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Observational Study
. 2017 Sep 1;45(9):947-953.
doi: 10.1016/j.ajic.2017.03.004. Epub 2017 Apr 18.

Transmission of methicillin-resistant Staphylococcus aureus to health care worker gowns and gloves during care of residents in Veterans Affairs nursing homes

Lisa Pineles  1 , Daniel J Morgan  1 , Alison Lydecker  1 , J Kristie Johnson  1 , John D Sorkin  1 , Patricia Langenberg  1 , Natalia Blanco  2 , Alan Lesse  3 , John Sellick  3 , Kalpana Gupta  4 , Luci Leykum  5 , Jose Cadena  5 , Nickie Lepcha  6 , Mary-Claire Roghmann  7
Affiliations
Observational Study

Transmission of methicillin-resistant Staphylococcus aureus to health care worker gowns and gloves during care of residents in Veterans Affairs nursing homes

Lisa Pineles et al. Am J Infect Control. .

Abstract

Background: This was an observational study designed to estimate the frequency of methicillin-resistant Staphylococcus aureus (MRSA) transmission to gowns and gloves worn by health care workers (HCWs) interacting with Veterans Affairs Community Living Center (VA nursing home) residents to inform MRSA prevention policies.

Methods: Participants included residents and HCWs from 7 VA nursing homes in 4 states and Washington, DC. Residents were cultured for MRSA at the anterior nares, perianal skin, and wound (if present). HCWs wore gowns and gloves during usual care activities. After each activity, a research coordinator swabbed the HCW's gown and gloves. Swabs were cultured for MRSA.

Results: There were 200 residents enrolled; 94 (46%) were MRSA colonized. Glove contamination was higher than gown contamination (20% vs 11%, respectively; P < .01). Transmission varied greatly by type of care from 0%-19% for gowns and 7%-37% for gloves. High-risk care activities (odds ratio [OR] > 1.0, P < .05) for gown contamination included changing dressings (eg, wound), dressing, providing hygiene (eg, brushing teeth), and bathing. Low-risk care activities (OR < 1.0, P < .05 or no transmission) for gown contamination included glucose monitoring, giving medications, and feeding.

Conclusions: MRSA transmission from colonized residents to gloves was higher than transmission to gowns. Transmission to gloves varies by type of care, but all care had a risk of contamination, demonstrating the importance of hand hygiene after all care. Transmission to gowns was significantly higher with certain types of care. Optimizing gown and glove use by targeting high-risk care activities could improve resident-centered care for MRSA-colonized residents by promoting a home-like environment.

Keywords: MRSA; Nursing home; Transmission.

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Conflict of interest statement

Potential conflicts of interest. All authors report no conflicts of interest relevant to this article.

Figures

Figure 1.
Figure 1.
MRSA Transmission to gowns and gloves of healthcare workers during care of MRSA colonized residents (n=94) by type of care provided during 1544 interactions
Figure 2.
Figure 2.
MRSA Transmission to gowns of healthcare workers during care of MRSA colonized residents (N=94) with and without wounds by type of care provided during 1543 interactions
See this image and copyright information in PMC

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