Risk of hand or glove contamination after contact with patients colonized with vancomycin-resistant Enterococcus or the colonized patients' environment
Risk of hand or glove contamination after contact with patients colonized with vancomycin-resistant Enterococcus or the colonized patients' environment
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DOI：
10.1086/524331
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发表时间：
2008-02-01
影响因子：
4.5
通讯作者：
Weinstein, Robert A.
中科院分区：
文献类型：
--
作者：
Hayden, Mary K.;Blom, Donald W.;Weinstein, Robert A.
objective.评估在常规护理期间接触万古霉素耐药肠球菌（VRE）定植患者和/或定植患者环境的医护人员（HCW）的手部或手套受VRE污染的水平。设计结构性观察研究。设置.一家拥有700张床位的三级护理教学医院的医疗重症监护室。参与者VRE定植患者及其护理人员。方法.我们在27次监测期间，在常规护理前后，从22名VRE定植患者的完整皮肤上的部位和患者房间的部位获得样本。在131次HCW观测中，共观测到98个独特的HCW。观察员记录了HCW接触过的地点。在护理之前和之后从HCW的手和手套获得培养样品。结果从平均（+/- SD）55% +/- 24%的患者部位（n = 256）和17% +/- 12%的环境部位（n = 1，572）中分离出VRE。大多数HCW（131 [56%]）接触患者和患者环境;没有HCW仅接触患者。在103名进入房间时手样本为VRE阴性的HCW中，52%在接触环境后污染了手或手套，70%在接触患者和环境后污染了手或手套（P = 0.101）。在单变量logistic回归模型中，手或手套污染的风险与接触次数相关（比值比，1.1 [ 95%]置信区间，1.01-1.19）。在多变量模型中，无法区分接触次数的影响与接触类型的影响（即，单独接触环境或同时接触患者和环境）。总的来说，37%的不戴手套的医护人员污染了他们的手，5%的戴手套的医护人员污染了他们的手（86%的差异）。结论HCW几乎一样有可能污染他们的手或手套后，触摸环境中的一个房间里的病人殖民VRE后，触摸殖民化的病人和病人的环境。手套对手部污染具有高度保护作用。
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.