943. Molecular Analysis of Transmission Events in the Antimicrobial Scrub and Transmission (ASCOT) Trial
Session: Oral Abstract Session: HAI: Surveillance and Reporting
Friday, October 28, 2016: 10:45 AM
Room: 388-390
Background: The transmission of pathogens to healthcare personnel (HCP) from patients and the patients’ environment is poorly understood.

Methods: We performed a microbiological and molecular analysis of samples obtained during the ASCOT trial, during which ICU nurse subjects wore a new set of surgical scrubs on 3 consecutive shifts. Cultures were obtained via RODAC plates from all nurses (sleeve, midriff, pocket) and each patients’ room environment (bed, bedrail, supply cart) at the beginning and end of each shift. Cultures were also obtained from all patients cared for by the nurse (nares, peri-rectum, integument) each shift. Genetic relatedness was tested through pulsed-field gel electrophoresis (PFGE) for 5 pathogens: S. maltophilia (SM), P. aeruginosa (PA), K. pneumoniae (KP), A. baumanii complex (ABC), and S. aureus (SA). A “potential” transmission event occurred if the same pathogen species was identified from the nurse’s uniform, the patient, and/or the environment. A potential transmission event was “confirmed” if the identified pathogens were identical by PFGE.

Results: A total of 167 unique patients received care from 40 nurse subjects over 120 individual 12-hour ICU shifts. A total of 2,185 cultures were obtained from nurse clothing, 455 cultures from patients, and 2,919 cultures from patients’ environments were evaluated. 26 (22%) potential transmission events were observed during the 120 shifts; 22 (18%) were confirmed transmissions: 6 (5% overall, 27% of events) from patient-to-nurse, 6 (5% overall, 27% of events) from environment-to-nurse, and 10 (8% overall, 38% of events) from patient-to-environment. Confirmed transmissions of important pathogens were observed, including 7 MSSA, 5 MRSA, 3 SM, 3 ABC, 2 KP, and 2 PA. We observed no nurse-to-patient or nurse-to-environment transmission events.

Conclusion: Important pathogens are regularly transmitted from patients and the environment to HCP clothing. HCP clothing may serve as a vector for transmission of these important pathogens.

Deverick Anderson, MD, MPH, FIDSA, FSHEA1, Bobby Warren, BS2, Rachel Addison, MT (ASCP), MPH3, Batu K Sharma-Kuinkel, PhD2, Yuliya Lokhnygina, MS, PhD4, Laura J Rojas, MSc5,6, Susan D. Rudin, BS6,7, Robert A. Bonomo, MD5, Vance G. Fowler Jr., MD2 and the CDC Prevention Epicenters Program, (1)Duke Infection Control Outreach Network, Duke University Medical Center, Durham, NC, (2)Duke University Medical Center, Durham, NC, (3)Duke Infection Control Outreach Network, Durham, NC, (4)Biostatistics and Bioinformatics, Duke University, Durham, NC, (5)Pharmacology, Molecular Biology, and Microbiology, Case Western Reserve University, Cleveland, OH, (6)Research Service Louis Stokes Cleveland VAMC, Cleveland, OH, (7)Case Western Reserve University, Cleveland, OH

Disclosures:

D. Anderson, None

B. Warren, None

R. Addison, None

B. K. Sharma-Kuinkel, None

Y. Lokhnygina, None

L. J. Rojas, None

S. D. Rudin, None

R. A. Bonomo, Merck: Grant Investigator and Scientific Advisor , Consulting fee and Research grant
Actavis: Invited Speaker , Speaker honorarium
Allergan: Grant Investigator , Research grant
Wockhardt: Grant Investigator , Research grant
GlaxoSmithKline: Grant Investigator , Research grant
AstraZeneca: Grant Investigator , Research grant

V. G. Fowler Jr., None

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