1119. Healthcare Worker Hand Carriage of Klebsiella Pneumoniae Carbapenemase-Producing Enterobacteriaceae and other Gram Negative Rods at Long Term Acute Care Hospitals
Session: Oral Abstract Session: Improving Healthcare Worker Hand Hygiene Adherence
Friday, October 4, 2013: 2:00 PM
Room: The Moscone Center: 200-212

Background: Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (KPC) can cause serious infections that may be untreatable due to multidrug resistance.  KPCs are primarily transmitted from patient-to-patient via healthcare worker (HCW) hands, making hand hygiene an important measure to control spread. We obtained HCW hand cultures as part of adherence monitoring during an intervention to control KPC spread in 4 Chicago long term acute care hospitals (LTACHs), where facility-wide HCW hand hygiene rates were 62-80% and patient KPC colonization rates were 21-57%.

Methods: During July 2012-April 2013, we cultured hands of a convenience sample of HCWs [clinical nursing assistants (CNAs), registered nurses (RNs), doctors (MDs), respiratory therapists (RTs), physical therapists (PTs) and others] at 4 LTACHs.  Hand cultures were taken before patient care via a modified “glove juice” technique with neutralizers.  Sampling solutions were filtered, and filters were placed onto MacConkey agar plates and incubated in ambient air at 35°C for 18-24 hours.  Individual colony morphologies were tested for blaKPC by PCR.  All blaKPC-positive isolates and a sample of blaKPC-negative isolates were identified to the species level.

Results: 127 HCWs were cultured. Gram negative rods (GNRs) were isolated from 75.6% of hand cultures; 8 (6.3%) hand cultures grew KPC (Figure).  KPC species identified included K. pneumoniae (6 HCWs), Enterobacter aerogenes (1 HCW) and Leclercia adecarboxylata (1 HCW).  blaKPC-negative GNRs isolated from the first 7 HCWs found to have GNR hand carriage were Enterobacter cloacae , Acinetobacter lwoffii (3 HCWs each);  Enterobacter agglomerans, K. pneumoniae, Klebsiella oxytoca  (2 HCWs each); and Leclercia adecarboxylata, Escherichia coli, Pseudomonas oryzihabitans (1 HCW each).  31 HCWs (24.4%) wore rings, and 5 (3.9%) had a hand rash or wound, but statistical relation to GNR or KPC carriage was not evident. 

Conclusion: The proportion of HCWs with KPC and other GNRs on their hands was unexpectedly high.  In settings with high KPC patient colonization pressure, hand hygiene rates may have to be extremely high to avoid KPC spread.

Rosie D. Lyles-Banks, MD, MHA1, Karen Lolans-Mazza, BS2, Shayna Weiner, MPH3, Donald Blom, RN, BA3, Nicholas Moore, MS, MLS(ASCP)3, Michael Y. Lin, MD, MPH3, Robert A Weinstein, MD, FIDSA3, Mary K Hayden, MD, FSHEA, FIDSA2 and for the CDC Prevention Epicenter Program (RAW-PI), (1)Cook County Health and Hospitals System, Chicago, IL, (2)Rush Univ. Med. Ctr., Chicago, IL, (3)Rush University Medical Center, Chicago, IL

Disclosures:

R. D. Lyles-Banks, None

K. Lolans-Mazza, None

S. Weiner, None

D. Blom, None

N. Moore, None

M. Y. Lin, None

R. A. Weinstein, None

M. K. Hayden, Sage, Inc.: Sage is providing 2% CHG impregnated cloths at no charge to facilities that are participating in this study., Sage, Inc is supplying 2% CHG cloths for this study at no charge to participating facilities.

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