Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-23T16:56:50.641Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk of Hand or Glove Contamination After Contact With Patients Colonized With Vancomycin-Resistant Enterococcus or the Colonized Patients' Environment

Published online by Cambridge University Press:  02 January 2015

Mary K. Hayden ,
Donald W. Blom ,
Elizabeth A. Lyle ,
Charity G. Moore  and
Robert A. Weinstein
Mary K. Hayden*
Affiliation:
Rush University Medical Center, Chicago, Illinois
Donald W. Blom
Affiliation:
Rush University Medical Center, Chicago, Illinois
Elizabeth A. Lyle
Affiliation:
Rush University Medical Center, Chicago, Illinois
Charity G. Moore
Affiliation:
University of North Carolina, Chapel Hill
Robert A. Weinstein
Affiliation:
Rush University Medical Center, Chicago, Illinois John H. Stroger (Cook County) Hospital, Chicago, Illinois
*
Rush University Medical Center, 1653 W. Congress Pkwy., Chicago, IL 60612 (mhayden@rush.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To estimate the level of hand or glove contamination with vancomycin-resistant enterococci (VRE) among healthcare workers (HCWs) who touch a patient colonized with VRE and/or the colonized patient's environment during routine care.

Design.

Structured observational study.

Setting.

Medical intensive care unit of a 700-bed, tertiary-care teaching hospital.

Participants.

VRE-colonized patients and their caregivers.

Methods.

We obtained samples from sites on the intact skin of 22 patients colonized with VRE and samples from sites in the patients' rooms, before and after routine care, during 27 monitoring episodes. A total of 98 unique HCWs were observed during 131 HCW observations. Observers recorded the sites touched by HCWs. Culture samples were obtained from HCWs' hands and gloves before and after care.

Results.

VRE were isolated from a mean (±SD) of 55% ± 24% of patient sites (n = 256) and 17% ± 12% of environmental sites (n = 1,572). Most HCWs (131 [56%]) touched both the patient and the patient's environment; no HCW touched only the patient. Of 103 HCWs whose hand samples were negative for VRE when they entered the room, 52% contaminated their hands or gloves after touching the environment, and 70% contaminated their hands or gloves after touching the patient and the environment (P = .101). In a univariate logistic regression model, the risk of hand or glove contamination was associated with the number of contacts made (odds ratio, 1.1 [95% confidence interval, 1.01-1.19). In a multivariate model, the effect of the number of contacts could not be distinguished from the effect of type of contact (ie, touching the environment alone or touching both the patient and the environment). Overall, 37% of HCWs who did not wear gloves contaminated their hands, and 5% of HCWs who wore gloves did so (an 86% difference).

Conclusion.

HCWs were nearly as likely to have contaminated their hands or gloves after touching the environment in a room occupied by a patient colonized by VRE as after touching the colonized patient and the patient's environment. Gloves were highly protective with respect to hand contamination.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 2 , February 2008 , pp. 149 - 154
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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.Pittet, D, Allegranzi, B, Sax, H, et al.Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis 2006;6:641–652.CrossRefGoogle ScholarPubMed
2.Bonten, MJ, Hayden, MK, Nathan, C, et al.Epidemiology of colonisation of patients and environment with vancomycin-resistant enterococci. Lancet 1996;348:1615–1619.CrossRefGoogle ScholarPubMed
3.Tenorio, AR, Badri, SM, Sahgal, NB, et al.Effectiveness of gloves in the prevention of hand carriage of vancomycin-resistant Enterococcus species by health care workers after patient care. Clin Infect Dis 2001;32:826–829.CrossRefGoogle ScholarPubMed
4.Bhalla, A, Pultz, NJ, Gries, DM, et al.Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients. Infect Control Hosp Epidemiol 2004;25:164–167.CrossRefGoogle ScholarPubMed
5.Ray, AJ, Hoyen, CK, Taub, TF, Eckstein, EC, Donskey, CJ. Nosocomial transmission of vancomycin-resistant enterococci from surfaces. JAMA 2002;287:1400–1401.CrossRefGoogle ScholarPubMed
6.Duckro, AN, Blom, DW, Lyle, EA, Weinstein, RA, Hayden, MK. Transfer of vancomycin-resistant enterococci via health care worker hands. Arch Intern Med 2005;165:302–307.Google Scholar
7.Larson, E, Friedman, C, Cohran, J, Treston-Aurand, J, Green, S. Prevalence and correlates of skin damage on the hands of nurses. Heart Lung 1997;26:404–412.CrossRefGoogle Scholar
8.Larson, EL, Strom, MS, Evans, CA. Analysis of three variables in sampling solutions used to assay bacteria of hands: type of solution, use of antiseptic neutralizers, and solution temperature. J Clin Microbiol 1980;12:355–360.CrossRefGoogle ScholarPubMed
9.Hayden, MK, Bonten, MJ, Blom, DW, Lyle, EA, van de Vijver, DA, Weinstein, RA. Reduction in acquisition of vancomycin-resistant Enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 2006;42:1552–1560.Google Scholar
10.Matushek, MG, Bonten, MJ, Hayden, MK. Rapid preparation of bacterial DNA for pulsed-field gel electrophoresis. J Clin Microbiol 1996;34:2598–2600.Google Scholar
11.Agresti, A. Categorical Data Analysis. New York, NY: John Wiley and Sons; 1990.Google Scholar
12.Hollander, M, Wolfe, DA. Nonparametric Statistical Methods. 2nd ed. New York, NY: John Wiley and Sons; 1999.Google Scholar
13.Liang, KY ZS. Longitudinal data analysis using generalized linear models. Biometrika 1986;73:13–22.Google Scholar
14.Pittet, D, Dharan, S, Touveneau, S, Sauvan, V, Perneger, TV. Bacterial contamination of the hands of hospital staff during routine patient care. Arch Intern Med 1999;159:821–826.CrossRefGoogle ScholarPubMed
15.Pessoa-Silva, CL, Dharan, S, Hugonnet, S, et al.Dynamics of bacterial hand contamination during routine neonatal care. Infect Control Hosp Epidemiol 2004;25:192–197.Google Scholar
16.Trick, WE, Vernon, MO, Hayes, RA, et al.Impact of ring wearing on hand contamination and comparison of hand hygiene agents in a hospital. Clin Infect Dis 2003;36:1383–1390.CrossRefGoogle ScholarPubMed
17.Grabsch, EA, Burrell, LJ, Padiglione, A, O'Keeffe, JM, Ballard, S, Grayson, ML. Risk of environmental and healthcare worker contamination with vancomycin-resistant enterococci during outpatient procedures and hemodialysis. Infect Control Hosp Epidemiol 2006;27:287–293.CrossRefGoogle ScholarPubMed
18.Recommendations for preventing the spread of vancomycin resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 1995;44(RR-12):1–13.Google Scholar
19.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(RR-16):1–45.Google Scholar
20.Huang, SS, Datta, R, Piatt, R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006;166:1945–1951.Google Scholar
21.Martinez, JA, Ruthazer, R, Hansjosten, K, Barefoot, L, Snydman, DR. Role of environmental contamination as a risk factor for acquisition of vancomycin-resistant enterococci in patients treated in a medical intensive care unit. Arch Intern Med 2003;163:1905–1912.CrossRefGoogle Scholar
22.McBryde, ES, McElwain, DL. A mathematical model investigating the impact of an environmental reservoir on the prevalence and control of vancomycin-resistant enterococci. J Infect Dis 2006;193:1473–1474.CrossRefGoogle ScholarPubMed
23.Vernon, MO, Hayden, MK, Trick, WE, Hayes, RA, Blom, DW, Weinstein, RA. Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Arch Intern Med 2006;166:306–312.Google Scholar