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2017 ; 45
(7
): e633-e639
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Factors Leading to Transmission Risk of Acinetobacter baumannii
#MMPMID28398924
Thom KA
; Rock C
; Jackson SS
; Johnson JK
; Srinivasan A
; Magder LS
; Roghmann MC
; Bonomo RA
; Harris AD
Crit Care Med
2017[Jul]; 45
(7
): e633-e639
PMID28398924
show ga
OBJECTIVES: To identify patient and healthcare worker factors associated with
transmission risk of Acinetobacter baumannii during patient care. DESIGN:
Prospective cohort study. SETTING: ICUs at a tertiary care medical center.
PATIENTS: Adult ICU patients known to be infected or colonized with A. baumannii.
MEASUREMENTS AND MAIN RESULTS: Cultures of skin, respiratory tract, and the
perianal area were obtained from participants and evaluated for the presence of
A. baumannii. Healthcare worker-patient interactions were observed (up to five
interactions/patient) and activities were recorded. Healthcare worker
hands/gloves were sampled at room exit (prior to hand hygiene or glove removal)
and then evaluated for the presence of A. baumannii. Two hundred fifty-four
healthcare worker-patient interactions were observed among 52 patients; A.
baumannii was identified from healthcare worker hands or gloves in 77 (30%)
interactions. In multivariate analysis, multidrug-resistant A. baumannii (odds
ratio, 4.78; 95% CI, 2.14-18.45) and specific healthcare worker activities
(touching the bed rail [odds ratio, 2.19; 95% CI, 1.00-4.82], performing a wound
dressing [odds ratio, 8.35; 95% CI, 2.07-33.63] and interacting with the
endotracheal tube or tracheotomy site [odds ratio, 5.15; 95% CI, 2.10-12.60]),
were associated with hand/glove contamination. CONCLUSIONS: Healthcare worker
hands/gloves are frequently contaminated with A. baumannii after patient care.
Patient-level factors were not associated with an increased transmission risk;
however, having multidrug-resistant-A. baumannii and specific healthcare worker
activities led to an increased contamination risk. Our findings reveal a
potential selective advantage possessed by multidrug-resistant-A. baumannii in
this environment and suggest possible areas for future research.
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