Hayden Mary K, Blom Donald W, Lyle Elizabeth A, Moore Charity G, Weinstein Robert A
Rush University Medical Center, Chicago, Illinois 60612, USA.
Infect Control Hosp Epidemiol. 2008 Feb;29(2):149-54. doi: 10.1086/524331.
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.
Structured observational study.
Medical intensive care unit of a 700-bed, tertiary-care teaching hospital.
VRE-colonized patients and their caregivers.
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.
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).
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.
评估在日常护理中接触耐万古霉素肠球菌（VRE）定植患者及其定植环境的医护人员（HCW）手部或手套被VRE污染的水平。
结构化观察性研究。
一家拥有700张床位的三级护理教学医院的医学重症监护病房。
VRE定植患者及其护理人员。
在27次监测期间，我们在常规护理前后，从22例VRE定植患者完整皮肤上的部位以及患者房间内的部位采集样本。在131次医护人员观察期间，共观察了98名不同的医护人员。观察者记录医护人员接触的部位。在护理前后从医护人员的手部和手套采集培养样本。
VRE从平均（±标准差）55%±24%的患者部位（n = 256）和17%±12%的环境部位（n = 1572）分离出来。大多数医护人员（131名[56%]）接触了患者及其环境；没有医护人员只接触患者。在进入房间时手部样本VRE检测为阴性的103名医护人员中，52%在接触环境后手部或手套被污染，70%在接触患者及其环境后手部或手套被污染（P = 0.101）。在单因素逻辑回归模型中，手部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]）。在多因素模型中，接触次数的影响与接触类型（即仅接触环境或同时接触患者和环境）的影响无法区分。总体而言，未戴手套的医护人员中有37%手部被污染，戴手套的医护人员中有5%手部被污染（相差86%）。
在接触VRE定植患者占用房间的环境后，医护人员手部或手套被污染的可能性与接触定植患者及其环境后几乎相同。手套对防止手部污染具有高度保护作用。
