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Transfer of multidrug-resistant bacteria to healthcare workers’ gloves and gowns after patient contact increases with environmental contamination*
Morgan, Daniel J. MD; Rogawski, Elizabeth BS; Thom, Kerri A. MD, MS; Johnson, J. Kristie PhD; Perencevich, Eli N. MD, MS; Shardell, Michelle PhD; Leekha, Surbhi MD, MPH; Harris, Anthony D. MD, MPH
Abstract
Objective: To assess the role of environmental contamination in the transmission of multidrug-resistant bacteria to healthcare workers’ clothing.
研究目的：估计环境污染在传播多重耐药菌到医务人员衣服身上的作用，
Design: Prospective cohort. 研究设计：前瞻性队列研究
Setting: Six intensive care units at a tertiary care hospital. 研究场所：三级医院的6个ICU
Subjects: Healthcare workers including registered nurses, patient care technicians, respiratory therapists, occupational/physical therapists, and physicians. Interventions: None. 干预措施：无。
Measurements and Main Results: 120 One hundred twenty of 585 (20.5%) healthcare worker/patient interactions resulted in contamination of healthcare workers’ gloves or gowns. 鲍曼依然是首要的污染源。其次是多重耐药绿脓杆菌，VRE，MRSA。
Multidrug-resistant Acinetobacter baumannii contamination occurred most frequently, 55 of 167 observations (32.9%; 95% confidence interval [CI] 25.8% to 40.0%), followed by multidrug-resistant Pseudomonas aeruginosa, 15 of 86 (17.4%; 95% CI 9.4% to 25.4%), vancomycin-resistant Enterococcus, 25 of 180 (13.9%, 95% CI 8.9, 18.9%) and methicillin-resistant Staphylococcus aureus, 21 of 152 (13.8%; 95% CI 8.3% to 19.2%). Independent risk factors associated with healthcare worker contamination with multidrug-resistant bacteria were positive environmental cultures (odds ratio [OR] 4.2; 95% CI 2.7–6.5), duration in room for >5 mins (OR 2.0; 95% CI 1.2–3.4), performing physical examinations (OR 1.7; 95% CI 1.1–2.8), and contact with the ventilator (OR 1.8; 95% CI, 1.1–2.8). Pulsed field gel electrophoresis determined that 91% of healthcare worker isolates were related to an environmental or patient isolate.
Conclusions: The contamination of healthcare workers’ protective clothing during routine care of patients with multidrug-resistant organisms is most frequent with A. baumannii. Environmental contamination was the major determinant of transmission to healthcare workers’ gloves or gowns. Compliance with contact precautions and more aggressive environmental cleaning may decrease transmission
在护理病患时，医务人员衣服上容易污染MDRO，其中主要的为鲍曼，环境污染是导致医务人员手套和隔离衣污染的组要的传播途径。因此，笔者最后认为，标准预防的依从性及更深入的清洁可以更好的降低MDRO的传播。
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发表于 2012-4-2 00:15
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