Bellissimo-Rodrigues Fernando, Pires Daniela, Soule Hervé, Gayet-Ageron Angèle, Pittet Didier
1Infection Control Programme and WHO Collaborating Centre on Patient Safety - Infection Control & Improving Practices,University of Geneva Hospitals and Faculty of Medicine,Geneva,Switzerland.
Infect Control Hosp Epidemiol. 2017 May;38(5):553-558. doi: 10.1017/ice.2017.9. Epub 2017 Feb 22.
BACKGROUND Although the hands of healthcare workers (HCWs) are implicated in most episodes of healthcare-associated infections, the correlation between hand contamination and the likelihood of cross-transmission remains unknown. METHODS We conducted a laboratory-based study involving pairs of HCWs. The hands of a HCW (transmitter) were contaminated with Escherichia coli ATCC 10536 before holding hands with another HCW (host) for 1 minute. Meanwhile, the unheld hand of the transmitter was sampled. Afterward, the host's held hand was also sampled. Each experiment consisted of 4 trials with increasing concentrations of E. coli (103-106 colony-forming units [cfu]/mL). The primary outcome was the likelihood of transmission of at least 1 cfu from transmitter to host. We used a mixed logistic regression model with a random effect on the subject to assess the association between transmission and bacterial count on the transmitter's hands. RESULTS In total, 6 HCWs performed 30 experiments and 120 trials. The bacterial counts recovered from host hands were directly associated with the bacterial counts on transmitter hands (P1 and ≤3 log10 cfu compared to ≤1 log10. When transmitter contamination was <1 log10 cfu, no cross-transmission was detected. CONCLUSION There is a direct relationship between the bacterial burden on HCWs hands and the likelihood of cross-transmission. Under the described conditions, at least 1 log10 cfu must be present on HCW hands to be potentially transmitted. Further studies are needed at the low contamination range. Infect Control Hosp Epidemiol 2017;38:553-558.
尽管医护人员的手与大多数医疗相关感染事件有关，但手部污染与交叉传播可能性之间的相关性仍不清楚。方法：我们开展了一项基于实验室的研究，涉及医护人员配对。一名医护人员（传播者）的手在与另一名医护人员（宿主）握手1分钟前被大肠埃希菌ATCC 10536污染。同时，对传播者未被握住的手进行采样。之后，也对宿主被握住的手进行采样。每个实验包括4次试验，大肠埃希菌浓度逐渐增加（103 - 106菌落形成单位[cfu]/mL）。主要结局是至少1个cfu从传播者传播到宿主的可能性。我们使用对个体有随机效应的混合逻辑回归模型来评估传播与传播者手部细菌计数之间的关联。结果：总共6名医护人员进行了30次实验和120次试验。从宿主手部回收的细菌计数与传播者手部的细菌计数直接相关（P1且≤3 log10 cfu相比于≤1 log10。当传播者污染<1 log10 cfu时，未检测到交叉传播。结论：医护人员手部的细菌负荷与交叉传播的可能性之间存在直接关系。在所描述的条件下，医护人员手上必须存在至少1 log10 cfu才有可能传播。在低污染范围内还需要进一步研究。《感染控制与医院流行病学》2017年；38:553 - 558。
