1388. Impact of Doffing Errors on Healthcare Worker (HCW) Self Contamination When Caring for Patients on Contact Precautions (CP)
Session: Poster Abstract Session: HAI: Occupational Health
Friday, October 28, 2016
Room: Poster Hall
Background: One putative path of hospital transmission of potential pathogens is by HCWs who contaminate their hands and/or clothing during patient contact. The role of errors in doffing of personal protective equipment (PPE) in HCW contamination is unknown.

Methods: We conducted an observational study to determine the impact of doffing errors on HCW contamination with multi-drug resistant organisms (MDROs) in 4 intensive care units (ICUs) at a large academic medical center from 9/2015-2/2016. HCWs who cared for patients on CP for methicillin-resistant S. aureus (MRSA), vancomycin resistant Enterococci (VRE), and multi-drug resistant gram negative bacilli (MDR-GNB) were enrolled. Samples were collected from standardized areas of patient body sites and high-touch environmental surfaces in patient rooms using nylon flocked swabs and cultured using selective and differential media. Contact plates with neutralizer were also used for environmental sampling. HCW hands, gloves, PPE, and equipment (e.g., phone, stethoscope) were sampled pre- and post-patient encounter. Research personnel observed PPE doffing and coded errors based on CDC recommendations.

Results: 125 HCWs were enrolled; most were nurses (66.4%) or physicians (19.2%). 95 patients were on CP for MRSA, 16 for VRE, and 14 for MDR-GNB. Patients were in the following ICUs: medical (45), surgical (34), cardiac (22), and neurologic (24). Among 5,125 cultured sites, 653 (12.7%) yielded the target MDRO. 45 (36%) HCWs were contaminated after patient encounters. 4 (3.2%) and 38 (30.4%) HCWs had the target MDRO on hands or PPE, respectively. 49 (39.2%) HCWs made multiple doffing errors and were more likely to have contaminated clothes following a patient encounter (RR 4.69, p=.04). All 4 HCWs with hand contamination made doffing errors. There was higher risk of hand contamination when gloves were removed before gowns during PPE doffing (RR 11.76, p = .025).

Conclusion: When caring for patients on CP for MDROs, HCWs appear to have differential risk for hand contamination based on their method of doffing PPE. An intervention on reducing errors in PPE doffing, even as simple as reinforcing the preferred order of doffing, may reduce HCW contamination with MDROs.

Koh Okamoto, MD1, Yoona Rhee, MD, ScM1, Michael Schoeny, PhD2, Karen Lolans, BS1, Jennifer Cheng, DO3, Shivani Reddy, DO1, Efrain Salazar, BS4, George Warpinski, BA5, Melanie Carr, BS1, Grace Mcilroy, BS6, Patriacia Mangan, BS6, Robert A. Weinstein, MD7, Mary K. Hayden, MD, FIDSA, FSHEA8, Kyle Popovich, MD1 and For the CDC Prevention Epicenters Program, .9, (1)Rush University Medical Center, Chicago, IL, (2)Rush University, Chicago, IL, (3)Infectious Disease, Rush University Medical Center, Chicago, IL, (4)Rush University, , College of Health Sciences, chicago, IL, (5)Rush Medical College, Chicago, IL, (6)Rush University Medical Center, chicago, IL, (7)Cook County Health and Hospitals System, Chicago, IL, (8)Internal Medicine (Infectious Diseases) and Pathology, Rush University Medical Center, Chicago, IL, (9)CDC, Atlanta, GA

Disclosures:

K. Okamoto, None

Y. Rhee, None

M. Schoeny, None

K. Lolans, None

J. Cheng, None

S. Reddy, None

E. Salazar, None

G. Warpinski, None

M. Carr, None

G. Mcilroy, None

P. Mangan, None

R. A. Weinstein, None

M. K. Hayden, None

K. Popovich, None

F. T. CDC Prevention Epicenters Program, None

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.