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    Bacterial burden is associated with increased transmission to health care workers from patients colonized with vancomycin-resistant Enterococcus

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    Author
    Jackson, S.S.
    Harris, A.D.
    Magder, L.S.
    Date
    2019
    Journal
    American Journal of Infection Control
    Publisher
    Mosby Inc.
    Type
    Article
    
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    https://doi.org/10.1016/j.ajic.2018.07.011
    Abstract
    Background: Health care workers (HCWs) are significant vectors for transmission of multidrug-resistant organisms among patients in intensive care units (ICUs). We studied ICU patients on contact precautions, colonized with vancomycin-resistant Enterococcus (VRE), to assess whether bacterial burden is associated with transmission to HCWs’ gloves or gowns, a surrogate outcome for transmission to subsequent patients. Methods: From this prospective cohort study, we analyzed 96 VRE-colonized ICU patients and 5 HCWs per patient. We obtained samples from patients’ perianal area, skin, and stool to assess bacterial burden and cultured HCWs’ gloves and gowns for VRE after patient care. Results: Seventy-one of 479 (15%) HCW-patient interactions led to contamination of HCWs’ gloves or gowns with VRE. HCW contamination was associated with VRE burden on the perianal swab (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.19, 1.57), skin swabs (OR, 2.14; 95% CI, 1.51, 3.02), and in stool (OR, 1.95; 95% CI, 1.39, 2.72). Compared with colonization with Enterococcus faecalis, colonization with Enterococcus faecium was associated with higher bacterial burden and higher odds of transmission to HCWs. Conclusions: We show that ICU patients with higher bacterial burden are more likely to transmit VRE to HCWs. These findings have implications for VRE decolonization and other infection control interventions. Copyright 2019 Association for Professionals in Infection Control and Epidemiology, Inc.
    Keyword
    Bacterial burden
    Contact precautions
    Health care workers
    Vancomycin-resistant Enterococcus
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85053877873&doi=10.1016%2fj.ajic.2018.07.011&partnerID=40&md5=5317cbf5d83564cb579269f79901eb5a; http://hdl.handle.net/10713/10560
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ajic.2018.07.011
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