LAUSR

Abstract Background Vancomycin-resistant Enterococcus (VRE) is transmitted from person-to-person, most commonly by healthcare workers (HCW) whose hands or attire have become contaminated while interacting with an infected or colonized patient. Our group recently found that VRE colonized patients transmitted this pathogen to HCW gowns or gloves 15% of the time. This study aims to describe patient-level factors associated with higher risk of transmission of VRE to HCW gowns or gloves and thus likely to subsequent patients. Methods We analyzed a prospective cohort that included 43 VRE-colonized patients and 215 HCW-patient interactions in medical or surgical intensive care units at the University of Maryland Medical Center. HCWs’ gowns and gloves were cultured for VRE after performing patient care and before doffing. Univariate and multivariable logistic regression models, using generalized estimating equations to account for patient clustering, were used to estimate the odds ratios associated with specific patient-level factors (i.e., age, race, Elixhauser comorbidity score components obtained by ICD-10 codes, diarrhea, and devices). Multivariable models with and without stool VRE burden were created. Results In the initial multivariable model, having a nasogastric tube, diarrhea, complicated diabetes, rheumatoid arthritis/collagen vascular diseases, neurological disorders or psychoses doubled (OR greater than 2) the patient’s risk of VRE transmission. After adjusting for VRE stool burden (OR 2.1 (95% CI 1.5–3.0)), having a nasogastric tube (OR 3.6 (95% CI 1.3–9.8)), diarrhea (OR 3.3 (95% CI 1.4–8.1)), or rheumatoid arthritis/collagen vascular diseases (OR 4.8 (95% CI 1.6–14.7)) remained significant in the model. Conclusion Patient-level factors associated with higher risk of VRE transmission to HCW gowns or gloves were identified even after adjusting for VRE stool burden, highlighting the importance of patient characteristics in VRE transmission. These patient-level factors may facilitate transmission by either increasing VRE stool shedding to the environment or the need for direct HCW-patient contact. These factors could be used to target more aggressive infection control interventions for these patients. Disclosures All authors: No reported disclosures.