Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-14T04:34:48.212Z Has data issue: false hasContentIssue false
  • English
  • Français

Transmission of Methicillin-Resistant Staphylococcus aureus (MRSA) to Healthcare Worker Gowns and Gloves During Care of Nursing Home Residents

Published online by Cambridge University Press:  26 May 2015

Mary-Claire Roghmann ,
J. Kristie Johnson ,
John D. Sorkin ,
Patricia Langenberg ,
Alison Lydecker ,
Brian Sorace ,
Lauren Levy  and
Lona Mody
Mary-Claire Roghmann*
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
J. Kristie Johnson
Affiliation:
Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
John D. Sorkin
Affiliation:
Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Patricia Langenberg
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Alison Lydecker
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Brian Sorace
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Lauren Levy
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Lona Mody
Affiliation:
Division of Geriatric and Palliative Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
*
Address correspondence to Mary-Claire Roghmann, MD, MS, University of Maryland School of Medicine, 10 South Pine Street, MTSF Room 336, Baltimore, MD 21201 (mroghman@epi.umaryland.edu).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To estimate the frequency of methicillin-resistant Staphylococcus aureus (MRSA) transmission to gowns and gloves worn by healthcare workers (HCWs) interacting with nursing home residents to better inform infection prevention policies in this setting

DESIGN

Observational study

SETTING

Participants were recruited from 13 community-based nursing homes in Maryland and Michigan

PARTICIPANTS

Residents and HCWs from these nursing homes

METHODS

Residents were cultured for MRSA at the anterior nares and perianal or perineal skin. HCWs wore gowns and gloves during usual care activities. At the end of each activity, a research coordinator swabbed the HCW’s gown and gloves.

RESULTS

A total of 403 residents were enrolled; 113 were MRSA colonized. Glove contamination was higher than gown contamination (24% vs 14% of 954 interactions; P<.01). Transmission varied greatly by type of care from 0% to 24% for gowns and from 8% to 37% for gloves. We identified high-risk care activities: dressing, transferring, providing hygiene, changing linens, and toileting the resident (OR >1.0; P<.05). We also identified low-risk care activities: giving medications and performing glucose monitoring (OR<1.0; P<.05). Residents with chronic skin breakdown had significantly higher rates of gown and glove contamination.

CONCLUSIONS

MRSA transmission from MRSA-positive residents to HCW gown and gloves is substantial; high-contact activities of daily living confer the highest risk. These activities do not involve overt contact with body fluids, skin breakdown, or mucous membranes, which suggests the need to modify current standards of care involving the use of gowns and gloves in the nursing home setting.

Infect. Control Hosp. Epidemiol. 2015;36(9):1050–1057

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 9 , September 2015 , pp. 1050 - 1057
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L. Healthcare Infection Control Practices Advisory Committee. Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006. Atlanta, GA: Centers for Disease Control and Prevention, 2006.Google Scholar
2. Trick, WE, Weinstein, RA, DeMarais, PL, et al. Comparison of routine glove use and contact-isolation precautions to prevent transmission of multidrug-resistant bacteria in a long-term care facility. J Am Geriatr Soc 2004;52:2003–2009.CrossRefGoogle ScholarPubMed
3. Hughes, C, Tunney, M, Bradley, MC. Infection control strategies for preventing the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people. Cochrane Database Syst Rev 2013;11:CD006354.Google Scholar
4. Johannessen, T. Controlled trials in single subjects. 1. Value in clinical medicine. BMJ 1991;303:173–174.CrossRefGoogle ScholarPubMed
5. Morgan, DJ, Rogawski, E, Thom, KA, et al. Transfer of multidrug-resistant bacteria to healthcare workers’ gloves and gowns after patient contact increases with environmental contamination. Crit Care Med 2012;40:1045–1051.CrossRefGoogle ScholarPubMed
6. Morgan, DJ, Liang, SY, Smith, CL, et al. Frequent multidrug-resistant Acinetobacter baumannii contamination of gloves, gowns, and hands of healthcare workers. Infect Control Hosp Epide miol 2010;31:716–721.CrossRefGoogle ScholarPubMed
7. Snyder, GM, Thom, KA, Furuno, JP, et al. Detection of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on the gowns and gloves of healthcare workers. Infect Control Hosp Epidemiol 2008;29:583–589.CrossRefGoogle ScholarPubMed
8. Centers for Medicare and Medicaid Services. Long-Term Care Facility Resident Assessment Instrument User’s Manual, 2014 Version 3.0. Baltimore, MD: Centers for Medicare and Medicaid Services, 2014.Google Scholar
9. Clinical Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. Wayne, PA: Clinical Laboratory Standards Institute, 2006.Google Scholar
10. Harmsen, D, Claus, H, Witte, W, Rothganger, J, Turnwald, D, Vogel, U. Typing of methicillin-resistant Staphylococcus aureus in a university hospital setting by using novel software for spa repeat determination and database management. J Clin Microbiol 2003;41:5442–5448.CrossRefGoogle Scholar
11. Strommenger, B, Kettlitz, C, Weniger, T, Harmsen, D, Friedrich, AW, Witte, W. Assignment of Staphylococcus isolates to groups by spa typing, SmaI macrorestriction analysis, and multilocus sequence typing. J Clin Microbiol 2006;44:2533–2540.CrossRefGoogle ScholarPubMed
12. Mody, L, Kauffman, CA, Donabedian, S, Zervos, M, Bradley, SF. Epidemiology of Staphylococcus aureus colonization in nursing home residents. Clin Infect Dis 2008;46:1368–1373.CrossRefGoogle ScholarPubMed
13. Hudson, LO, Reynolds, C, Spratt, BG, et al. Diversity of methicillin-resistant Staphylococcus aureus strains isolated from residents of 26 nursing homes in Orange County, California. J Clin Microbiol 2013;51:3788–3795.CrossRefGoogle ScholarPubMed
14. Evans, ME, Kralovic, SM, Simbartl, LA, et al. Nationwide reduction of health care-associated methicillin-resistant Staphylococcus aureus infections in Veterans Affairs long-term care facilities. Am J Infect Control 2014;42:60–62.CrossRefGoogle ScholarPubMed
15. Crnich, CJ, Duster, M, Hess, T, Zimmerman, DR, Drinka, P. Antibiotic resistance in non-major metropolitan skilled nursing facilities: prevalence and interfacility variation. Infect Control Hosp Epidemiol 2012;33:1172–1174.CrossRefGoogle ScholarPubMed
16. Gaspard, P, Eschbach, E, Gunther, D, Gayet, S, Bertrand, X, Talon, D. Meticillin-resistant Staphylococcus aureus contamination of healthcare workers’ uniforms in long-term care facilities. J Hosp Infect 2009;71(2):170–175.CrossRefGoogle ScholarPubMed
17. Stone, ND. Revisiting standard precautions to reduce antimicrobial resistance in nursing homes. JAMA Intern M ed 2015;175:723–724.CrossRefGoogle ScholarPubMed
18. Strausbaugh, LJ, Jacobson, C, Sewell, DL, Potter, S, Ward, TT. Methicillin-resistant Staphylococcus aureus in extended-care facilities: experiences in a Veterans’ Affairs nursing home and a review of the literature. Infect Control Hosp Epidemiol 1991;12:36–45.CrossRefGoogle Scholar
19. Rock, C, Harris, AD, Reich, NG, Johnson, JK, Thom, KA. Is hand hygiene before putting on nonsterile gloves in the intensive care unit a waste of health care worker time?—a randomized controlled trial. Am J Infect Control 2013;41:994–996.CrossRefGoogle ScholarPubMed
20. Harris, AD, Pineles, L, Belton, B, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 2013;310:1571–1580.Google ScholarPubMed
21. Mody, L, Krein, SL, Saint, SK, et al. A targeted infection prevention intervention in nursing home residents with indwelling devices: a randomized clinical trial. JAMA Intern M ed 2015;175:714–723.CrossRefGoogle ScholarPubMed
22. Boyce, JM, Pittet, D, Healthcare Infection Control Practices Advisory Committee, HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep 2002;51:1–45; quiz CE1–4.Google ScholarPubMed
23. Thompson, BL, Dwyer, DM, Ussery, XT, Denman, S, Vacek, P, Schwartz, B. Handwashing and glove use in a long-term-care facility. Infect Control Hosp Epidemiol 1997;18:97–103.CrossRefGoogle ScholarPubMed
24. Harrington, C, Carrillo, H, Dowdell, M, Tang, P, Blank, B. Nursing, Facilities, Staffing, Residents, and Facility Deficiencies, 2005 Through 2010. San Francisco, CA: University of California Department of Social and Behavioral Sciences, 2012.Google Scholar
25. Jones, AL, Dwyer, LL, Bercovitz, AR, Strahan, GW. The National Nursing Home Survey: 2004 overview. Vital Health Stat 13 2009;167:1–155.Google Scholar
26. Harris-Kojetin, L, Sengupta, M, Park-Lee, E, Valverde, R. Long-term Care Services in the United States: 2013 Overview National Healthcare Statistics Report. No. 1. Hyattsville, MD: National Center for Healthcare Statistics, 2013.Google ScholarPubMed
27. Mitchell, SL, Shaffer, ML, Loeb, MB, et al. Infection management and multidrug-resistant organisms in nursing home residents with advanced dementia. JAMA Intern Med 2014;174:1660–1667.CrossRefGoogle ScholarPubMed
28. Fisch, J, Lansing, B, Wang, L, et al. New acquisition of antibiotic-resistant organisms in skilled nursing facilities. J Clin Microbiol 2012;50:1698–1703.CrossRefGoogle ScholarPubMed