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Contamination of Gowns, Gloves, and Stethoscopes With Vancomycin-Resistant Enterococci

Published online by Cambridge University Press:  02 January 2015

Kimon C. Zachary ,
Pamela S. Bayne ,
Victoria J. Morrison ,
Dale S. Ford ,
Leah Christine Silver  and
David C. Hooper
Kimon C. Zachary
Affiliation:
Infectious Disease Division, Massachusetts General Hospital, Boston, Massachusetts Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
Pamela S. Bayne
Affiliation:
Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
Victoria J. Morrison
Affiliation:
Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
Dale S. Ford
Affiliation:
Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
Leah Christine Silver
Affiliation:
Infectious Disease Division, Massachusetts General Hospital, Boston, Massachusetts
David C. Hooper*
Affiliation:
Infectious Disease Division, Massachusetts General Hospital, Boston, Massachusetts Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts
*
Infectious Disease Division, Department of Medicine, Massachusetts General Hospital, 55 Fruit St, GRJ504, Boston, MA 02114-2696
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Abstract

Objective:

To measure directly the rate of contamination, during routine patient examination, of gowns, gloves, and stethoscopes with vancomycin-resistant enterococci (VRE).

Setting:

A large, academic, tertiary-care hospital.

Patients:

Between January 1997 and December 1998, 49 patients colonized or infected with VRE were entered in the study.

Design:

After routine examination, the examiner's glove fingertips, gown (the umbilical region and the cuffs), and stethoscope diaphragm were pressed onto Columbia colistin-nalidixic acid (CNA) agar plates with 5% sheep blood plus vancomycin 6 ug/mL. The stethoscope diaphragm was sampled again after cleaning with a 70% isopropanol wipe.

Results:

VRE were isolated from at least 1 examiner site (gloves, gowns, or stethoscope) in 33 (67%) of 49 cases. Gloves were contaminated in 63%, gowns in 37%, and stethoscopes in 31%. All three items were positive for VRE in 24%. One case each had stethoscope and gown contamination without glove contamination. Only 1 (2%) of 49 stethoscopes was positive after wiping with an alcohol swab. Contamination at any site was more likely when the patient had a colostomy or ileostomy. Patients identified by rectal-swab culture alone were as likely to contaminate their examiners as were those identified by clinical specimens.

Conclusions:

Our study revealed a high rate of examiner contamination with VRE. The similar risk of contamination identified by surveillance and clinical cases reinforces concerns that patients not known to be colonized with VRE could serve as sources for dissemination. Wiping with alcohol is effective in decontaminating stethoscopes.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 9 , September 2001 , pp. 560 - 564
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

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References

1.Centers for Disease Control and Prevention. Recommendation for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1995;44:1–12.Google Scholar
2.Boyce, JM, Opal, SM, Chow, JW, Zervos, MJ, Potter-Bynoe, G, Sherman, CB, et al. Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol 1994;32:1148–1153.Google Scholar
3.Boyce, JM, Mermel, LA, Zervos, MJ, Rice, LB, Potter-Bynoe, G, Giorgio, C, et al. Controlling vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 1995;16:634–637.Google Scholar
4.Boyce, JM. Vancomycin-resistant enterococcus. Infect Dis Clin North Am 1997;11:367–384.Google Scholar
5.Edmond, MB, Ober, JF, Weinbaum, DL, Pfaller, MA, Hwang, T, Sanford, MD, et al. Vancomycin-resistant Enterococcus faecium bacteremia: risk factors for infection. Clin Infect Dis 1995;20:1126–1133.Google Scholar
6.Handwerger, S, Raucher, B, Altarac, D, Monka, J, Marchione, S, Singh, KV, et al. Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillin, and gentamicin. Clin Infect Dis 1993;16:750–755.Google Scholar
7.Karanfil, LV, Murphy, M, Josephson, A, Gaynes, R, Mandel, L, Hill, BC, et al. A cluster of vancomycin-resistant Enterococcus faecium in an intensive care unit. Infect Control Hosp Epidemiol 1992;13:195–200.Google Scholar
8.Montecalvo, MA, Shay, DK, Patel, P, Tacsa, L, Maloney, SA, Jarvis, JVR, et al. Bloodstream infections with vancomycin-resistant enterococci. Arch Intern Med 1996;156:1458–1462.Google Scholar
9.Morris, JG Jr, Shay, DK, Hebden, JN, McCarter, RI Jr, Perdue, BE, Jarvis, W, et al. Enterococci resistant to multiple antimicrobial agents, including vancomycin: establishment of endemicity in a university niedical center. Ann Intern Med 1995;123:250–259.Google Scholar
10.Carmeli, Y, Samore, M, Huskins, WC. The association between antecedent vancomycin treatment and hospital-acquired vancomycin resistant enterococci. Arch Intern Med 1999;159:2461–2468.Google Scholar
11.Beezhold, DW, Slaughter, S, Hayden, MK, Matushek, M, Natlian, C, Trenholme, GM, et al. Skin colonization with vancomycin-resistant enterococci among hospitalized patients with bacteremia. Clin Infect Dis 1997;24:704–706.Google Scholar
12.Slaughter, S, Hayden, MK, Nathan, C, Hu, TC, Rice, T, Van Voorhjs, J, et al. A comparison of the effect of universal use of gloves and gowrjs with that of glove use alone on acquisition of vancomycin-resistant Enterococci in a medical intensive care unit. Ann Intern Med 1996;125:448–456.Google Scholar
13.Carvalho, MG, Teixeira, LM, Facklam, RR. Use of tests for acidification of methyl-alpha-D-glucopyranoside and susceptibility to efrotomycin for differentiation of strains of Enterococcus and some related genera. J Clin Microbiol 1998;36:1584–1587.Google Scholar
14.Pegues, DA, Pegues, CF, Hibberd, PL, Ford, DS, Hooper, DC. Emergence and dissemination of a highly vancomycin-resistant vanA strain of Enterococcus faecium at a large teaching hospital. J Clin Microbiol 1997;35:1565–1570.CrossRefGoogle Scholar
15.Montecalvo, MA, Shay, DK, Gedris, C, Petrullo, C, Uman, J, Rodney, K, et al. A semiquantitative analysis of the fecal flora of patients with vancomycin-resistant enterococci: colonized patients pose an infection control risk. Clin Infect Dis 1997;25:929–930.CrossRefGoogle ScholarPubMed
16.Morrison, D, Woodford, N, Barrett, SP, Sisson, P, Cookson, BD. DNA banding pattern polymorphism in vancomycin-resistant Enterococcus faecium and criteria for defining strains. J Clin Microbiol 1999;37:1084–1091.Google Scholar
17.De Lencastre, H, Brown, AE, Chung, M, Armstrong, D, Tomasz, A. Role of transposon Tn5482 in the epidemiology of vancomycin-resistant Enterococcus faecium in the pediatric oncology unit of a New York City hospital. Microb Drug Resist 1999;5:113–128.CrossRefGoogle ScholarPubMed