TY - JOUR
T1 - Factors Leading to Transmission Risk of Acinetobacter baumannii
AU - Thom, Kerri A.
AU - Rock, Clare
AU - Jackson, Sarah S.
AU - Johnson, J. Kristie
AU - Srinivasan, Arjun
AU - Magder, Laurence S.
AU - Roghmann, Mary Claire
AU - Bonomo, Robert A.
AU - Harris, Anthony D.
N1 - Funding Information:
This research and Dr. Thom was supported by National Institutes of Health (NIH) Career Development Grant 1K23AI08250-01A1.
Publisher Copyright:
© 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
PY - 2017/7/1
Y1 - 2017/7/1
N2 - Objectives: To identify patient and healthcare worker factors associated with transmission risk of Acinetobacter baumannii during patient care. Design: Prospective cohort study. Setting: ICUs at a tertiary care medical center. Patients: Adult ICU patients known to be infected or colonized with A. baumannii. Measurements and Main Results: Cultures of skin, respiratory tract, and the perianal area were obtained from participants and evaluated for the presence of A. baumannii. Healthcare worker-patient interactions were observed (up to five interactions/patient) and activities were recorded. Healthcare worker hands/gloves were sampled at room exit (prior to hand hygiene or glove removal) and then evaluated for the presence of A. baumannii. Two hundred fifty-four healthcare worker-patient interactions were observed among 52 patients; A. baumannii was identified from healthcare worker hands or gloves in 77 (30%) interactions. In multivariate analysis, multidrug-resistant A. baumannii (odds ratio, 4.78; 95% CI, 2.14-18.45) and specific healthcare worker activities (touching the bed rail [odds ratio, 2.19; 95% CI, 1.00-4.82], performing a wound dressing [odds ratio, 8.35; 95% CI, 2.07-33.63] and interacting with the endotracheal tube or tracheotomy site [odds ratio, 5.15; 95% CI, 2.10-12.60]), were associated with hand/glove contamination. Conclusions: Healthcare worker hands/gloves are frequently contaminated with A. baumannii after patient care. Patient-level factors were not associated with an increased transmission risk; however, having multidrug-resistant-A. baumannii and specific healthcare worker activities led to an increased contamination risk. Our findings reveal a potential selective advantage possessed by multidrug-resistant-A. baumannii in this environment and suggest possible areas for future research.
AB - Objectives: To identify patient and healthcare worker factors associated with transmission risk of Acinetobacter baumannii during patient care. Design: Prospective cohort study. Setting: ICUs at a tertiary care medical center. Patients: Adult ICU patients known to be infected or colonized with A. baumannii. Measurements and Main Results: Cultures of skin, respiratory tract, and the perianal area were obtained from participants and evaluated for the presence of A. baumannii. Healthcare worker-patient interactions were observed (up to five interactions/patient) and activities were recorded. Healthcare worker hands/gloves were sampled at room exit (prior to hand hygiene or glove removal) and then evaluated for the presence of A. baumannii. Two hundred fifty-four healthcare worker-patient interactions were observed among 52 patients; A. baumannii was identified from healthcare worker hands or gloves in 77 (30%) interactions. In multivariate analysis, multidrug-resistant A. baumannii (odds ratio, 4.78; 95% CI, 2.14-18.45) and specific healthcare worker activities (touching the bed rail [odds ratio, 2.19; 95% CI, 1.00-4.82], performing a wound dressing [odds ratio, 8.35; 95% CI, 2.07-33.63] and interacting with the endotracheal tube or tracheotomy site [odds ratio, 5.15; 95% CI, 2.10-12.60]), were associated with hand/glove contamination. Conclusions: Healthcare worker hands/gloves are frequently contaminated with A. baumannii after patient care. Patient-level factors were not associated with an increased transmission risk; however, having multidrug-resistant-A. baumannii and specific healthcare worker activities led to an increased contamination risk. Our findings reveal a potential selective advantage possessed by multidrug-resistant-A. baumannii in this environment and suggest possible areas for future research.
KW - Acinetobacter baumannii
KW - healthcare-associated infections
KW - hospital epidemiology
KW - transmission
UR - http://www.scopus.com/inward/record.url?scp=85017409937&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85017409937&partnerID=8YFLogxK
U2 - 10.1097/CCM.0000000000002318
DO - 10.1097/CCM.0000000000002318
M3 - Article
C2 - 28398924
AN - SCOPUS:85017409937
SN - 0090-3493
VL - 45
SP - e633-e639
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 7
ER -