Noskin G A, Stosor V, Cooper I, Peterson L R
Department of Medicine, Northwestern University Medical School, Chicago, Illinois, USA.
Infect Control Hosp Epidemiol. 1995 Oct;16(10):577-81. doi: 10.1086/647011.
To determine the recovery of vancomycin-resistant enterococci (VRE) on fingertips, gloved fingertips, and environmental surfaces commonly encountered in the healthcare setting, and to examine the importance of handwashing on the removal of these organisms.
Two clinical isolates of VRE (Enterococcus faecalis and Enterococcus faecium) were inoculated onto the hands of healthy human volunteers and the following environmental surfaces: countertops, bedrails, telephones, and stethoscopes. Following inoculation, samples were obtained at various time intervals to determine rates of recovery of organisms. To evaluate the effects of handwashing on enterococcal recovery, two different soap preparations were tested. Hands were washed with water alone or with one of the soaps and water. The soap and water studies were performed with a 5-second and a 30-second wash.
Both enterococcal strains survived for at least 60 minutes on gloved and ungloved fingertips. The E faecalis was recoverable from countertops for 5 days; the E faecium persisted for 7 days. For bedrails, both enterococcal species survived for 24 hours without significant reduction in colony counts. The bacteria persisted for 60 minutes on the telephone handpiece and for 30 minutes on the diaphragmatic surface of the stethoscope. A 5-second wash with water alone resulted in virtually no change in recovery of enterococci; a 30-second wash with water plus either soap was necessary to eradicate the bacteria from hands completely.
VRE are capable of prolonged survival on hands, gloves, and environmental surfaces. Hands should be washed thoroughly and gloves removed following contact with patients infected or colonized with these multidrug-resistant bacteria. Finally, environmental surfaces may serve as potential reservoirs for nosocomial transmission of VRE and need to be considered when formulating institutional infection control policies.
确定医疗环境中常见的指尖、戴手套的指尖及环境表面上耐万古霉素肠球菌（VRE）的存活情况，并研究洗手对于去除这些微生物的重要性。
将两种VRE临床分离株（粪肠球菌和屎肠球菌）接种到健康人类志愿者的手上以及以下环境表面：台面、床栏、电话和听诊器。接种后，在不同时间间隔采集样本以确定微生物的存活比率。为评估洗手对肠球菌存活的影响，测试了两种不同的肥皂制剂。手只用清水冲洗，或用其中一种肥皂与水混合冲洗。肥皂与水混合冲洗的研究分别进行了5秒和30秒的冲洗。
两种肠球菌菌株在戴手套和未戴手套的指尖上均存活至少60分钟。粪肠球菌在台面上可存活5天；屎肠球菌可存活7天。在床栏上，两种肠球菌均存活24小时，菌落数无显著减少。细菌在电话听筒上存活60分钟，在听诊器的膜片表面存活30分钟。仅用清水冲洗5秒，肠球菌的存活情况几乎没有变化；用清水加任意一种肥皂冲洗30秒，才能完全清除手上的细菌。
VRE能够在手部、手套和环境表面长期存活。接触感染或定植有这些多重耐药菌的患者后，应彻底洗手并摘除手套。最后，环境表面可能是VRE医院内传播的潜在储存源，在制定机构感染控制政策时需要予以考虑。
