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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?

Author information

1
Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Detroit, Michigan.
2
Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Detroit, Michigan.
3
Department of Infection Prevention and Epidemiology, Michigan Medicine, Detroit, Michigan.
4
Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Detroit, Michigan.
5
Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Detroit, Michigan.
6
Division of Hospital Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Detroit, Michigan.
7
Division of Infectious Diseases, Henry Ford Health System, Detroit, Michigan.
8
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

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

PMID:
30980082
DOI:
10.1093/cid/ciz092

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