Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Detroit, Michigan.
Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Detroit, Michigan.
Clin Infect Dis. 2019 Nov 13;69(11):1837-1844. doi: 10.1093/cid/ciz092.
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.
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.
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.
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.
医疗保健人员手部污染对多重耐药菌（MDRO）传播的影响很重要，并且已有大量研究；然而，患者手部污染的作用仍需进一步研究。
在密歇根州东南部的 2 家医院中，招募入院后 24 小时内的患者，并通过对鼻腔、优势手和 6 个高频接触环境表面的微生物监测进行前瞻性随访。在入院时、第 3 天和第 7 天以及每周进行采样，直至出院。对从患者手部和病房表面分离出的耐甲氧西林金黄色葡萄球菌（MRSA）的配对样本进行脉冲场凝胶电泳和葡萄球菌盒式染色体 mec 以及杀白细胞素 Panton-Valentine 分型，以评估其相关性。
共纳入 399 例（平均年龄 60.8 岁，49%为男性）患者，随访 710 次。14%（56/399）的患者在基线时定植有 MDRO；10%（40/399）的患者手部携带 MDRO。29%的病房携带 MDRO。6%（14/225 例至少有 2 次就诊的患者）在住院期间手部新获得 MDRO。患者手部新获得 MDRO 的发生率为 24.6/1000 患者日，病房为 58.6/1000 患者日。分型结果表明，患者手部和病房表面的 MRSA 之间存在高度相关性。
我们的数据表明，患者手部 MDRO 污染很常见，且与高频接触病房表面的污染有关。应考虑患者手部卫生方案，以减少病原体传播和医源性感染。
