Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-25T00:24:19.440Z Has data issue: false hasContentIssue false
  • English
  • Français

Use of simulations to evaluate the effectiveness of barrier precautions to prevent patient-to-patient transfer of healthcare-associated pathogens

Published online by Cambridge University Press:  12 October 2020

Heba Alhmidi ,
Daniel F. Li ,
Jennifer L. Cadnum ,
Muhammed F. Haq ,
Natalia C. Pinto-Herrera ,
Brigid M. Wilson  and
Curtis J. Donskey
Heba Alhmidi
Affiliation:
Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
Daniel F. Li
Affiliation:
Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio Case Western Reserve University School of Medicine, Cleveland, Ohio
Jennifer L. Cadnum
Affiliation:
Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
Muhammed F. Haq
Affiliation:
Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
Natalia C. Pinto-Herrera
Affiliation:
Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
Brigid M. Wilson
Affiliation:
Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH
Curtis J. Donskey*
Affiliation:
Case Western Reserve University School of Medicine, Cleveland, Ohio Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH
*
Author for correspondence: Curtis J. Donskey, E-mail: Curtis.Donskey@va.gov
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

There is controversy regarding whether the addition of cover gowns offers a substantial benefit over gloves alone in reducing personnel contamination and preventing pathogen transmission.

Design:

Simulated patient care interactions.

Objective:

To evaluate the efficacy of different types of barrier precautions and to identify routes of transmission.

Methods:

In randomly ordered sequence, 30 personnel each performed 3 standardized examinations of mannequins contaminated with pathogen surrogate markers (cauliflower mosaic virus DNA, bacteriophage MS2, nontoxigenic Clostridioides difficile spores, and fluorescent tracer) while wearing no barriers, gloves, or gloves plus gowns followed by examination of a noncontaminated mannequin. We compared the frequency and routes of transfer of the surrogate markers to the second mannequin or the environment.

Results:

For a composite of all surrogate markers, transfer by hands occurred at significantly lower rates in the gloves-alone group (OR, 0.02; P < .001) and the gloves-plus-gown group (OR, 0.06; P = .002). Transfer by stethoscope diaphragms was common in all groups and was reduced by wiping the stethoscope between simulations (OR, 0.06; P < .001). Compared to the no-barriers group, wearing a cover gown and gloves resulted in reduced contamination of clothing (OR, 0.15; P < .001), but wearing gloves alone did not.

Conclusions:

Wearing gloves alone or gloves plus gowns reduces hand transfer of pathogens but may not address transfer by devices such as stethoscopes. Cover gowns reduce the risk of contaminating the clothing of personnel.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 4 , April 2021 , pp. 425 - 430
Check for updates
Creative Commons
This work is classified, for copyright purposes, as a work of the U.S. Government and is not subject to copyright protection within the United States.
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Tomas, ME, Kundrapu, S, Thota, P et al. Contamination of the skin and clothing of healthcare personnel during removal of personal protective equipment. JAMA Intern Med 2015;175:1904–1910.CrossRefGoogle ScholarPubMed
Donskey, CJ. Does improving surface cleaning and disinfection reduce healthcare-associated infections? Am J Infect Control 2013;41:S12–S19.CrossRefGoogle Scholar
Johnson, S, Gerding, DN, Olson, MM, et al. Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission. Am J Med 1990;88:137–140.CrossRefGoogle ScholarPubMed
Tenorio, AR, Badri, SM, Sahgal, NB, et al. Effectiveness of gloves in the prevention of hand carriage of vancomycin-resistant Enterococcus species by healthcare workers after patient care. Clin Infect Dis 2001;32:826–829.CrossRefGoogle ScholarPubMed
Alhmidi, H, Gonzalez-Orta, M, Cadnum, JL, Mana, TSC, Jencson, AL, Wilson, BM, Donskey, CJ. Contamination of healthcare personnel during removal of contaminated gloves. Am J Infect Control 2019;47:850–852.CrossRefGoogle Scholar
Williams, C, McGraw, P, Schneck, EE, et al. Impact of universal gowning and gloving on healthcare worker clothing contamination. Infect Control Hosp Epidemiol 2015;36:431–37.CrossRefGoogle ScholarPubMed
Srinivasan, A, Song, X, Ross, T, Merz, W, Brower, R, Perl, TM. A prospective study to determine whether cover gowns in addition to gloves decrease nosocomial transmission of vancomycin-resistant enterococci in an intensive care unit. Infect Control Hosp Epidemiol 2002;23:424–428.CrossRefGoogle Scholar
Puzniak, LA, Leet, T, Mayfield, J, Kollef, M, Mundy, LM. To gown or not to gown: the effect on acquisition of vancomycin-resistant enterococci. Clin Infect Dis 2002;35:18–25.CrossRefGoogle ScholarPubMed
Boyce, JM, Opal, SM, Chow, JW, et al. Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol 1994;32:1148–1153.CrossRefGoogle ScholarPubMed
Slaughter, S, Hayden, MK, Nathan, C, et al. A comparison of the effect of universal use of gloves and gowns 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.CrossRefGoogle Scholar
Webster, J, Pritchard, MA. Gowning by attendants and visitors in newborn nurseries for prevention of neonatal morbidity and mortality. Cochrane Database Syst Rev 2003;3:CD003670.Google Scholar
Kwon, JH, Burnham, CD, Reske, KA, et al. Assessment of healthcare worker protocol deviations and self-contamination during personal protective equipment donning and doffing. Infect Control Hosp Epidemiol 2017;38:1077–1083.CrossRefGoogle ScholarPubMed
Oelberg, DG, Joyner, SE, Jiang, X, Laborde, D, Islam, MP, Pickering, LK. Detection of pathogen transmission in neonatal nurseries using DNA markers as surrogate indicators. Pediatrics 2000;105:311–315.CrossRefGoogle ScholarPubMed
John, A, Alhmidi, H, Cadnum, JL, Jencson, AL, Donskey, CJ. Contaminated portable equipment is a potential vector for dissemination of pathogens in the intensive care unit. Infect Control Hosp Epidemiol 2017;38:1247–1249.CrossRefGoogle ScholarPubMed
John, AR, Alhmidi, H, Cadnum, JL, Jencson, AL, Gestrich, S, Donskey, CJ. Evaluation of the potential for electronic thermometers to contribute to spread of healthcare-associated pathogens. Am J Infect Control 2018;46:708–710.CrossRefGoogle ScholarPubMed
Alhmidi, H, Cadnum, JL, Jencson, AL, Gweder, AA, Donskey, CJ. Sharing is not always a good thing: use of a DNA marker to investigate the potential for ward-to-ward dissemination of healthcare-associated pathogens. Infect Control Hosp Epidemiol 2019;40:214–216.CrossRefGoogle Scholar
John, AR, et al. A randomized trial to determine whether wearing short-sleeved white coats reduces risk of pathogen transmission. Infect Control Hosp Epidemiol 2018;39:233–234.CrossRefGoogle ScholarPubMed
Alhmidi, H, John, A, Mana, TC, Koganti, S, Cadnum, JL, Shelton, MB, Donskey, CJ. Evaluation of viral surrogate markers for study of pathogen dissemination during simulations of patient care. Open Forum Infect Dis 2017;4:ofx128.CrossRefGoogle Scholar
Kundrapu, S, Sunkesula, V, Jury, I, Deshpande, A, Donskey, CJ. A randomized trial of soap and water hand wash versus alcohol hand rub for removal of Clostridium difficile spores from hands of patients. Infect Control Hosp Epidemiol 2014;35:204–206.CrossRefGoogle ScholarPubMed
Vajravelu, RK, Vajravelu, RK, Guerrero, DM, Jury, LA, Donskey, CJ. Evaluation of stethoscopes as vectors of Clostridium difficile and methicillin-resistant Staphylococcus aureus . Infect Control Hosp Epidemiol 2012;33:96–98.CrossRefGoogle ScholarPubMed
Longtin, Y, Schneider, A, Tschopp, C, et al. Contamination of stethoscopes and physicians’ hands after a physical examination. Mayo Clin Proc 2014;89:291–299.CrossRefGoogle ScholarPubMed
Mehta, AK, Halvosa, JS, Gould, CV, Steinberg, JP. Efficacy of alcohol-based hand rubs in the disinfection of stethoscopes. Infect Control Hosp Epidemiol 2010;31:870–872.CrossRefGoogle ScholarPubMed
Faulx, GR, Emig, E, Alhmidi, H, et al. Efficacy of a wearable ultraviolet-C light device for semi-automated decontamination of stethoscopes between each use. Infect Control Hosp Epidemiol 2020;48:100–102.Google Scholar
Sickbert-Bennett, EE, Weber, DJ, Gergen-Teague, MF, Sobsey, MD, Samsa, GP, Rutala, WA. Comparative efficacy of hand hygiene agents in the reduction of bacteria and viruses. Am J Infect Control 2005;33:67–77.CrossRefGoogle ScholarPubMed
Boone, SA, Gerba, CP. Significance of fomites in the spread of respiratory and enteric viral disease. Appl Environ Microbiol 2007;73:1687–1696.CrossRefGoogle ScholarPubMed
Flores, A, Pevalin, DJ. Healthcare workers’ compliance with glove use and the effect of glove use on hand hygiene compliance. Br J Infect Contr 2006;7:15–19.CrossRefGoogle Scholar
Cusini, A, Nydegger, D, Kaspar, T, Schweiger, A, Kuhn, R, Marschall, J. Improved hand hygiene compliance after eliminating mandatory glove use from contact precautions—Is less more? Am J Infect Control 2015;43:922–927.CrossRefGoogle ScholarPubMed