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Am J Infect Control. 2019 Jun;47(6):693-703. doi: 10.1016/j.ajic.2018.10.017. Epub 2018 Dec 5.

How often are health care personnel hands colonized with multidrug- resistant organisms? A systematic review and meta-analysis.

Author information

1
Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI. Electronic address: amontoya@med.umich.edu.
2
Division of Hospital Medicine, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI; Division of General Medicine,Department of Internal Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.
3
Division of Hospital Medicine, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI.
4
Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI; Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.

Abstract

BACKGROUND:

Hands of health care personnel (HCP) can transmit multidrug-resistant organisms (MDROs), resulting in infections. Our aim was to determine MDRO prevalence on HCP hands in adult acute care and nursing facility settings.

METHODS:

A systematic search of PubMed/MEDLINE, Web of Science, CINAHL, Embase, and Cochrane CENTRAL was performed. Studies were included if they reported microbiologic culture results following HCP hands sampling; included prevalent MDROs, such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus, Clostridium difficile, Acinetobacter baumannii, or Pseudomonas aeruginosa, and were conducted in acute care or nursing facility settings.

RESULTS:

Fifty-nine articles comprising 6,840 hand cultures were included. Pooled prevalence for MRSA, P aeruginosa, A baumannii, and vancomycin-resistant Enterococcus were 4.26%, 4.59%, 6.18%, and 9.03%, respectively. Substantial heterogeneity in rates of pathogen isolation were observed across studies (I2 = 81%-95%). Only 4 of 59 studies sampled for C difficile, with 2 of 4 finding no growth. Subgroup analysis of MRSA revealed the highest HCP hand contamination rates in North America (8.28%). Sample collection methods used were comparable for MRSA isolation (4%-7%) except for agar direct contact (1.55%).

CONCLUSIONS:

Prevalence of common MDROs on HCP hands vary by pathogen, care setting, culture acquisition method, study design, and geography. When obtained at an institutional level, these prevalence data can be utilized to enhance knowledge, practice, and research to prevent health care-associated infections.

KEYWORDS:

Acute care; Hand cultures; Hand hygiene; Health care provider hands; Nursing facility

PMID:
30527283
DOI:
10.1016/j.ajic.2018.10.017
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