' gloves or gowns. Multidrug-resistant Acinetobacter baumannii contamination occurred most frequently, 55 of 167 observations (32.9%; 95% confidence interval [CI] 25.8% to 40.0%), followed by multidrug-resistant Pseudomonas aeruginosa, 15 of 86 (17.4%; 95% CI 9.4% to 25.4%), vancomycin-resistant Enterococcus, 25 of 180 (13.9%, 95% CI 8.9, 18.9%) and methicillin-resistant Staphylococcus aureus, 21 of 152 (13.8%; 95% CI 8.3% to 19.2%). Independent risk factors associated with healthcare worker contamination with multidrug-resistant bacteria were positive environmental cultures (odds ratio [OR] 4.2; 95% CI 2.7-6.5), duration in room for >5 mins (OR 2.0; 95% CI 1.2-3.4), performing physical examinations (OR 1.7; 95% CI 1.1-2.8), and contact with the ventilator (OR 1.8; 95% CI, 1.1-2.8). Pulsed field gel electrophoresis determined that 91% of healthcare worker isolates were related to an environmental or patient isolate.


CONCLUSIONS
The contamination of healthcare workers' protective clothing during routine care of patients with multidrug-resistant organisms is most frequent with A. baumannii. Environmental contamination was the major determinant of transmission to healthcare workers' gloves or gowns. Compliance with contact precautions and more aggressive environmental cleaning may decrease transmission.
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA. dmorgan@epi.umaryland.edu
Daniel J
DJ
Morgan
Elizabeth
E
Rogawski
Kerri A
KA
Thom
J Kristie
JK
Johnson
Eli N
EN
Perencevich
Michelle
M
Shardell
Surbhi
S
Leekha
Anthony D
AD
Harris
D000046:Academic Medical Centers; D000151:Acinetobacter Infections / Q000635:transmission; D040981:Acinetobacter baumannii; D003428:Cross Infection / Q000382:microbiology / Q000635:transmission*; D024901:Drug Resistance, Multiple, Bacterial; D004783:Environmental Microbiology; D017575:Gloves, Protective / Q000382:microbiology*; D006282:Health Personnel; D006801:Humans; D011446:Prospective Studies; D011481:Protective Clothing / Q000382:microbiology*; D012307:Risk Factors