Certain Healthcare Personnel Patient Interactions Carry Higher Risk of MRSA Transmission

Gloves and gowns are common intensive care unit (ICU) fomites that are frequently contaminated with antibiotic-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA). Guidelines recommend use of contact precautions for healthcare personnel (HCP) when dealing with patients infected with MRSA, but the efficacy of these standards are unclear.

In a study presented at IDWeek 2019, investigators with the University of Maryland, Weill Cornell Medicine, and Harbor UCLA sought to determine which patients are more likely to transfer MRSA to HCP gloves or gowns and to identify HCP interactions more likely to lead to glove or gown contamination.

The study comprised a total of 402 MRSA-colonized patients and 3982 HCP interactions. The research team cultured HCP gloves and gowns following patient interaction but before doffing. They also sampled patients’ anterior nares, perianal area, chest, and arms to assess the association between bacterial burden and contamination.

HCP gloves and gowns were contaminated with MRSA in 14.3% and 5.9% of interactions, respectively. Contamination of either gloves or gowns occurred in 16.2% of interactions.

In terms of HCP types associated with the highest rates of contamination, occupational/physical therapists were at high risk (odds ratio [OR]: 6.96 [95% confidence interval [CI]: 3.51-13.79]), followed by respiratory therapists (OR: 5.34 [95% CI: 3.04-9.39]), when compared with the “other” category.

Naturally, HCP who have to physically touch patients are more at risk of contamination (OR: 2.59 [95% CI: 1.04-6.51]) when compared with HCP who touch nothing in a patient’s room. Furthermore, HCP who touched only the environment were not at risk of contamination (OR: 1.13 [95% CI: 0.43, 3.00]) when compared with touching nothing.

Investigators also identified an association between increasing bacterial burden in the patient’s nares, perianal area, and chest skin and glove or gown contamination.

“Contamination of HCP gloves and gowns with MRSA occurs frequently when caring for ICU patients,” investigators concluded. “Hospitals may consider optimizing contact precautions by using less precautions for low-risk interactions and more precautions for high-risk interactions.”

The study, Considerations for a Targeted Approach to Contact Precautions for Patients with MRSA in Hospitals: A Multicenter Cohort Study to Identify High-Risk Patient Characteristics and Healthcare Personnel Interactions, will be presented in an oral abstract session on Friday, October 4, 2019, at IDWeek in Washington, DC.