Transmission of Methicillin-Resistant Staphylococcus aureus (MRSA) to Healthcare Worker Gowns and Gloves During Care of Nursing Home Residents

OBJECTIVE. To estimate the frequency of methicillin-resistant Staphylococcus aureus (MRSA) transmission to gowns and gloves worn by healthcare workers (HCWs) interacting with nursing home residents to better inform infection prevention policies in this setting design. Observational study setting. Participants were recruited from 13 community-based nursing homes in Maryland and Michigan participants. Residents and HCWs from these nursing homes METHODS. Residents were cultured for MRSA at the anterior nares and perianal or perineal skin. HCWs wore gowns and gloves during usual care activities. At the end of each activity, a research coordinator swabbed the HCW's gown and gloves. RESULTS. A total of 403 residents were enrolled; 113 were MRSA colonized. Glove contamination was higher than gown contamination (24% vs 14% of 954 interactions; P < .01). Transmission varied greatly by type of care from 0% to 24% for gowns and from 8% to 37% for gloves. We identified high-risk care activities: dressing, transferring, providing hygiene, changing linens, and toileting the resident (OR > 1.0; P < .05). We also identified low-risk care activities: giving medications and performing glucose monitoring (OR < 1.0; P < .05). Residents with chronic skin breakdown had significantly higher rates of gown and glove contamination. CONCLUSIONS. MRSA transmission from MRSA-positive residents to HCW gown and gloves is substantial; high-contact activities of daily living confer the highest risk. These activities do not involve overt contact with body fluids, skin breakdown, or mucous membranes, which suggests the need to modify current standards of care involving the use of gowns and gloves in the nursing home setting.