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

Abstract

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.).

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

“…10 These findings were also consistent with the high risk and low risk types of care associated with MRSA transmission in this same population. 9 …”

“…9,10,19 Other potential sources of RGNB exist that could explain these findings such as other body sites of RGNB colonization (e.g. skin or wounds) or the environment.…”

“…10 Although both colonized populations had similar antibiotic use at enrollment, the current population received mostly broad spectrum antibiotics, which could have impacted both Gram negative and Gram positive bacteria colonization and, as a result, their transmission to HCP’s gowns and gloves. Topical antibiotic use was not recorded for the current study which could help explain this difference.…”

“…We are unable to estimate how often contamination of gowns and gloves results in transmission to other HCP or residents. 10,19 We did not perform molecular typing to compare the residents’ strains with the strains isolated from gowns and gloves. In earlier studies, we observed a high concordance (up to 89%) between antibiotic resistant strains from residents and those detected on gowns and gloves.…”

“…10 However, the majority of nursing homes in the United States are not part of the VA system and are known as community nursing facilities. In contrast to VA-nursing homes, residents living here are older and more likely to be women.…”