Researchers Discover Ease of Acinetobacter Transmission Via PPE, Unwashed Hands

Items of personal protective equipment (PPE) such as gowns and gloves, as well as the unwashed hands of healthcare workers, are frequently contaminated with multidrug-resistant Acinetobacter baumannii, which they say is more easily transmitted than previously thought.

Daniel J. Morgan, MD, of the Department of Epidemiology and Preventive Medicine at the University of Maryland, Baltimore, and colleagues, sought to determine the incidence of transmission of resistant Acinetobacter baumannii and Pseudomonas aeruginosa from patients to healthcare workers during routine patient care. In a prospective cohort study set in medical and surgical intensive care units, the researchers observed healthcare workers who entered rooms of patients colonized with resistant A. baumannii or colonized with both resistant A. baumannii and resistant P. aeruginosa. Morgan and his fellow researchers examined the healthcare workers' 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 performing proper hand hygiene.

The researchers report that there were 65 interactions between healthcare workers and patients colonized with MDR A. baumannii and 134 interactions with patients colonized with both MDR A. baumannii and MDR P. aeruginosa. Of 199 interactions between healthcare workers and patients colonized with MDR A. baumannii, 77 (38.7 percent) resulted in contamination of healthcare workers' gloves and/or gowns, and nine (4.5 percent) resulted in contamination of healthcare workers' hands after glove removal before hand hygiene.

Of 134 interactions with patients colonized with MDR P. aeruginosa, 11 (8.2 percent) resulted in contamination of healthcare workers' gloves and/or gowns, and one resulted in contamination of healthcare workers' hands. Independent risk factors for contamination with MDR A. baumannii were manipulation of wound dressing, manipulation of artificial airway, time in the patient room longer than 5 minutes, being a physician or nurse practitioner, and being a nurse. According to the researchers, "A higher incidence of contamination of physicians or nurses... is especially concerning, because physicians typically see more patients and have lower rates of hand hygiene than other healthcare workers."

The researchers add, "Protective gloves and gowns are contaminated with MDR A. baumannii much more often than with other MDR bacteria in the course of routine patient-care activities. This may in part explain the rapid emergence of MDR A. baumannii in the hospital setting. Both contact precautions and hand hygiene are essential for controlling the spread of this organism.

Reference: Morgan DJ, et al. Frequent multidrug-resistant Acinetobacter baumannii contamination of gloves, gowns and hands of healthcare workers. Infect Control Hosp Epidemiol 2010;31:716721.