Thorough hand-washing protocols aren’t just for healthcare professionals anymore. Patients also need to be educated to prevent hospital-acquired infections

Microbiologists and clinical laboratory managers will be particularly interested to learn that patients are bringing deadly organisms into hospitals on their hands. That’s the conclusion of a University of Michigan (UM) study which found that as patients enter and move throughout hospitals, they deposit and spread multi-drug resistant organisms, or MDROs on clinical surfaces. When those surfaces are not properly decontaminated, the bacterial contamination spreads on contact.

This finding has implications for the nosocomial infection teams in hospitals that include microbiologists and clinical laboratories. After all, every day there is a large flow of walk-in patients and visitors who come in contact with dozens of surfaces. The potential for contamination with multi-drug resistant organisms is high.

Antibiotic-resistant bacteria have been the root cause of a marked increase in hospital-acquired infections (HAIs), which Dark Daily has covered extensively. That’s why healthcare professionals practice proper hand-washing protocols to help reduce the transmission of pathogens and curtail possible infections.

The UM study, however, suggests that patients also should be educated on proper hand hygiene to diminish the potential spread of bacteria, especially before making trips to the emergency room.

The UM researchers published their study in the Oxford Academic journal Clinical Infectious Diseases.

How to Kill a Superbug

Between February and July of 2017, UM researchers at two hospitals in Southeast Michigan tested 399 general medicine hospital patients for the presence of MDROs, also known as superbugs. They swabbed the palms, fingers, and around the nails of the patients’ dominant hands and the interior of both nostrils.

The researchers found that 14% of the patients tested positive for MDROs. In addition, nearly one third of high-touch objects and surfaces in the hospital rooms tested positive for superbugs as well.  

The hospital room surfaces that were swabbed for the presence of MDROs were:

  • Bed control/bed rail;
  • Call button/television remote;
  • Bedside tray table top;
  • Telephone;
  • Toilet seat; and
  • Bathroom door knob.

The research team specifically looked for:

Due to the overuse of antibiotics, these types of bacteria are often resistant to the drugs that were once used to kill them.

“Hand hygiene narrative has largely focused on physicians, nurses, and other frontline staff, and all the policies and performance measurements have centered on them, and rightfully so,” said Lona Mody, MD (above) in a press release. Mody is Professor of Internal Medicine at UM and one of the lead researchers for the study. “But our findings make an argument for addressing transmission of MDROs in a way that involves patients, too.”

Anatomy of a Hospital-Acquired Infection

The scientists tested patients and surfaces at different stages of their hospital stays. The samples were taken on the day of admission, days three and seven of the stays, and weekly thereafter until the patients were discharged.

The team found that 6% of the patients who did not have MDROs present at the beginning of their hospital stays tested positive for superbugs at later stages of their stays. Additionally, 20% of the tested objects and surfaces in the patients’ rooms had superbugs on them at later test stages that were not present earlier in the hospital stays.

“This study highlights the importance of hand washing and environmental cleaning, especially within a healthcare setting where patients’ immune systems are compromised,” noted Katherine Reyes, MD, Department of Infectious Diseases, Henry Ford Hospital, in the press release. “This step is crucial not only for healthcare providers, but also for patients and their families. Germs are on our hands; you do not need to see to believe it. And they travel. When these germs are not washed off, they pass easily from person to person and objects to person and make people sick.”

Patients included in the study had to be new admissions, on general medicine floors, and at least 18 years of age. Criteria that excluded individuals from participation in the research included:

  • Being in observation status, typically after a medical procedure;
  • Transfers from other hospitals;
  • Transfers from intensive care units;
  • Having cystic fibrosis (these patients have a higher likelihood of MDRO colonization);
  • Receiving end-of-life care; and
  • Non-English speaking.

Patients who were transferred to a room on a nonparticipating floor within the hospitals were immediately discharged from the study. 

Patients Travel Throughout Hospitals Spreading Germs

The presence of superbugs on patients or surfaces does not automatically translate to a patient getting sick with antibiotic-resistant bacteria. Only six of the patients in this study developed MRSA. However, all six of those individuals tested positive for the superbug either on their hands or on surfaces within their room. 

The researchers noted that hospital patients typically do not stay in their rooms. They are encouraged to walk throughout the hospital to speed up the recovery process, and often are transported to other areas of hospitals for medical tests and procedures. Patients also may be picking up superbugs from other patients and staff members, other hospital areas, and commonly-touched surfaces.

The UM researchers concluded in their study that “while the burden of preventing infections has largely been borne by [healthcare personnel], our study shows that patient hands are an important reservoir and play a crucial role in the transmission of pathogens in acute care hospitals. Thus, patient hand hygiene protocols should be implemented and tested for their ability to reduce environmental contamination, pathogen transmission, and healthcare-associated infections, as well as to increase meaningful patient engagement in infection prevention.”

“Infection prevention is everybody’s business,” stated Mody in the press release. “We are all in 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 food, after using a toilet, and before and after caring for someone who is sick—to protect yourself and others.”

These research findings should prove to be valuable for infection control teams and microbiology laboratories in the nation’s hospitals and health systems, as well as independent clinical laboratories, urgent care centers, and retail healthcare clinics.

Learning more about the transmission of infectious agents from patient to patient and from surfaces to patients could aid in the development of new techniques and strategies to prevent superbugs from manifesting in medical environments.

—JP Schlingman

Related Information:

‘Superbugs’ Found on Many Hospital Patients’ Hands and What They Touch Most Often

Multidrug-resistant Organisms in Hospitals: What Is on Patient Hands and in Their Rooms?

Unexpected Discovery of Source of Lethal, Antibiotic-Resistant Strain of E. Coli Could Lead to New Medical Laboratory Tests and Preventative Treatment

Lurking Below: NIH Study Reveals Surprising New Source of Antibiotic Resistance That Will Interest Microbiologists and Medical Laboratory Scientists

Pathologists and Clinical Laboratories to Play Critical Role in Developing New Tools to Fight Antibiotic ResistanceCould Proximity of Toilets to Sinks in Medical Intensive Care Units Contribute to Hospital-Acquired Infections?