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Colonized with MDROs, patients’ hands contaminate high-touch surfaces
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A microbial surveillance study conducted at six post-acute care facilities in Michigan revealed that patient hand colonization with multidrug-resistant organisms, or MDROs, was linked to environmental contamination on high-touch surface areas.
During their investigation, Payal K. Patel, MD, MPH, a clinical lecturer in infectious diseases and internal medicine at the University of Michigan Medical School, and colleagues also found that patients with disabilities were more likely to have MDRO hand colonization than patients without disabilities.
“In our study, patient hand colonization with an MDRO was pervasive,” the researchers wrote. “Our results support other work showing that MDRO colonization in [post-acute care (PAC)] is widespread and that patient disability increases the risk of acquiring an MDRO.”
The analysis included bacterial swabs from 650 patients and 14,869 environmental samples obtained from high-touch surfaces in patients’ rooms. Most of the patients (94.9%) were admitted to a PAC facility after a stay at an acute-care hospital.
At baseline, 25.4% of patients had hand colonization with MDROs. Multivariate predictors of hand colonization included male sex (RR = 1.62; 95% CI, 1.30-2.01), physical self-maintenance scale score (RR = 1.10; 95% CI, 1.08-1.12), urinary catheter (RR = 1.79; 95% CI, 1.13-2.86), antibiotic use within 30 days (RR = 2.24; 95% CI, 1.78-2.80) and a recent hospital stay that lasted longer than 2 weeks (RR = 5.01; 95% CI, 2.71-9.27). Independent predictors of hand colonization included disabilities in bathing (RR = 2.22; 95% CI, 1.66-2.97), ambulation (RR = 2.66; 95% CI, 2.05-3.44), using the toilet (RR = 2.44; 95% CI, 2.09-2.85), dressing (RR = 2.19; 95% CI, 1.40-3.43) and grooming (RR = 1.79; 95% CI, 1.30-2.46).
“The connection between disability and risk of MDRO colonization is important; when patients are unable to independently move around or use the bathroom, they are less likely to have direct access to a sink or alcohol-based hand rub, increasing the risk of transmission,” Patel and colleagues wrote.
The researchers conducted 1,607 study visits to assess MDRO colonization. They found that patients’ hands were colonized with vancomycin-resistant Enterococcus (VRE) during 13.6% of visits; MRSA during 10.8% of visits; and resistant gram-negative bacteria (RGNB) during 5.7% of visits. Patients’ rooms were contaminated with VRE during 45.1% of visits; MRSA during 26.7% of visits; and RGNB during 31.2% of visits. The same organism was detected on patients’ hands and in their rooms during 21.9% of visits, leading the researchers to conclude that VRE, MRSA and RGNB hand colonization was associated with environmental contamination.
“Further investigation of patient hands as a target of enhanced infection prevention in those with known pathogen colonization may yield productive results,” they wrote. “If hand colonization with pathogens can be decreased, there may be an associated decrease in environmental colonization and possibly infection.” – by Stephanie Viguers
Disclosure: The researchers report no relevant financial disclosures.
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