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Factors Leading to Transmission Risk of Acinetobacter baumannii
Kerri A Thom1, Clare Rock, Sarah S Jackson
11Department of Epidemiology, University of Maryland School of Medicine, Baltimore, MD.2Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.3Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA.4VA Maryland Health Care System, Baltimore, MD.5Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center and Case Western Reserve University, Cleveland, OH.
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.