Impact of doffing errors on healthcare worker self-contamination when caring for patients on contact precautions
| Autor: | Mary K. Hayden, Yoona Rhee, Jennifer Cheng, Shivani Reddy, Robert A. Weinstein, Kyle J. Popovich, Michael Schoeny, Koh Okamoto, Prevention Epicenters Program, Karen Lolans |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Microbiology (medical) medicine.medical_specialty Epidemiology Health Personnel Teaching hospital Tertiary Care Centers Young Adult 03 medical and health sciences 0302 clinical medicine Protective Clothing Drug Resistance Multiple Bacterial medicine Humans In patient Prospective Studies 030212 general & internal medicine Personal protective equipment Hand disinfection Aged Chicago Cross Infection Infection Control 0303 health sciences Medical Errors 030306 microbiology business.industry Healthcare worker Middle Aged Contamination Infectious Diseases Contact precautions Relative risk Emergency medicine Equipment Contamination Female Gloves Protective business Hand Disinfection |
| Zdroj: | Infection Control & Hospital Epidemiology. 40:559-565 |
| ISSN: | 1559-6834 0899-823X |
| DOI: | 10.1017/ice.2019.33 |
| Popis: | Objective:We assessed the impact of personal protective equipment (PPE) doffing errors on healthcare worker (HCW) contamination with multidrug-resistant organisms (MDROs).Design:Prospective, observational study.Setting:The study was conducted at 4 adult ICUs at 1 tertiary-care teaching hospital.Participants:HCWs who cared for patients on contact precautions for methicillin-resistantStaphylococcus aureus(MRSA), vancomycin-resistant Enterococci, or multidrug-resistant gram-negative bacilli were enrolled. Samples were collected from standardized areas of patient body, garb sites, and high-touch environmental surfaces in patient rooms. HCW hands, gloves, PPE, and equipment were sampled before and after patient interaction. Research personnel observed PPE doffing and coded errors based on CDC guidelines.Results:We enrolled 125 HCWs; most were nurses (66.4%) or physicians (19.2%). During the study, 95 patients were on contact precautions for MRSA. Among 5,093 cultured sites (HCW, patient, environment), 652 (14.7%) yielded the target MDRO. Moreover, 45 HCWs (36%) were contaminated with the target MDRO after patient interactions, including 4 (3.2%) on hands and 38 (30.4%) on PPE. Overall, 49 HCWs (39.2%) made multiple doffing errors and were more likely to have contaminated clothes following a patient interaction (risk ratio [RR], 4.69;P= .04). All 4 HCWs with hand contamination made doffing errors. The risk of hand contamination was higher when gloves were removed before gowns during PPE doffing (RR, 11.76;P= .025).Conclusion:When caring for patients on CP for MDROs, HCWs appear to have differential risk for hand contamination based on their method of doffing PPE. An intervention as simple as reinforcing the preferred order of doffing may reduce HCW contamination with MDROs. |
| Databáze: | OpenAIRE |
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