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Clin Microbiol Infect. 2019 Nov 13. pii: S1198-743X(19)30602-0. doi: 10.1016/j.cmi.2019.11.005. [Epub ahead of print]

Contamination of healthcare workers' hands with E. coli and Klebsiella species after routine patient care: a prospective observational study.

Author information

1
Department of Internal Medicine, Carver College of Medicine, Iowa City, IA, USA. Electronic address: mireia-puigasensio@uiowa.edu.
2
Department of Internal Medicine, Carver College of Medicine, Iowa City, IA, USA; Department of Pathology, Carver College of Medicine, Iowa City, IA, USA.
3
Department of Pathology, Carver College of Medicine, Iowa City, IA, USA.
4
Department of Internal Medicine, Carver College of Medicine, Iowa City, IA, USA.
5
Department of Internal Medicine, Carver College of Medicine, Iowa City, IA, USA; Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA.

Abstract

OBJECTIVE:

To compare the frequency of healthcare worker (HCW) hand contamination by E. coli vs. Klebsiella species after patient care and determine activities associated with contamination.

METHODS:

We conducted a prospective observational study at two tertiary-care centres. We observed HCWs caring for patients colonised/infected with E. coli or Klebsiella. HCW hands were cultured before room entry and after patient care. Contamination was defined as detecting E. coli or Klebsiella on HCW hands. Risk factors for contamination were analysed using logistic regression. Patient-to-HCW transmission was confirmed by pulsed-field gel electrophoresis (PFGE).

RESULTS:

We performed 466 HCW observations: 290 from patients with E. coli, 149 with Klebsiella, and 27 with both species. Eighty-seven percent of observations (404/464) occurred in patients who had received chlorhexidine bathing within 2 days. HCW hand contamination rates were similar between E. coli (6.2% [18/290]) and Klebsiella (7.4% [11/149]), p=0.6. High-risk activities independently associated with contamination were toilet assistance (OR 9.34; 95% CI, 3.10-28.16), contact with moist secretions (OR 6.93; 95% CI, 2.82-17.00), and hygiene/bed-bathing (OR 3.80; 95% CI, 1.48-9.80). PFGE identified identical/closely related isolates in the patient and HCW hands in 100% (18/18) of E. coli and 54.5% (6/11) of Klebsiella observations.

CONCLUSIONS:

We did not find a difference in HCW hand contamination rates between E. coli and Klebsiella after patient care. Hand hygiene should be reinforced after high-risk activities. Discrepancies in matching patient and HCW hand isolate occurred more frequently for Klebsiella than for E. coli; differences in species-level transmission dynamics might exist.

KEYWORDS:

Escherichia coli; Hand hygiene; Healthcare worker; Klebsiella; Patient-to-Professional

PMID:
31733378
DOI:
10.1016/j.cmi.2019.11.005

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