Biomedical Engineering Reference
In-Depth Information
4.2.3 Contamination of Medical Equipment
When a patient is known to be colonized or infected with a transmittable pathogen,
dedicated equipment (i.e. stethoscopes) should be used when possible along with
other personal protective equipment such as gowns, gloves and masks. Frequently
touched hospital surfaces and medical equipment, such as doorknobs, bed rails, faucet
handles, and intravenous (IV) poles, have been identified as reservoirs of pathogenic
microbes [ 10 , 56 ]. In addition to medical equipment and healthy or intact skin, there
have been reports of the transfer of bacteria to the gloves and gowns of healthcare
workers after patient contact [ 6 , 18 , 33 , 49 ]. Specifically, Morgan and colleagues
reported that the transfer of multi-drug resistant bacteria (MDR) to the gowns and
gloves of healthcare workers occurred after routine contact, and that this was found to
increase as environmental contamination increased [ 49 ]. The intent of the study was
to evaluate the differential rate of contamination by a MDR variant of Acinetobacter
baumannii compared with other MDR bacteria while attempting to understand the
importance of environmental contamination in the transfer of MDR bacteria to
personal protective equipment (PPE, (gowns and gloves)) of healthcare workers.
Here the microbe most frequently recovered was the extremely recalcitrant
multidrug resistant variant of A. baumannii. Most striking however, were the
conclusions that resulted from the modeling of their data. Here a positive envi-
ronmental culture was found to be the strongest risk factor associated with the
contamination of the clothing of the healthcare worker by MDR bacteria (Odds
ratio (OR) 4.2; 95 % CI 2.7-6.5) [ 49 ]. Other independent variables, such as
presence in the patient's room for greater than 5 min (OR 2.0; p
0.014),
¼
performing a physical examination (OR 1.7; p
0.019) or contact with a venti-
¼
lator (OR 1.8; p
0.014) were similarly significant in raising the likelihood or risk
of transfer of MDR bacteria but at rates lower than the rate observed for a positive
environmental culture [ 49 ]. Intuition would suggest transfer was greater when
interacting with a patient. However, the higher risk associated with a positive
environmental culture serves to reinforce the importance that the microbial
burden of the built clinical environment represents to the set of circumstances
required for colonization and infection of patients while hospitalized.
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4.2.4 Risk to Patient When Prior Room Occupant
Colonized or Infected with Epidemiologically
Important Organisms
Even with environmental cleaning, studies have suggested that certain organisms
can be transmitted to the subsequent occupants in the setting of patient care.
Specifically, methicillin resistant Staphylococcus aureus (MRSA), vancomycin
resistant enterococci (VRE), C. difficile, and Gram negative pathogens have been
implicated. In a study by Martinez, and others in 2003 an epidemiologic link was
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