Objective: To estimate the risk of transmission of antibiotic resistant Gram-negative bacteria (RGNB) to gowns and gloves (G&G) worn by healthcare workers (HCWs) when providing care to nursing home residents and to identify types of care and resident characteristics associated with transmission.
Methods: A multi-center, prospective observational study was conducted enrolling residents and HCWs from VA nursing homes. Perianal swabs to detect RGNB were collected from residents. HCWs wore G&G during usual care activities and at the end of the interaction the G&G were swabbed in a standardized manner. Transmission of RGNB from a colonized resident to G&G by type of care was measured. Odds ratios (OR) associated with type of care or resident characteristics was estimated.
Results: Fifty-seven of 185 (31%) enrolled residents were colonized with at least one RGNB. RGNB transmission to either HCWs gloves or gowns occurred during 9% of the interactions (n=905). Seven percent of time to only gloves and 2% to gowns. Bathing the resident, as well as providing hygiene and toilet assistance were associated with high-risk of transmission. Glucose monitoring and assistance with feeding or medication were associated with low-risk of transmission. In addition, antibiotic use by the resident was strongly associated with greater transmission (OR 2.51, p<0.01).
Conclusions: RGNB were transferred to HCWs during approximately 9% of visits. High-risk types of care were identified for which use of G&G could be prioritized. Antibiotic use was associated with a 2.5 times greater risk of transmission, emphasizing the importance of antibiotic stewardship.
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