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Clin Infect Dis. 2019 Apr 13. pii: ciz092. doi: 10.1093/cid/ciz092. [Epub ahead of print]

Multidrug-resistant Organisms in Hospitals: What Is on Patient Hands and in Their Rooms?

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Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Detroit, Michigan.
Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Detroit, Michigan.
Department of Infection Prevention and Epidemiology, Michigan Medicine, Detroit, Michigan.
Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Detroit, Michigan.
Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Detroit, Michigan.
Division of Hospital Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Detroit, Michigan.
Division of Infectious Diseases, Henry Ford Health System, Detroit, Michigan.
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.



The impact of healthcare personnel hand contamination in multidrug-resistant organism (MDRO) transmission is important and well studied; however, the role of patient hand contamination needs to be characterized further.


Patients from 2 hospitals in southeast Michigan were recruited within 24 hours of arrival to their room and followed prospectively using microbial surveillance of nares, dominant hand, and 6 high-touch environmental surfaces. Sampling was performed on admission, days 3 and 7, and weekly until discharge. Paired samples of methicillin-resistant Staphylococcus aureus (MRSA) isolated from the patients' hand and room surfaces were evaluated for relatedness using pulsed-field gel electrophoresis and staphylococcal cassette chromosome mec, and Panton-Valentine leukocidin typing.


A total of 399 patients (mean age, 60.8 years; 49% male) were enrolled and followed for 710 visits. Fourteen percent (n = 56/399) of patients were colonized with an MDRO at baseline; 10% (40/399) had an MDRO on their hands. Twenty-nine percent of rooms harbored an MDRO. Six percent (14/225 patients with at least 2 visits) newly acquired an MDRO on their hands during their stay. New MDRO acquisition in patients occurred at a rate of 24.6/1000 patient-days, and in rooms at a rate of 58.6/1000 patient-days. Typing demonstrated a high correlation between MRSA on patient hands and room surfaces.


Our data suggest that patient hand contamination with MDROs is common and correlates with contamination on high-touch room surfaces. Patient hand hygiene protocols should be considered to reduce transmission of pathogens and healthcare-associated infections.


acute care hospitals; colonization; contamination; multidrug-resistant organisms; new acquisition


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