Transmission of methicillin-resistant Staphylococcus aureus to health care worker gowns and gloves during care of residents in Veterans Affairs nursing homes

Pineles, Lisa; Morgan, Daniel J.; Lydecker, Alison D.; Johnson, J. Kristie; Sorkin, John D.; Langenberg, Patricia; Blanco, Natalia; Lesse, Alan J.; Sellick, John A.; Gupta, Kalpana; Leykum, Luci K.; Cadena, José; Lepcha, Nickie; Roghmann, Mary-Claire

doi:10.1016/j.ajic.2017.03.004

Cited by 30 publications

(37 citation statements)

References 23 publications

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“…However, high (up to 89%) concordance between antibioticresistant strains in similar transmission studies was published by our group (14,16). Although the generalizability of our results may be limited by a veteran population, our study is strengthened by its multisite prospective design, which is representative of the national VA nursing home population (12).…”

Section: Discussionsupporting

confidence: 67%

“…Our results are consistent with previously published results by our group about MRSA transmission to HCW gowns and gloves from MRSA-colonized residents in the same population. We observed 3 times higher overall transmission of MRSA than RGNB (12). This observed difference may be due to the higher skin concentrations of MRSA versus RGNB (19,20).…”

Section: Discussionmentioning

confidence: 60%

“…Our study is limited by the fact that our outcome, transmission to HCW gowns and gloves, acts as a surrogate for RGNB transmission to other nursing home residents. We were unable to determine how often contamination of gowns and gloves results in transmission to other HCWs or residents (12). In addition, we did not perform pulsedfield gel electrophoresis to compare the resident strains with the strains isolated from gowns and gloves.…”

Section: Discussionmentioning

confidence: 99%

“…Our group recently reported that transmission of methicillin-resistant Staphylococcus aureus (MRSA) from colonized residents to HCW gloves and gowns (20% and 11%, respectively) occurs frequently (12). Transmission varied by type of care, which allowed us to identify high-risk types of care (e.g., changing wound dressings, dressing and bathing the resident, and assisting with hygiene) where use of gowns and gloves would significantly decrease transmission rates without unduly increasing the burden of caring for residents without stigmatizing them (12).…”

mentioning

confidence: 99%

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Transmission of Resistant Gram-Negative Bacteria to Health Care Worker Gowns and Gloves during Care of Nursing Home Residents in Veterans Affairs Community Living Centers

Blanco

Pineles

Lydecker

et al. 2017

Antimicrob Agents Chemother

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The objectives of the study were to estimate the risk of transmission of antibiotic-resistant Gram-negative bacteria (RGNB) to gowns and gloves (G&G) worn by health care workers (HCWs) when providing care to nursing home residents and to identify the types of care and resident characteristics associated with transmission. A multicenter, prospective observational study was conducted with residents and HCWs from Veterans Affairs (VA) nursing homes. Perianal swabs to detect RGNB were collected from residents. HCWs wore G&G during usual care activities, and the G&G were swabbed at the end of the interaction in a standardized manner. Transmission of RGNB from a colonized resident to G&G by type of care was measured. Odds ratios (ORs) associated with type of care or resident characteristics were estimated. Fifty-seven (31%) of 185 enrolled residents were colonized with ≥1 RGNB. RGNB transmission to HCW gloves or gowns occurred during 9% of the interactions ( = 905): 7% to only gloves and 2% to only gowns. Bathing the resident and providing hygiene and toilet assistance were associated with a high risk of transmission. Glucose monitoring and assistance with feeding or medication were associated with a low risk of transmission. In addition, antibiotic use by the resident was strongly associated with greater transmission (OR, 2.51; < 0.01). RGNB were transferred to HCWs during ∼9% of visits. High-risk types of care were identified for which use of G&G may be prioritized. Antibiotic use was associated with 2.5 times greater risk of transmission, emphasizing the importance of antibiotic stewardship. (This study has been registered at ClinicalTrials.gov under registration no. NCT01350479.).

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Transmission of Resistant Gram-Negative Bacteria to Health Care Worker Gowns and Gloves during Care of Nursing Home Residents in Veterans Affairs Community Living Centers

Blanco

Pineles

Lydecker

et al. 2017

Antimicrob Agents Chemother

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show abstract

“…2,3 The studies enrolled 401 residents from 13 community based nursing homes in Maryland and Michigan and 200 residents from five VA CLCs in four states and the District of Columbia. Selection within the community-based facilities was designed to be representative of all nursing home residents, whereas among the VA CLCs, two groups of residents were enrolled: residents with a recent (within 1 year) history of MRSA colonization and residents without recent MRSA colonization.…”

Section: To the Editormentioning

confidence: 99%