Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
J Hosp Infect. 2021 Mar;109:58-64. doi: 10.1016/j.jhin.2020.12.012. Epub 2021 Jan 15.
Hospitals are sources for acquisition of carbapenem-resistant Entero-bacterales (CRE), and it is believed that the contamination of healthcare personnel (HCP) hands and clothing play a major role in patient-to-patient transmission of antibiotic-resistant bacteria.
The aim of this study was to determine which HCP types, HCP-patient interactions, and patient characteristics are associated with greater transmission of CRE to HCP gloves and gowns in the hospital.
This was a prospective observational cohort study that enrolled patients with recent surveillance or clinical cultures positive for CRE at five hospitals in four states in the USA. HCP gloves and gown were cultured after patient care. Samples were also obtained from patients' stool, perianal area, and skin of the chest and arm to assess bacterial burden.
Among 313 CRE-colonized patients and 3070 glove and gown cultures obtained after patient care, HCP gloves and gowns were found to be contaminated with CRE 7.9% and 4.3% of the time, respectively. Contamination of either gloves or gowns occurred in 10.0% of interactions. Contamination was highest (15.3%) among respiratory therapists (odds ratio: 3.79; 95% confidence interval: 1.61-8.94) and when any HCP touched the patient (1.52; 1.10-2.12). Associations were also found between CRE transmission to HCP gloves or gown and: being in the intensive care unit, having a positive clinical culture, and increasing bacterial burden on the patient.
CRE transmission to HCP gloves and gown occurred frequently. These findings may inform evidence-based policies about what situations and for which patients contact precautions are most important.
医院是获得碳青霉烯类耐药肠杆菌科（CRE）的来源，人们认为医护人员（HCP）的手和衣物污染在耐抗生素细菌在患者之间的传播中起着重要作用。
本研究旨在确定哪些 HCP 类型、HCP-患者互动和患者特征与 CRE 更频繁地传播到医院 HCP 手套和手术服有关。
这是一项在美国四个州的五家医院进行的前瞻性观察队列研究，该研究纳入了最近 surveillance 或临床培养阳性的 CRE 患者。在患者护理后，对 HCP 手套和手术服进行了培养。还从患者的粪便、肛周区域以及胸部和手臂的皮肤中获取样本，以评估细菌负荷。
在 313 例 CRE 定植患者和 3070 例患者护理后获得的手套和手术服培养样本中，HCP 手套和手术服分别有 7.9%和 4.3%被 CRE 污染。在 10.0%的互动中，手套或手术服都被污染。呼吸治疗师（比值比：3.79；95%置信区间：1.61-8.94）和任何 HCP 接触患者时（1.52；1.10-2.12）的污染率最高（15.3%）。还发现 CRE 传播到 HCP 手套或手术服与以下因素之间存在关联：入住重症监护病房、临床培养阳性和患者的细菌负荷增加。
CRE 传播到 HCP 手套和手术服的情况经常发生。这些发现可能为基于证据的政策提供信息，说明在哪些情况下以及对哪些患者实施接触预防措施最重要。
