The devil is in the details: Factors influencing hand hygiene adherence and contamination with antibiotic-resistant organisms among healthcare providers in nursing facilities

2019 ◽  
Vol 40 (12) ◽  
pp. 1394-1399 ◽  
Author(s):  
John P. Mills ◽  
Ziwei Zhu ◽  
Julia Mantey ◽  
Savannah Hatt ◽  
Payal Patel ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Patient Care ◽  
Healthcare Providers ◽  
Routine Care ◽  
Healthcare Personnel ◽  
Resistant Organism ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Antibiotic Resistant ◽  
Before And After

AbstractBackground:Antibiotic-resistant organism (ARO) colonization rates in skilled nursing facilities (NFs) are high; hand hygiene is crucial to interrupt transmission. We aimed to determine factors associated with hand hygiene adherence in NFs and to assess rates of ARO acquisition among healthcare personnel (HCP).Methods:HCP were observed during routine care at 6 NFs. We recorded hand hygiene adherence, glove use, activities, and time in room. HCP hands were cultured before and after patient care; patients and high-touch surfaces were cultured. HCP activities were categorized as high-versus low-risk for self-contamination. Multivariable regression was performed to identify predictors of hand hygiene adherence.Results:We recorded 385 HCP observations and paired them with cultures performed before and after patient care. Hand hygiene adherence occurred in 96 of 352 observations (27.3%) before patient care and 165 of 358 observations (46.1%) after patient care. Gloves were worn in 169 of 376 observations (44.9%). Higher adherence was associated with glove use before patient care (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.44–4.54) and after patient care (OR, 3.11; 95% CI, 1.77–5.48). Compared with nurses, certified nurse assistants had lower hand hygiene adherence (OR, 0.31; 95% CI, 0.15–0.67) before patient care and physical/occupational therapists (OR, 0.22; 95% CI, 0.11–0.44) after patient care. Hand hygiene varied by activity performed and time in the room. HCP hands were contaminated with AROs in 35 of 385 cultures of hands before patient care (0.9%) and 22 of 350 cultures of hands after patient care (6.3%).Conclusions:Hand hygiene adherence in NFs remain low; it is influenced by job title, type of care activity, and glove use. Hand hygiene programs should incorporate these unique care and staffing factors to reduce ARO transmission.

scholarly journals Quantifying the Risk of Methicillin-Resistant Staphylococcus aureus (MRSA) Transmission From Patient to Healthcare Personnel in the Critical Care Setting

2020 ◽  
Vol 41 (S1) ◽  
pp. s364-s364
Author(s):  
Timileyin Adediran ◽  
Anthony Harris ◽  
J. Kristie Johnson ◽  
Mary-Claire Roghmann ◽  
Stephanie Hitchcok ◽  
...  
Keyword(s):  
Patient Care ◽  
Wound Care ◽  
Medical Center ◽  
Glucose Monitoring ◽  
Routine Care ◽  
Healthcare Personnel ◽  
Medication Delivery ◽  
Care Activity ◽  
The Mean ◽  
Specific Care

Background: Healthcare personnel (HCP) acquire MRSA on their gown and gloves during routine care activities for patients who are colonized or infected with MRSA at a rate of ∼15%. Certain care activities (eg, physical exam, care of endotracheal tube, wound care and bathing/hygiene) have been associated with a higher frequency of transmission from the patient to HCP gown and gloves than other activities (ie, administration of oral medicines, glucose monitoring, and manipulation of IV tubing/medication delivery). However, quantification of MRSA contamination and risk to subsequent patients is poorly defined. Objective: We sought to determine the mean MRSA colony-forming units (CFU) found on the gloves and gowns of HCP who acquire MRSA after various care activities involving patients with MRSA. Methods: We conducted a prospective cohort study at the University of Maryland Medical Center from December 2018 to October 2019. We identified patients colonized or infected with MRSA based on culture data from the prior 7 days. HCP performing prespecified care activities on eligible patients were observed. To isolate the risk of each care activity, HCP donned new gloves and gown prior to a specific care activity. Once that care activity was performed, HCP gloves and gown were swabbed prior to the any further care activities. HCP gloves were cultured with an E-swab by swabbing each digit up and down 3 times followed by 2 circles on the palm of their hands. HCP gowns were sampled by swabbing a 15 × 30-cm area along the beltline of the gown and along each inner forearm twice. E-swab liquid was then serially diluted and plated in triplicate on CHROMagar MRSA II (BD, Sparks, MD) to obtain CFU. We calculated the median CFUs and the interquartile range (IQR) for each specific care activity stratified by gown and gloves. Results: In total, 604 HCP–patient care interactions were observed. Table 1 displays the mean MRSA CFUs stratified by gown and gloves for each patient care activity of interest. Conclusions: The quantity of MRSA found on gowns and gloves varies depending on patient care activities. Recognition of differential transmission rates between various activities may allow different approaches to infection prevention, such as the use of personal protective equipment in high- versus low-risk activities and/or the use of more aggressive interventions for high-risk activities.Funding: NoneDisclosures: None

scholarly journals 2852. Epidemiology of Emerging Carbapenemase-Producing Organisms (CPO) in Chicago, Illinois, 2013–2018

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S73-S74
Author(s):  
Massimo Pacilli ◽  
Hira Adil ◽  
Kelly Walblay ◽  
Shannon N Xydis ◽  
Whitney Clegg ◽  
...  
Keyword(s):  
Public Health ◽  
Infection Control ◽  
Healthcare Facility ◽  
The United States ◽  
Resistant Organism ◽  
Molecular Testing ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Chicago Area

Abstract Background Emerging CPO in the Chicago area poses clinical and infection control challenges across the spectrum of care. Since November 2013, CPO are reportable to the Illinois’ Extensively Drug-resistant Organism (XDRO) registry. We examined trends in mechanism of resistance (MOR) among CPO reported through December 2018. Methods MOR reported into the XDRO registry were identified by clinical laboratories performing molecular methods on routine clinical cultures, by public health laboratories during point prevalence surveys (PPS) in response to clusters and as part of a project to assess CPO prevalence in high-risk Chicago area healthcare settings. Chicago patients with known MOR other than Klebsiella pneumoniae carbapenemase (KPC) are investigated by Chicago Department of Public Health (CDPH) to implement containment strategies and identify risk factors within 6 months of culture date. Results MOR was identified in 40% (1,216/3,587) of CPO-positive specimens collected from unique Chicago patients; 87% were KPC, 7% New Delhi metallo-β-lactamase (NDM), 5% Verona integron-mediated metallo-β-lactamase (VIM), 0.6% OXA-48-type carbapenemases, and 0.01% Imipenemase metallo-β-lactamase (IMP) (figure). Since 2017, 15 patients with CPO expressed more than one MOR; 14 were identified during PPS at ventilator capable skilled nursing facilities (vSNF) or long-term acute care hospitals (LTACH), and one was hospitalized in India. Among 156 patients with non-KPC CPO, the median age was 64 years (range, 20–97), 107 (69%) were identified from rectal screening and 49 (31%) were from clinical specimens, most of which were urine 23 (47%) or blood 6 (12%). Among 134 patients with risk factor history, 64% had history of tracheostomy (Table 1). Among 113 patients without documented travel outside of the United States, all stayed overnight at an Illinois healthcare facility; 62% stayed in a vSNF and 24% in an LTACH within 6 months of identification (Table 2). Conclusion We have increasingly detected non-KPC CPO in Chicago; however, estimates of prevalence are limited by lack of systematic surveillance and molecular testing. The high proportion of CPO patients without travel who stayed in vSNF or LTACH underscores the need for infection control training and surveillance in these settings. Disclosures All Authors: No reported Disclosures.

scholarly journals 1197. Microbiological Surveillance of Duodenoscopes Before and After High-Level Disinfection Following Endoscopic Retrograde Cholangiopancreatography (ERCP)

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S362-S362
Author(s):  
Bert K Lopansri ◽  
Tasha Fernley ◽  
Jana Coombs ◽  
Michaela A Gazdik ◽  
Lori Smit ◽  
...  
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Bacterial Colonization ◽  
Resistant Bacteria ◽  
Resistant Organism ◽  
Antibiotic Resistant Bacteria ◽  
Endoscopic Retrograde ◽  
Antibiotic Resistant ◽  
Before And After ◽  
Intermountain Healthcare ◽  
High Level

Abstract Background Transmission of antibiotic-resistant bacteria during endoscopic retrograde cholangiopancreatography (ERCP) has been linked to the complex design of the duodenoscope (scope) elevator channel and cantilever. We implemented a scope culturing program to monitor the efficacy of disinfection and to identify frequency of pre-disinfection exposure to antibiotic-resistant bacteria. Methods Facilities performing ERCPs within the Intermountain Healthcare system voluntarily submit scope cultures to the Infectious Diseases Epidemiology Laboratory. Cultures are collected at designated intervals based on procedure volumes at each site. Samples are submitted by endoscopy techs trained to collect flush and swab samples of the distal end of the scope using a previously described method before (PRE) and after (POST) high-level disinfection. Selective media is used to screen for Gram-negative bacilli-resistant to third-generation cephalosporins (ESBL) and vancomycin-resistant Enterococcus (VRE). Results Between March 7, 2016 and April 18, 2018, 1,255 scope samples from 10 facilities were cultured (533 PRE samples and 722 POST samples). 483 (90.6%) PRE samples were positive, with 75 (15.5%) screening positive for an antibiotic-resistant organism (60 ESBL and 15 VRE). 19 (2.6%) POST samples were positive, with 4 (21.1%) screening positive for ESBL. One of the four ESBL positive POST samples had a corresponding PRE sample for comparison; E. coli and Klebsiella variicola were isolated in both indicating residual contamination. Two of the ESBL-positive POST cultures did not have corresponding PRE samples and one had a PRE culture negative for ESBL. No POST samples contained VRE. Endoscopy personnel were contacted for each positive POST culture and endoscopy reprocessing practices were reviewed. Additionally, scopes were quarantined, reprocessed and re-cultured. Scopes were returned to use once POST cultures were negative. Conclusion Contamination of scopes with antibiotic-resistant bacteria during ERCP is common. High-level disinfection is effective at reducing bacterial burden but is imperfect. Routine surveillance for post-reprocessing bacterial colonization has been helpful to minimize patient exposure and to maintain focus on the importance of reprocessing. Disclosures All authors: No reported disclosures.

scholarly journals MANAGING MANAGED CARE: PERSPECTIVES FROM KEY STAKEHOLDERS IN SKILLED NURSING FACILITIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S498-S499
Author(s):  
Andrea E Daddato ◽  
Cynthia Drake ◽  
Edward A Miller ◽  
Pamela Nadash ◽  
Denise Tyler ◽  
...  
Keyword(s):  
Managed Care ◽  
Patient Care ◽  
Decision Makers ◽  
Skilled Nursing Facilities ◽  
Future Research ◽  
Fee For Service ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Key Stakeholders ◽  
The Relationship

Abstract In recent years, Medicare Advantage (MA) plan enrollment has increased, a trend that is expected to continue. Many skilled nursing facilities (SNFs) rely on MA managed care insurer referrals to maintain their census in a market with high competition for post-acute care patients. This study used semi-structured interviews to describe the relationship between MA plans and SNFs from the perspective of key decision-makers in SNFs. Twenty-three interviews were conducted with key stakeholders from 11 Denver Metropolitan area SNFs. A combined purposive-snowball sampling approach was used to identify and recruit select staff from the participating facilities. Interviews focused on the relationship between MA plans and SNFs, including mechanisms of control, power dynamics, and preferences for MA versus Fee-for-Service (FFS) Medicare patients. Key findings included: 1) challenges SNF staff had navigating MA plans’ case management processes, a key mechanism used by MA plans to influence the behavior of SNF decision-makers; 2) MA plans exercising power over beneficiaries’ length of stay, potentially leading to early discharge and heightened risk for rehospitalization; 3) SNF preference for admitting Medicare FFS over MA patients due to higher rates of Medicare FFS reimbursement and greater control over patient care. SNFs are increasingly reliant on MA plans for patient referrals and revenue. The themes suggest that this growing reliance may place SNFs at odds with MA plans on how best to manage overall patient care. It is therefore important that future research investigate how MA plans’ influence over care affects patient outcomes in SNFs and other post-acute settings.

scholarly journals Transmission of resistant Gram-negative bacteria to healthcare personnel gowns and gloves during care of residents in community-based nursing facilities

2018 ◽  
Vol 39 (12) ◽  
pp. 1425-1430 ◽  
Author(s):  
Natalia Blanco ◽  
J. Kristie Johnson ◽  
John D. Sorkin ◽  
Alison D. Lydecker ◽  
Lauren Levy ◽  
...  
Keyword(s):  
High Risk ◽  
Prospective Observational Study ◽  
Glucose Monitoring ◽  
Healthcare Personnel ◽  
Gram Negative Bacteria ◽  
Nursing Facilities ◽  
Community Based ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Resident Characteristic

AbstractObjectiveTo estimate the risk of transmission of antibiotic-resistant Gram-negative bacteria (RGNB) to gowns and gloves worn by healthcare personnel (HCP) when providing care to residents of community-based nursing facilities to identify the types of care and resident characteristics associated with transmission.DesignProspective observational study.Settings and participantsResidents and HCP from 13 community-based nursing facilities in Maryland and Michigan.MethodsPerianal swabs were collected from residents and cultured to detect RGNB. HCP wore gowns and gloves during usual care activities, and at the end of each interaction, these were swabbed in a standardized manner. Transmission of RGNB from a colonized resident to gowns and gloves was estimated. Odds ratios (ORs) of transmission associated with type of care or resident characteristic were calculated.ResultsWe enrolled 403 residents and their HCP in this study. Overall, 19% of enrolled residents with a perianal swab (n=399) were colonized with at least 1 RGNB. RGNB transmission to either gloves or gowns occurred during 11% of the 584 interactions. Showering the resident, hygiene or toilet assistance, and wound dressing changes were associated with a high risk of transmission. Glucose monitoring and assistance with feeding or medication were associated with a low risk of transmission. Residents with a pressure ulcer were 3 times more likely to transmit RGNB than residents without one (OR, 3.3; 95% confidence interval [CI], 1.0–11.1).ConclusionsGown and glove use in community nursing facilities should be prioritized for certain residents and care interactions that are deemed a high risk for transmission.

scholarly journals Hospital Policies Related to Transmission of Methicillin-Resistant Staphylococcus aureus (MRSA)

2020 ◽  
Vol 41 (S1) ◽  
pp. s252-s253
Author(s):  
Lindsey Lesher Erickson ◽  
Toben Nelson ◽  
J. Michael Oakes
Keyword(s):  
Hand Hygiene ◽  
Influenza Vaccination ◽  
Traffic Safety ◽  
Multidrug Resistant ◽  
Healthcare Personnel ◽  
Resistant Organism ◽  
Training And Education ◽  
Hospital Policies ◽  
Corrective Actions ◽  
Organizational Rules

Background: MRSA continues to spread in hospitals, despite modest recent success. Gaps exist regarding how hospital policies impact MRSA transmission in hospitals. Characterization of the policy environment has been useful in approaching other public health issues including control of alcohol, firearms, tobacco, and traffic safety. Objective: Our goal was to describe measurable and modifiable policy components designed to prevent MRSA in hospital settings. Methods: We examined 4 types of hospital policies from 5 metropolitan hospitals in Minnesota: hand hygiene, multidrug-resistant organism (MDRO) and isolation, healthcare personnel influenza vaccination, and whistleblower (corporate compliance). We developed a tool to systematically evaluate policies for each topic that included 19–23 instructional and implementation elements guided by regulatory and clinical practice guidelines: purpose, expectations, education and training, monitoring, enforcement, corrective actions, responsibilities, and corrective actions. Each policy element was evaluated for its presence (yes or no) and thoroughness (nonexistent = 0, cursory = 1, thorough = 2). Results: All hospitals had hand hygiene and MDRO and isolation policies; 3 of 5 had influenza and whistleblower policies. The policies varied in comprehensiveness and thoroughness across hospitals and topics. Most policies included purpose and policy statements with a statement of organizational rules (14 of 16 and 16 of 16, respectively) with mean thoroughness scores of 1.04 and 1.20, respectively. Most policies lacked consequences for noncompliance (6 of 16), accountability (6 of 16), and monitoring and enforcement of policy expectations (5 of 16). When included, the policy components scored low for thoroughness, and 50% of policies (8 of 16; range, 20% for hand hygiene and 100% for influenza vaccination) specified expectations for educating staff about the policy topic, with a mean thoroughness score of 0.75. Responsibilities for policy expectations were lacking: responsibilities for product needs and availability (3 of 13), training and education (1 of 16); and monitoring compliance with skills and techniques (4 of 16). Of the 4 policy types, influenza vaccination was the most complete. All influenza policies had 50% of categories completed versus hand hygiene (26%), MDRO (17%), and whistleblower (26%). The hand hygiene policies scored highest for thoroughness; 48% of policy elements scored >1.0 versus MDRO (22%), influenza (25%), and whistleblower (11%). Conclusions: We developed a systematic method to quantitatively evaluate hospital policies. Our review of hospital policies most commonly contained thorough instructional elements such as organizational requirements and protocols and procedures. Policies often lacked implementation elements such as expectations for monitoring, enforcement, responsibilities, accountabilities, and staff training and education. As we begin to characterize policy, endogenous in nature, as a potential exposure, it is important that we develop rigorous measurement. We have provided a first step in developing such an approach.Funding: NoneDisclosures: None

scholarly journals Knowledge and Attitude Regarding Infection Control and Standard Precautions among Healthcare Workers of Rural Nepal

2018 ◽  
Vol 3 (2) ◽  
pp. 453-457
Author(s):  
Ajay Kumar Rajbhandari ◽  
Reshu Agrawal Sagtani ◽  
Bijay Thapa ◽  
Puspanjali Adhikari
Keyword(s):  
Infection Control ◽  
Patient Care ◽  
Healthcare Workers ◽  
Healthcare Personnel ◽  
Healthcare Associated Infection ◽  
Standard Precautions ◽  
Cross Sectional ◽  
Before And After ◽  
Knowledge And Attitude ◽  
Micro Organisms

Introduction: A healthcare associated infection (HCAI) during patient care is an emerging challenge to healthcare service delivery. Transmission of most of these HCAIs can be prevented through application of standard precautions which are a set of infection control practices followed during patient care, whether or not they appear infectious or symptomatic.Objective: This study aims to assess the existing knowledge and attitude on infection control and standard precautions among healthcare personnel working in peripheral healthcare settings of Nepal.Methodology: It was a cross-sectional study and included nine different health facilities in Makwanpur district. Knowledge and attitude regarding infection control and standard precautions were assessed with the help of a self-administered questionnaire on a pre-determined scale. The results are presented as frequency distribution table and valid proportions.Results: In the study, 91.9% of the HCWs agreed that HCAI is caused by micro-organisms that can be transmitted between patients while 51.5% of them disagreed that HCAI can be caused by micro-organisms carried on the hands of healthcare workers. Majority (98.6%) of the HCWs believed that the use of gloves, mask and apron reduces the risk of HCAI whereas 13.5% of HCWs disagreed that gloves should be changed between the examination of different patients. Although 97% of the HCWs agreed that hand should be washed before and after examining the patient, 17.6% of them informed that they do not always wash their hands before and after examining a patient.Conclusion: Irrespective of limited availability of infection control guidelines, it was found that the knowledge on HCAI control was good and majority of the respondents showed favorable attitude towards infection control and standard precautions.  BJHS 2018;3(2)6: 453-457.

scholarly journals 1177. Carbapenemase-Producing Carbapenem-Resistant Organism Colonization Screening Surveys, Maryland, April 2017–April 2018

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S355-S355
Author(s):  
Richard B Brooks ◽  
Elisabeth Vaeth ◽  
Niketa M Jani ◽  
Catherine E Dominguez ◽  
Jonathan R Johnston
Keyword(s):  
Resistant Organism ◽  
New Delhi ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Contact Precautions ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Carbapenem Resistant ◽  
Control And Prevention ◽  
Incident Cases

Abstract Background In April 2017, the Maryland Department of Health (MDH) began screening healthcare contacts of confirmed cases of carbapenemase-producing carbapenem-resistant organisms (CP-CROs) to identify potential transmission, per guidance published by the Centers for Disease Control and Prevention. The results of MDH’s CP-CRO colonization screening surveys (CSSs) conducted as of April 1, 2018, are summarized. Methods Rectal swabs were collected on epidemiologically linked CP-CRO contacts and sent to the MDH Laboratories Administration, where the Cepheid Xpert® Carba-R assay was used to detect five carbapenemases: Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-β-lactamase (NDM), Verona integron encoded metallo-β-lactamase (VIM), imipenemase (IMP), and oxacillinase-48-like carbapenemase (OXA-48). Identification of CP-CROs in contacts sometimes resulted in additional CSSs to ensure complete case detection. Non-KPC cases were combined for analysis. Results During April 1, 2017–April 1, 2018, MDH received reports of 278 incident cases of confirmed CP-CROs. Of these, 16 (6%) expressed non-KPC carbapenemases. The 7 (3%) cases with healthcare contacts prompting CSSs led to screening of 132 first-round contacts, with additional CP-CROs identified in 13 (10%), all of which had KPC. Of these, 12 (92%) resided in ventilator units of skilled nursing facilities (vSNFs). In the first-round CSS at one vSNF, 64% of screened contacts were positive for KPC, which had not been identified in the index case. Weekly follow-up CP-CRO admission screenings and serial follow-up CSSs at the vSNF resulted in screening of a total of 72 unique patients; 38 (53%) were KPC-positive. Of these 38 cases, 32 (89%) were previously unidentified and were placed on contact precautions if not already on them. Staff were re-trained in infection prevention (IP) techniques, and staff and KPC-positive patients were cohorted. Conclusion Detection of CP-CROs that express non-KPC carbapenemases in Maryland is rare, and transmission of these carbapenemases has not been identified. However, CSSs identified previously unknown cases of KPC, most commonly in vSNFs, demonstrating the utility of CSSs to detect CP-CROs, and resulting in important IP interventions. Disclosures All authors: No reported disclosures.

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