Transfer of multidrug-resistant bacteria to healthcare workers' gloves and gowns after patient contact increases with environmental contamination.
Transfer of multidrug-resistant bacteria to healthcare workers' gloves and gowns after patient contact increases with environmental contamination.
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DOI：
10.1097/ccm.0b013e31823bc7c8
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发表时间：
2012-04
影响因子：
8.8
通讯作者：
Harris AD
中科院分区：
文献类型：
--
作者：
Morgan DJ;Rogawski E;Thom KA;Johnson JK;Perencevich EN;Shardell M;Leekha S;Harris AD
评估环境污染在将多重耐药细菌传播到医护人员衣服上的作用。未来的队列。一家三级护理医院的六个重症监护室。医护人员，包括注册护士、病人护理技术员、呼吸治疗师、职业/物理治疗师和医生。没有。在585例医护人员/患者的互动中，有120例(20.5%)导致医护人员的手套或长袍受到污染。其次是耐多药铜绿假单胞菌15株(17.4%；95%CI 9.4%~25.4%)；耐万古霉素肠球菌25株(13.9%，95%CI 8.9，18.9%)；耐甲氧西林金黄色葡萄球菌21株(13.8%；95%CI 8.3%~19.2%)。与医护人员感染多重耐药菌有关的独立危险因素是环境培养阳性(优势比[OR]4.2；95%CI 2.7~6.5)、在室内停留5分钟(OR 2.0；95%CI 1.2~3.4)、进行体检(OR 1.7；95%CI 1.1~2.8)、接触呼吸机(OR 1.8；95%CI 1.1~2.8)。脉冲场凝胶电泳法检测到91%的医护人员分离株与环境或患者分离株有关。鲍曼不动杆菌感染患者的常规护理过程中，医护人员的防护服受到污染的情况最为常见。环境污染是传播到医护人员手套或长袍的主要决定因素。遵守接触预防措施和更积极的环境清洁可能会减少传播。
To assess the role of environmental contamination in the transmission of multidrug-resistant bacteria to healthcare workers’ clothing. Prospective cohort. Six intensive care units at a tertiary care hospital. Healthcare workers including registered nurses, patient care technicians, respiratory therapists, occupational/physical therapists, and physicians. None. One hundred twenty of 585 (20.5%) healthcare worker/patient interactions resulted in contamination of healthcare workers’ gloves or gowns. Multidrug-resistant Acinetobacter baumannii contamination occurred most frequently, 55 of 167 observations (32.9%; 95% confidence interval [CI] 25.8% to 40.0%), followed by multidrug-resistant Pseudomonas aeruginosa, 15 of 86 (17.4%; 95% CI 9.4% to 25.4%), vancomycin-resistant Enterococcus, 25 of 180 (13.9%, 95% CI 8.9, 18.9%) and methicillin-resistant Staphylococcus aureus, 21 of 152 (13.8%; 95% CI 8.3% to 19.2%). Independent risk factors associated with healthcare worker contamination with multidrug-resistant bacteria were positive environmental cultures (odds ratio [OR] 4.2; 95% CI 2.7–6.5), duration in room for >5 mins (OR 2.0; 95% CI 1.2–3.4), performing physical examinations (OR 1.7; 95% CI 1.1–2.8), and contact with the ventilator (OR 1.8; 95% CI, 1.1–2.8). Pulsed field gel electrophoresis determined that 91% of healthcare worker isolates were related to an environmental or patient isolate. The contamination of healthcare workers’ protective clothing during routine care of patients with multidrug- resistant organisms is most frequent with A. baumannii. Environmental contamination was the major determinant of transmission to healthcare workers’ gloves or gowns. Compliance with contact precautions and more aggressive environmental cleaning may decrease transmission.