Study finds transmission rates high in daily activities previously considered low-risk
Healthcare workers frequently contaminate their gloves and gowns during every day care of nursing homes residents with drug resistant Staphylococcus aureus or MRSA, according to a new study. The findings were published online in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.
"One in four nursing home residents harbor MRSA in some settings. We know that healthcare workers serve as a vector for MRSA transmission from one resident to another in settings such as nursing homes," said Mary-Claire Roghmann, M.D., lead author of the study. "The use of barrier precautions, such as gowns and gloves, limit this transmission, but guidance on when to use them is limited. The goal of our research was to determine the most important times to wear gowns and gloves in nursing homes by measuring the risk of MRSA contamination during different types of care."
Researchers conducted a prospective observational study at 13 community-based nursing homes in Maryland and Michigan, evaluating 403 residents for MRSA colonization and then assessing whether interactions with healthcare workers lead to contamination of their gowns and gloves by MRSA bacteria. The study found 28 percent of residents (113 out of 403) harbored MRSA. Glove contamination was higher than gown contamination (24 percent vs. 14 percent) reinforcing the importance of hand hygiene between residents to prevent transmission of MRSA.
High-risk activities linked to glove or gown contamination included dressing residents, transferring residents, providing hygiene such as brushing teeth or combing hair, and changing linens and diapers. Healthcare workers do not wear gowns during much of this care because they don't anticipate that their clothing will come into contact with body secretions during this care.
"This research is particularly important since residents in these communities require a lot of assistance from their healthcare workers. New MRSA acquisition in nursing homes is substantial. Our study, for the first time, defines the type of care that increases the risk of transmission and suggests modifications to the current indications of gown and glove use," said Roghmann.