Nursing home study illustrates risk of resistant bacteria transmission

A multicenter study of nursing home residents has found that 11% of interactions with healthcare workers resulted in the transmission of antibiotic-resistant gram-negative bacteria (RGNB) to gloves and gowns worn by those workers when providing care.

In the study, which was published today in Infection Control and Hospital Epidemiology,investigators collected perianal swabs from 399 residents of 13 community-based nursing facilities in Maryland and Michigan to detect RGNB. Healthcare personnel (HCP) at the facilities were asked to wear gowns and gloves during usual care activities, and those items were swabbed when HCP were finished with those activities. The objective was to estimate the risk of transmission of RGNB to gloves and gowns worn by HCP when providing care and to identify the types of care and resident characteristics associated with transmission.

Overall, 19% of the residents were colonized with at least one RGNB at enrollment. Either gloves or gowns were contaminated with RGNB during 11% of 584 interactions with colonized residents. RGNB transmission to HCP varied by activity, but showering and bathing residents, changing wound dressings, and assisting with hygiene and toilet needs were associated with a high risk of transmission, while glucose monitoring and assisting with feeding or medication were associated with low risk of transmission. Residents with a pressure ulcer were three times more likely to transmit RGNB than residents without one.

The findings are noteworthy because though previous studies have found that more half (57%) of nursing home residents are colonized with multidrug-resistant organisms, there are few evidence-based guidelines describing best practices for preventing transmission of these organisms in nursing homes. The authors of the study suggest that glove and gown use in community nursing facilities should be prioritized for certain residents and care interactions that are deemed a high risk for transmission.

Source: CIDRAP