Transmission of resistant Gram-negative bacteria to healthcare personnel gowns and gloves during care of residents in community-based nursing facilities

Abstract

Objective: To estimate the risk of transmission of antibiotic resistant Gram-negative bacteria (RGNB) to gowns and gloves worn by healthcare personnel (HCP) when providing care to residents of community-based nursing facilities in order to identify the types of care and resident characteristics associated with transmission. Design: Prospective observational study Settings and participants: Residents and HCP from 13 community-based nursing facilities in Maryland and Michigan Methods: Perianal swabs were collected from residents and cultured to detect RGNB. HCP wore gowns and gloves during usual care activities, and at the end of each interaction, these were swabbed in a standardized manner. Transmission of RGNB from a colonized resident to gowns and gloves was estimated. Odds ratios (OR) of transmission associated with type of care or resident characteristic were calculated. Results: 403 residents and their HCP were enrolled. Nineteen percent of enrolled residents with a perianal swab (n=399) were colonized with at least one RGNB. RGNB transmission to either gloves or gowns occurred during 11% of the 584 interactions. Showering the resident, hygiene or toilet assistance, and wound dressing changes were associated with a high risk of transmission. Glucose monitoring and assistance with feeding or medication were associated with a low risk of transmission. Residents with a pressure ulcer were 3 times more likely to transmit RGNB than residents without one (OR=3.3, 95%CI 1.0–11.1). Conclusions: Results suggest that gowns and gloves use in community nursing facilities should be prioritized for certain residents and care interactions found to be high risk for transmission.

The devil is in the details: Factors influencing hand hygiene adherence and contamination with antibiotic-resistant organisms among healthcare providers in nursing facilities

“…The rate of ARO acquisition was similar to rates reported in prior studies of transmission of R-GNB to the gloves of NF HCP and was lower than rates observed in MRSA transmission. [22][23][24] Pathogen acquisition was diverse, with relatively equal numbers of VRE, MRSA, and R-GNB isolated. In most cases, the relevant pathogen was also cultivated from the patient or environment, with identical PFGE patterns in a small subset of tested isolates.…”

“…High rates of ARO acquisition were observed with both high-risk (eg, incontinence care, dressing assist) and low-risk (eg, repositioning, patient transfers) activities. Prior work by Blanco et al 23 found assisting residents with dressing, bathing, hygiene, incontinence care, and transfers, in addition to showering, to be the highest risk activities for HCP in the NF setting, each with a R-GNB transmission rate of >12%. Potential exposure to mucous membranes or body fluid among these activities is variable; sustained patient contact may be a more important risk factor for ARO acquisition among HCP in the NF setting; however, further studies are needed.…”

Transmission of novel Klebsiella pneumoniae carbapenemase-producing Escherichia coli sequence type 1193 among residents and caregivers in a community-based, residential care setting—Nevada, 2018

“…Activities defined as high risk for transmission of pathogens included cleaning toilets and showers, handling soiled linens, and assisting residents with bathing and toileting. 2…”

Do Clean Common Areas Save Lives?

“…Accordingly, nursing home staff also has contact with residents outside of their rooms in dining, bathing, and rehabilitation areas. Several recent studies have examined the transmission of MDROs to healthcare workers while caring for nursing home residents in their rooms, finding that the activities most likely to result in MDRO transmission from residents to healthcare workers are those that involve close contact: assistance with activities of daily living, physical examination, dressing changes, and the care or use of indwelling medical devices …”

“…Several recent studies have examined the transmission of MDROs to healthcare workers while caring for nursing home residents in their rooms, finding that the activities most likely to result in MDRO transmission from residents to healthcare workers are those that involve close contact: assistance with activities of daily living, physical examination, dressing changes, and the care or use of indwelling medical devices. 4,5 In this issue of the Journal of the American Geriatrics Society, Gontjes et al examine the burden of MDROs recovered in nursing homes from environments outside of resident rooms. 6 In doing so, they are also moving into new territory for infection prevention and control-that of common and rehabilitations areas in nursing homes.…”