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Transfer of pathogens to and from patients, healthcare providers, and medical devices during care activity—a systematic review and meta-analysis

Published online by Cambridge University Press:  24 July 2018

Aline Wolfensberger ,
Lauren Clack ,
Stefan P. Kuster ,
Simone Passerini ,
Lona Mody ,
Vineet Chopra ,
Jason Mann  and
Hugo Sax
Aline Wolfensberger*
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Lauren Clack
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Stefan P. Kuster
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Simone Passerini
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Lona Mody
Affiliation:
Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
Vineet Chopra
Affiliation:
Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan Division of General Medicine, Department of Internal Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
Jason Mann
Affiliation:
Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan
Hugo Sax
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
*
Author for correspondence: Aline Wolfensberger MD, Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland. E-mail: [email protected]
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Abstract

Objective

The transfer of pathogens may spread antimicrobial resistance and lead to healthcare-acquired infections. We performed a systematic literature review to generate estimates of pathogen transfer in relation to healthcare provider (HCP) activities.

Methods

For this systematic review and meta-analysis, Medline/Ovid, EMBASE, and the Cochrane Library were searched for studies published before July 7, 2017. We reviewed the literature, examining transfer of pathogens associated with HCP activities. We included studies that (1) quantified transfer of pathogens from a defined origin to a defined destination surface; (2) reported a microbiological sampling technique; and (3) described the associated activity leading to transfer. For studies reporting transfer frequencies, we extracted data and calculated the estimated proportion using Freeman-Tukey double arcsine transformation and the DerSimonian-Laird random-effects model.

Results

Of 13,121 identified articles, 32 were included. Most articles (n=27, 84%) examined transfer from patients and their environment to HCP hands, gloves, and gowns, with an estimated proportion for transfer frequency of 33% (95% confidence interval [CI], 12%–57%), 30% (95% CI, 23%–38%) and 10% (95% CI, 6%–14%), respectively. Other articles addressed transfer involving the hospital environment and medical devices. Risk factor analyses in 12 studies suggested higher transfer frequencies after contact with moist body sites (n=7), longer duration of care (n=5), and care of patients with an invasive device (n=3).

Conclusions

Recognizing the heterogeneity in study designs, the available evidence suggests that pathogen transfer to HCPs occurs frequently. More systematic research is urgently warranted to support targeted and economic prevention policies and interventions.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 9 , September 2018 , pp. 1093 - 1107
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

Cite this article: Wolfensberger A, et al. (2018). Transfer of pathogens to and from patients, healthcare providers, and medical devices during care activity—a systematic review and meta-analysis. Infection Control & Hospital Epidemiology. 2018, 39, 1093–1107. doi: 10.1017/ice.2018.156

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