Gram-negative bacilli as nontransient flora on the hands of hospital personnel

Abstract

The possibility that gram-negative bacilli (GNB) are part of the nontransient flora on hands was examined by using a broth rinse technique to detect low titers of GNB after a hygienic hand wash with soap and water. A total of 100 nurses who had direct patient contact and 40 controls without patient contact had a similar rate of recovery of GNB (46 and 55%, respectively). GNB persisted on the hands of 10 nurses throughout five successive hand washes with soap and water. Hand cultures were obtained daily from 12 nurses before and after a work shift in a surgical intensive care unit. GNB were recovered from 57% of individuals before patient contact and from only 24% after the work shift. Nontransient GNB on the hands of hospital personnel are a potential reservoir for hospital strains, and patient contact is not an obvious source for the acquisition of nontransient GNB.

Epidemiologic Background of Hand Hygiene and Evaluation of the Most Important Agents for Scrubs and Rubs

“…Colonization with gram-negative bacteria is influenced by various factors. For example, it is higher before patient contact than after the work shift (187). Hands with artificial fingernails harbor gram-negative bacteria more often than those without (207).…”

“…Washing hands with soap and water has been described to be ineffective in eliminating adenovirus from the culture-positive hands of a physician and patients, indicating that mechanical removal was incomplete (235). Transient gram-negative bacteria remained on the hands of health care workers in 10 of 10 cases despite five successive hand washes with soap and water (187). Furthermore, transmission of gram-negative bacteria from hands has been shown to occur 11 of 12 cases when a simple hand wash is carried out (129).…”

Cleaning and decontamination of the healthcare environment

“…61 Many previous studies have demonstrated transient and persistent carriage of hospital organisms on the hands of healthcare workers. 9,27,29,32,55,[62][63][64][65][66][67][68] About 40% nurses' hands yield coliforms without prior disinfection, although rates depend upon the type of unit in which sampling takes place. 29,63 Another study showed that 17% ICU staff carried Klebsiella on their hands, and that these strains were probably related to those colonising or infecting patients resident on the unit.…”

“…7,56,73 Contamination of hands or gloves with hospital organisms provides a highly plausible route of transmission between patients on a ward. 7,55,63,64 Hand hygiene is an easy practical method of interrupting such transmission but compliance rarely reaches the levels required to remove the risk of HAI for many different reasons. 54,74 Even when staff know that a patient is isolated because they are colonised or infected with a hospital pathogen, hand hygiene compliance is still only about 50%.…”

“…70,75 Neither chlorhexidine, alcohol, nor soap and water necessarily remove contamination from hands, and some hand cleansing products are ineffective against specifi c pathogens. 63,70,[76][77][78]…”