|
 "No one is perfect and inadvertent healthcare worker contamination
with multi-drug resistant organisms can occur and may be a key step
in the spread of potential pathogens in healthcare settings," said
lead study author Dr. Koh Okamoto of Rush University Medical Center
in Chicago.
"The more we understand how and why contamination happens, the
better prepared we are to help healthcare workers avoid it," he told
Reuters Health by email.
Over a six-month period, Okamoto and colleagues observed 125
healthcare workers, including 83 nurses and 24 doctors, in four
adult intensive care units at their hospital. Half of the doctors
and nurses had received formal training in the use of personal
protective equipment for the Ebola virus within the previous year,
and 90 percent had received "donning and doffing" training within
the previous five years.
During the study, the workers oversaw 95 patients with contact
precautions for methicillin-resistant Staphylococcus aureus, or MRSA,
as well as vancomycin-resistant Enterococci and multidrug-resistant
gram-negative bacilli.
The research team collected 6,000 samples from 5,000 sites around
the ICUs, including items that had touched the patient's body and
environmental surfaces such as blood pressure cuffs, call buttons
and sinks. They also tested the healthcare workers' hands, gloves
and gowns before and after patient interactions. In addition, they
watched the "doffing," or removal process, and recorded errors based
on Center of Disease Control and Prevention guidelines, which
recommends removing gowns and gloves together.
According to a report published in Infection Control and Hospital
Epidemiology, they found that more than a third of the healthcare
workers acquired a multidrug-resistant organism during a patient
encounter. Notably, four healthcare workers had it on their hands,
four had it on their clothes or jewelry, three had it on their
stethoscope, and two had it on their in-hospital mobile phones.
About 70 percent of environmental sites had organisms, especially
items that were close to patients such as blood pressure cuffs, call
buttons and bed rails.
[to top of second column]
 |
Overall, 49 workers, or 39 percent, made multiple doffing errors and
were more likely to have contaminated clothes after a patient
interaction. For instance, all four healthcare workers with hand
contamination made errors while removing their gowns and gloves. In
particular, hand contamination was 10 times higher when gloves were
removed before gowns.
"Our study occurred in a real-world busy ICU setting where the rush
of crisis care makes simple slip-ups more likely," Okamoto said.
"This allowed us to better observe donning and doffing methods and
potential errors of various healthcare workers."
Simple interventions are needed that reinforce the preferred order
of doffing, which could reduce contamination, he said. Removing
gloves and gowns together as a unit, for instance, seemed most
helpful in preventing self-contamination.
"While we need more research to better understand potential
transmission risk, we can also focus on strategies to assist
healthcare workers with properly removing gowns and gloves," said
Sarah Krein of the University of Michigan in Ann Arbor. Krein, who
wasn't involved with this study, has researched infectious agent
transmission precautions in hospitals.
For example, signs or cues inside patient rooms could remind
healthcare workers of the proper procedures for removing gowns and
gloves, she said. Some researchers are also working on a gown
redesign that would use color coding to better identify the outside
of the gown, so workers can more carefully remove it, roll it up and
dispose it.
"Although a seemingly simple process, mistakes can occur during the
removal of gowns and gloves," Krein told Reuters Health by email.
"While this doesn't necessarily lead to an infection, it is
important to find better ways to help healthcare workers with this
process to ensure patient and healthcare worker safety."
SOURCE: http://bit.ly/2I0yalE Infection Control and Hospital
Epidemiology, online March 20, 2019.
[© 2019 Thomson Reuters. All rights
reserved.] Copyright 2019 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
Thompson Reuters is solely responsible for this content. |
