Frequent Multidrug-ResistantAcinetobacter baumanniiContamination of Gloves, Gowns, and Hands of Healthcare Workers

Abstract

Background.: Multidrug-resistant (MDR) gram-negative bacilli are important nosocomial pathogens.Objective.: To determine the incidence of transmission of MDRAcinetobacter baumanniiandPseudomonas aeruginosafrom patients to healthcare workers (HCWs) during routine patient care.Design.: Prospective cohort study.Setting.: Medical and surgical intensive care units.Methods.: We observed HCWs who entered the rooms of patients colonized with MDRA. baumanniior colonized with both MDRA. baumanniiand MDRP. aeruginosa. We examined their hands before room entry, their disposable gloves and/or gowns upon completion of patient care, and their hands after removal of gloves and/or gowns and before hand hygiene.Results.: Sixty-five interactions occurred with patients colonized with MDRA. baumanniiand 134 with patients colonized with both MDRA. baumanniiand MDRP. aeruginosa. Of 199 interactions between HCWs and patients colonized with MDRA. baumannii, 77 (38.7% [95% confidence interval {CI}, 31.9%–45.5%]) resulted in HCW contamination of gloves and/or gowns, and 9 (4.5% [95% CI, 1.6%–7.4%]) resulted in contamination of HCW hands after glove removal before hand hygiene. Of 134 interactions with patients colonized with MDRP. aeruginosa, 11 (8.2% [95% CI, 3.6%–12.9%]) resulted in HCW contamination of gloves and/or gowns, and 1 resulted in HCW contamination of hands. Independent risk factors for contamination with MDRA. baumanniiwere manipulation of wound dressing (adjusted odds ratio [aQR], 25.9 [95% CI, 3.1–208.8]), manipulation of artificial airway (aOR, 2.1 [95% CI, 1.1–4.0]), time in room longer than 5 minutes (aOR, 4.3 [95% CI, 2.0–9.1]), being a physician or nurse practitioner (aOR, 7.4 [95% CI, 1.6–35.2]), and being a nurse (aOR, 2.3 [95% CI, 1.1–4.8]).Conclusions.: Gowns, gloves, and unwashed hands of HCWs were frequently contaminated with MDRA. baumannii. MDRA. baumanniiappears to be more easily transmitted than MDRP. aeruginosaand perhaps more easily transmitted than previously studied methicillin-resistantStaphylococcus aureusor vancomycin-resistantEnterococcus. This ease of transmission may help explain the emergence of MDRA. baumannii.