For decades, hospitals have worked to get doctors, nurses and others to wash their hands and prevent the spread of germs.
But a new study suggests they may want to expand these efforts to their patients too.
14% of the 399 hospital patients tested in the study had superb "antibiotic" bacteria on their hands or nostrils very early in their hospital stay, the research finds. And almost a third of tests for such bacteria on objects that patients commonly touch in their rooms, such as the nurse call button, came back positive.
Another six percent of patients who did not have drug-resistant multi-drug organisms, or MDRO, in their hands at the beginning of their hospitalization were positive for them in their hands later during their stay. A fifth of the objects tested in their rooms also had similar superbugs.
The research team warns that the presence of MDRO on patients or objects in their rooms does not necessarily mean that patients become infected with antibiotic-resistant bacteria. And they note that the hands of healthcare workers are still the main mode of transmission of microbes to patients.
"The narrative on hand hygiene has mainly focused on doctors, nurses and other frontline workers, and all policies and performance measurements have focused on them, and rightly so," says Lona Mody, MD. , M.Sc., geriatrics of the University of Michigan, epidemiologist and safety researcher of the patient who led the research group. "But our findings are a topic for addressing MDRO transmission in a way that also involves patients."
Studying the spread
Mody and his colleagues report in the new document in Clinical infectious diseases that of the six patients in their study who developed an infection with a superbattero called MRSA while in the hospital, all had positive tests for MRSA on their hands and on the surfaces of the hospital room.
In addition to MRSA, short for methicillin-resistant Staphylococcus aureus, the study looked for superbugs called VRE (vancomycin-resistant enterococcus) and a group called RGNB, for Gram-negative resistant bacteria. Because of the excessive use of antibiotics, these bacteria have developed the ability to resist attempts to treat infections with drugs that once killed.
Mody notes that the study suggests that many of the MDROs seen on patients are also seen in their rooms at the start of their stay, suggesting that transmission to the room's surfaces is rapid. He is head of the research group on the prevention of infections in old age at the U-M Medical School and the VA Ann Arbor Healthcare System.
Also, since many patients arrive at the hospital through the emergency room, and can get exams in other areas before reaching their hospital room, it will be important to study the ecology of MDROs even in those areas, she says.
"This study underlines the importance of handwashing and environmental cleansing, especially in a healthcare environment where the patients' immune system is compromised," says infectious disease doctor Katherine Reyes, MD, lead author of the researchers at Henry Ford Health system involved in the study. "This step is crucial not only for health professionals, but also for patients and their families: germs are in our hands, there is no need to see to believe and travel and when these germs are not washed away , easily pass from person to person and objects to person and make people sick ".
More information on the study
The team carried out more than 700 visits to the rooms of general medical patients at two hospitals, working to enroll them in the study and take samples from their bodies and surfaces often touched as early as possible during their stay. They were unable to test the rooms before the patients arrived and did not test patients who had undergone surgery or were in intensive care or other types of units.
Using digital fingerprinting techniques, they tried to see if the MRSA bacteria strains on patient hands were the same as those in their rooms. They found the two matched in almost all cases – suggesting that the transfer to and from the patient was happening. The technique is not able to distinguish the direction of the transfer, whether it is from the patient to the objects in the room, or from those objects to the patients.
The cleaning procedures for hospital rooms among patients, especially when a patient was diagnosed with an MDRO infection, have improved over the years, says Mody, and research has shown that they are effective if used consistently. So persistent contamination by past patients may not have been an important factor.
But the question of exactly where patients collected MDROs that were found on their body and were transmitted to surfaces in their rooms is not addressed by the current study and would be an important next step based on these results.
Because MDROs are important
Equally important, Mody says, is the fact that hospital patients don't just stay in their rooms: current practice encourages them to get up and walk in the corridors as part of their recovery from many diseases, and can be transported to other areas of the hospital. Hospital for testing and procedures.
While traveling, they can collect MDRO from other patients and staff and leave them on the surfaces they touch.
So even if a relatively healthy person has an MDRO on their skin, and his immune system can fight it if he enters his body, a more vulnerable person in the same hospital can take it and get sick. Researchers are studying the study of MDRO on patients in other types of hospital units that may be more susceptible to infections.
Patients and staff can also be colonized with MDRO in outpatient care facilities that have become the site of so much of American health care, including urgent care centers, independent imaging and surgery centers, and others.
Mody and colleagues are presenting new data on MDROs in qualified care facilities at a conference on infectious diseases in Europe in the coming days. They showed that privacy curtains – often used to separate patients in the same room, or to shield patients from sight when dressing or being examined – are also often colonized with superbugs.
"Infection prevention is everyone's business," says Mody, a professor of internal medicine at U-M Medical School. "We are all on this together. No matter where you are, in a healthcare environment or not, this study is a good reminder to clean your hands often, using good techniques – especially before and after preparing food, before eating, afterwards use a bathroom, and before and after caring for someone who is sick … to protect yourself and others. "
In addition to Mody and Reyes, the study group includes the senior author and doctor of infectious diseases HFHS Marcus Zervos, MD, doctors of the UM and VAAAHS Sanjay Saint and Vineet Chopra, doctors of infectious diseases UM Laraine Washer and Keith Kaye, members of the UM geriatrics research team Kristen Gibson, Marco Cassone and Julia Mantey; Bioinformatics student U-M Jie Cao, members of the HFHS team Sarah Altamimi and Mary Perri, and Hugo Sax, head of infection control and hospital epidemiology at the University Hospital of Zurich, Switzerland. Mody, Kaye, Saint and Chopra are members of the U-M Institute for Healthcare Policy and Innovation and the U-M / VA Patient Enhancement Program.
The study was funded by the Centers for Disease Control and Prevention, BAA 200-2016-91954
Reference: Clinical infectious diseases, DOI: 10.1093 / cid / ciz092
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