High-contact activities of daily living such as dressing and toileting are significant causes of MRSA transmission from nursing home residents to workers’ gowns and gloves, according to research published in Infection Control and Hospital Epidemiology.
“Health care workers (HCWs) serve as a vector for methicillin-resistant Staphylococcus aureus transmission in institutional settings,” Mary-Claire Roghmann, MD, MS, professor of epidemiology and public health at the University of Maryland School of Medicine, and colleagues wrote. “In acute care hospitals, contact precautions (eg, single room, gown and gloves for all patient-HCW contact, patient room restriction) are used for patients colonized with MRSA to prevent transmission to other patients. The usefulness of contact precautions for MRSA-colonized residents in nursing homes has not been evaluated.”
The study included 401 residents from 13 community-based nursing homes in Maryland and Michigan. Residents were cultured for MRSA at the anterior nares and perianal or perineal skin. Researchers observed interactions between study participants and HCWs who were required to wear gowns and gloves when interacting with study participants. Afterward, they swabbed workers’ gowns and gloves for MRSA.
Overall, 28% of participating residents were colonized with MRSA. The researchers wrote that 24% of gloves and 14% of gowns were contaminated with MRSA after 954 worker interactions with a MRSA-infected resident. These residents were confirmed as the cause of contamination of MRSA by spa typing. In addition, residents with chronic skin breakdown were more likely to transmit MRSA during risky interactions with HCWs than those without chronic skin breakdown (P = .02).
The most common interactions that led to transmission of MRSA to workers’ gowns included dressing (OR = 2.33; 95% CI, 1.5-1.61), transferring (OR = 2.13; 95% CI, 1.44-3.13) and assisting patients with hygiene (OR = 1.98; 95% CI, 1.2-3.28). The most common causes of MRSA transfer to workers’ gloves were dressing (OR = 1.81; 95% CI, 1.33-2.45), changing linens (OR = 1.77; 95% CI, 1.13-2.78) and assisting with hygiene (OR = 1.58; 95% CI, 1.09-2.3).
“The risk of gown and glove contamination is high when providing care to MRSA-colonized residents,” Roghmann and colleagues wrote. “In our study, high-risk care activities were all high-contact activities of daily living and often did not involve overt contact with body fluids, skin breakdown, or mucous membranes. This finding indicates the need to modify current CDC standards of care involving use of gowns and gloves in this setting because under standard precautions, gowns and gloves are not recommended to be worn for what we define here as high-risk care.”– by David Jwanier
Disclosure: The researchers report no relevant financial disclosures.