How often are health care personnel hands colonized with multidrug- resistant organisms? A systematic review and meta-analysis

Abstract

Background: Hands of health care personnel (HCP) can transmit multidrug-resistant organisms (MDROs), resulting in infections. Our aim was to determine MDRO prevalence on HCP hands in adult acute care and nursing facility settings. Methods: A systematic search of PubMed/MEDLINE, Web of Science, CINAHL, Embase, and Cochrane CEN-TRAL was performed. Studies were included if they reported microbiologic culture results following HCP hands sampling; included prevalent MDROs, such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus, Clostridium difficile, Acinetobacter baumannii, or Pseudomonas aeruginosa, and were conducted in acute care or nursing facility settings. Results: Fifty-nine articles comprising 6,840 hand cultures were included. Pooled prevalence for MRSA, P aeruginosa, A baumannii, and vancomycin-resistant Enterococcus were 4.26%, 4.59%, 6.18%, and 9.03%, respectively. Substantial heterogeneity in rates of pathogen isolation were observed across studies (I 2 = 81%-95%). Only 4 of 59 studies sampled for C difficile, with 2 of 4 finding no growth. Subgroup analysis of MRSA revealed the highest HCP hand contamination rates in North America (8.28%). Sample collection methods used were comparable for MRSA isolation (4%-7%) except for agar direct contact (1.55%). Conclusions: Prevalence of common MDROs on HCP hands vary by pathogen, care setting, culture acquisition method, study design, and geography. When obtained at an institutional level, these prevalence data can be utilized to enhance knowledge, practice, and research to prevent health care−associated infections.

Do Clean Common Areas Save Lives?

“…Participation in rehabilitation, which is often the reason residents are in nursing homes, may also pose a risk of MDRO transmission. That less than 5% of samples from personnel were positive for an MDRO suggests their hand hygiene practices are similar to previously observed rates among healthcare workers . The implications of recovering pathogens from rehabilitation equipment are less obvious.…”

“…That less than 5% of samples from personnel were positive for an MDRO suggests their hand hygiene practices are similar to previously observed rates among healthcare workers. 10 The implications of recovering pathogens from rehabilitation equipment are less obvious. The activities associated with increased risks of MDRO transmission, such as accessing indwelling medical devices and changing dressings, typically occur in resident's rooms.…”

Prevalence, Risk Factors and Antimicrobial Susceptibility Profile of Methicillin-Resistant <i>Staphylococcus aureus</i> (MRSA) Obtained From Nares of Patients and Staff of Sokoto State-Owned Hospitals in Nigeria

“…Overall, the category of participants with the highest carriage rate was healthcare workers, probably because of greater exposure to circulating microbes [27]. Healthcare workers (HCWs) are more often colonized, serving as a reservoir for endogenous infections and dissemination [28]. This is corroborated by the 31% prevalence rate reported among health-care workers by other authors [29].…”

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

“…Numerous studies show that on average, about 5% of HCP hands are contaminated with an MDRO [25–27], the most common being MRSA, VRE, and RGNB, such as Acinetobacter species and Pseudomonas aeruginosa [27]. Research on patient hand contamination by pathogens is now emerging [6, 7, 21, 28–31].…”