Methicillin-resistant S. aureus (MRSA) and Methicillin-susceptible S. aureus (MSSA) Transmission to the Gowns and Gloves of Health Care Workers interacting with Nursing Home (NH) Residents
Background: The usefulness of barrier precautions in NHs in unknown. The primary objective of this multi-center study was to estimate the frequency of and risk factors for S. aureus transmission to protective gowns and gloves worn by health care workers (HCW) when interacting with colonized NH residents.
Methods: Residents from 14 community NHs in Maryland and Michigan were enrolled and cultured for S. aureus at the anterior nares and perirectal skin. HCWs were asked to wear disposable gowns and gloves during a usual care activity (e.g. wound dressing). A research coordinator observed and recorded the type of care delivered with each activity and swabbed the HCW gown and gloves to test for the transfer of S. aureus.
Results: 96 (24%) residents were colonized with MRSA and 58 (15%) with MSSA from 398 enrolled residents. Compared with MSSA colonized residents, MRSA colonized residents were significantly older (80 vs 75 years, p<0.01), more likely to be on antibiotics (14% vs 3%, p=0.05), have a pressure ulcer (24% vs 11%, p=0.04), and have perirectal colonization with S. aureus (39% vs 14%, p<0.01). We observed an average of 8.6 care activities per resident. The number and duration of activities did not vary by colonization status; however, the common types of care activities did vary by whether residents were colonized with MRSA or MSSA. For example, transferring the resident was 93% more common care with MRSA colonized residents. Transmission varied by type of care activity from 0% to 41% for gloves and 6% to 26% for gowns (see Figures 1 and 2). Transmission to both gloves (28% vs 21%, p<0.01) and gowns (16% vs 12%, p=0.03) was more common during care of MRSA vs MSSA colonized residents.
Conclusion : S. aureus transmission to gowns and gloves was common; MRSA transmission was 33% more common than MSSA transmission. This difference could be due to greater burden of S. aureus in MRSA colonized residents as suggested by the higher level of perirectal colonization and greater skin breakdown; however, it could also be due to different care activities. To our knowledge, this is the first study to study MRSA transmission by type of care activity in NHs. Our results have substantial implications for infection prevention policy in NHs.
M. C. Roghmann,
AHRQ: Grant Investigator, Grant recipient and Research grant
J. Sorkin, None
P. Langenberg, None
B. Sorace, None
L. Mody, None