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Amy N. Duckro, DO; Donald W. Blom, RN; Elizabeth A. Lyle, AB; Robert A. Weinstein, MD; Mary K. Hayden, MD

Arch Intern Med. 2005;165:302-307.

Background  The roles of the contaminated hospital environment and of patient skin carriage in the spread of vancomycin-resistant enterococci (VRE) are uncertain. Transfer of VRE via health care worker (HCW) hands is assumed but unproved. We sought to determine the frequency of VRE transmission from sites in the environment or on patients’ intact skin to clean environmental or skin sites via contaminated hands of HCWs during routine care.

Methods  We cultured sites on the intact skin of 22 patients colonized by VRE, as well as sites in the patients’ rooms, before and after routine care by 98 HCWs. Observers recorded sites touched by HCWs. Cultures were obtained from HCW hands and/or gloves before and after care. All isolates underwent pulsed-field gel electrophoresis. We defined a transfer to have occurred when a culture-negative site became positive with a VRE pulsotype after being touched by an HCW who had the same pulsotype on his or her hands or gloves and who had previously touched a colonized or contaminated site.

Results  Health care workers touched 151 negative sites after touching a site that was positive for VRE. Sixteen negative sites (10.6%) became positive after contact. The percentage of times that contact with a site led to a transfer was highest for antecubital fossae and blood pressure cuffs.

Conclusions  Vancomycin-resistant enterococci were transferred from contaminated sites in the environment or on patients’ intact skin to clean sites via HCW hands or gloves in 10.6% of opportunities. Controlling VRE by decontaminating the environment and patients’ intact skin may be an important adjunctive infection control measure.

Author Affiliations: Department of Internal Medicine, Section of Infectious Diseases (Drs Duckro, Weinstein, and Hayden, Mr Blom, and Ms Lyle), and Department of Pathology (Dr Hayden), Rush University Medical Center, and Department of Internal Medicine, Division of Infectious Diseases, John H. Stroger Hospital of Cook County (Drs Duckro and Weinstein), Chicago, Ill.

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