1136. Gown and Glove Use to Prevent the Spread of MRSA in VA Community Living Centers (CLCs)
Session: Poster Abstract Session: MRSA/VRE Epidemiology
Friday, October 9, 2015
Room: Poster Hall
Posters
  • resized ID Week 2015 Poster- VAG&G.pdf (234.8 kB)
  • Background: The usefulness of barrier precautions in CLCs is unknown. The primary objective of this multi-center study is to estimate the frequency of methicillin-resistant Staphylococcus aureus (MRSA) transmission to gowns and gloves worn by healthcare workers (HCW) interacting with CLC residents in order to inform MRSA prevention policies in this setting.

    Methods: Residents with a history of MRSA in the past year were cultured for MRSA at the anterior nares, perianal skin and largest wound (if present).  HCWs wore gowns and gloves during usual care activities (e.g. wound dressing).  A research coordinator observed and recorded the types of care delivered with each activity and swabbed the HCW gown and gloves on room exit to test for contamination with MRSA.

    Results: 103 residents have been enrolled to date; 58% were MRSA colonized; 20% have chronic skin breakdown.  Glove contamination was higher than gown contamination (22% vs. 12% of 1068 interactions, p<0.01).  Transmission varied greatly by type of care from 0% to 39% for gowns and 8% to 46% for gloves.  High rates of transmission were seen in the following care activities: wound dressing change, Foley care, hygiene (brushing teeth, etc.), dressing, bathing, or transfer of resident.  Low rates of transmission were seen for feeding, collection of surveillance swabs, respiratory therapy, physical exam and giving medications.  Overall, transmission to both gowns (23% v 6%, p<0.01) and gloves (32% to 18%, p<0.01) was more common during care of residents with chronic skin breakdown compared to care of residents without chronic skin breakdown.

    Conclusion: MRSA transmission from MRSA positive residents to HCW gowns and gloves is substantial in VA CLCs.  Glove contamination is higher than gown contamination, highlighting the importance of hand washing.  The risk of transmission varies greatly by type of care, suggesting we can identify the most important care activities for gown and glove use.

    Lisa Pineles, MA1, Daniel Morgan, MD, MS, FIDSA, FSHEA1, J. Kristie Johnson, PhD1, John Sorkin, MD, PhD1, Patricia Langenberg, PhD1, Alison Lydecker, MPH1, Alan Lesse, MD, FIDSA2, John Sellick, DO2, Kalpana Gupta, MD, MPH3, Luci Leykum, MD, MBA4, Nickie Lepcha, MD5 and Mary-Claire Roghmann, MD, MS, FIDSA, FSHEA1, (1)VA Maryland Healthcare System, Baltimore, MD, (2)VA Western New York Health Care System, Buffalo, NY, (3)VA Boston Health Care System, West Roxbury, MA, (4)South Texas Veterans Health Care System, San Antonio, TX, (5)Washington DC VA Medical Center, Washington, DC

    Disclosures:

    L. Pineles, None

    D. Morgan, None

    J. K. Johnson, None

    J. Sorkin, None

    P. Langenberg, None

    A. Lydecker, None

    A. Lesse, None

    J. Sellick, None

    K. Gupta, None

    L. Leykum, None

    N. Lepcha, None

    M. C. Roghmann, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.