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Antibiotic-resistant pathogens often found on nurses’ scrubs
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NEW ORLEANS — Findings from the ASCOT trial showed that antibiotic-resistant pathogens were frequently transmitted from patients in the ICU and their environments to nurses’ clothing.
The results emphasize the importance of infection control, but also indicate there is still much to learn about the spread of bacteria in hospitals, according to Deverick J. Anderson, MD, MPH, FIDSA, FSHEA, associate professor of medicine in the division of infectious diseases at Duke University Medical Center.
“We know there are bad germs in hospitals but we’re just beginning to understand how they are spread,” Anderson said in a press release. “This study shows we need to be 100% diligent about infection control strategies.”
The CDC estimates that hospital-acquired infections occur in one in 25 hospitalized patients, and that many of these infections are acquired in the ICU. To better characterize the nosocomial transmission of bacteria, Anderson and colleagues performed a microbiological and molecular analysis of samples obtained from nurses’ scrubs, patients and their environments.
The analysis included 167 patients who received care from 40 nurses during three separate 12-hour shifts in the ICU. Anderson and colleagues cultured three different areas on the nurses’ clothing, the patients and their room at the beginning and end of each shift. They identified 22 transmissions of the same strain of bacteria through pulsed-field gel electrophoresis. Of these transmissions, 38% were from patient to room, 27% were from patient to nurse and 27% were from room to nurse. The most commonly contaminated areas were nurses’ sleeves and pockets and patients’ bed railings.
Epidemiologically important pathogens, including Staphylococcus aureus, MRSA, Stenotrophomonas maltophilia, Acinetobacter baumannii complex, Klebsiella pneumoniae and Pseudomonas aeruginosa, were transmitted to nurses at least 10% of the time, even when they were treating patients requiring contact precautions, according to Anderson. Although nonadherence to protective clothing may be a factor, he said that transmission more likely occurred during gown and glove removal.
“Gloves are not the equivalence of hand hygiene,” he said. “You get contaminated almost universally when you’re removing gloves, so if you don’t do that next step of hand hygiene, your hands are as though you weren’t wearing gloves. This contamination does pose a risk for clinical issues and outbreaks.”
The high prevalence of contamination from the patients’ environments to nurses indicates that transmission is a complicated process and bacteria move much more frequently than previously thought, Anderson said. He further noted in the release that bacteria were uncovered from patients’ rooms regardless of where they obtained cultures.
“As a result from the findings of this study, health care workers really need to be aware that not only can they become contaminated when dealing with their patients, but simply going into the hospital room poses a risk,” Anderson said. “I think the takeaway point from that is we really have to emphasize the importance of our basic infection control practices like hand hygiene, and when appropriate, contact precautions. [Even if] you’re not taking care of the patient, you still have some opportunity for contamination.” – by Stephanie Viguers
Reference:
Anderson D, et al. Abstract 953. Presented at: IDWeek; New Orleans; Oct. 26-20, 2016.
Disclosures: Anderson reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.