Role of hand contamination of personnel in the epidemiology of gram-negative nosocomial infections

Knittle, Mary A.; Eitzman, Donald V.; Baer, Herman

doi:10.1016/s0022-3476(75)80980-2

Cited by 168 publications

(54 citation statements)

References 6 publications

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“…22 Because the initial outbreak control measures included reinforcement of good hand hygiene practices, our primary intention in requesting hand cultures of a variety of HCWs was to focus attention on the hands as a possible means of patient-to-patient indirect transmission. Although we knew from previous studies performed in our NICU that HCWs' hands may be colonized with gram-negative bacteria, 23 we were surprised to find five HCWs with hand cultures positive for P. aeruginosa.…”

Section: Discussionmentioning

confidence: 99%

An Outbreak of Pseudomonas aeruginosa Pneumonia and Bloodstream Infection Associated With Intermittent Otitis Externa in a Healthcare Worker

Zawacki¹,

OʼRourke

Potter-Bynoe³

et al. 2004

Infect. Control Hosp. Epidemiol.

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ArstractObjectives:To investigate an outbreak ofPseudomonas aeruginosapneumonia and bloodstream infection among four neonates, determine risk factors for infection, and implement preventive strategies.Design:Retrospective case finding; prospective surveillance cultures of patients, personnel, and environmental sites; molecular typing by pulsed-field gel electrophoresis; and a matched case-control study.Patients and Setting:Neonates in the level-III neonatal intensive care unit of a tertiary-care pediatric institution.Interventions:Cohorting of patients with positive results forP. aeruginosa, work restrictions for staff with positive results, implementation of an alcohol-based hand product, review of infection control policies and procedures, and closure of the unit until completion of the investigation.Results:Seven (4%) of 190 environmental cultures and 5 (3%) of 178 cultures of individual healthcare workers' hands grewP. aeruginosa. All four outbreak isolates and one previous bloodstream isolate were genotypically identical, as were theP. aeruginosaisolates from the hands and external auditory canal of a healthcare worker with intermittent otitis externa. Four of 5 case-patients versus 5 of 15 matched control-patients had been cared for by this healthcare worker (P= .05). The healthcare worker was treated and no further cases occurred.Conclusions:These findings suggest that a healthcare worker with intermittent otitis externa may have caused this cluster of fatalP. aeruginosainfections, adding the external ear to the list of colonized body sites that may serve as a source of potentially pathogenic organisms.

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Section: Discussionmentioning

confidence: 99%

An Outbreak of Pseudomonas aeruginosa Pneumonia and Bloodstream Infection Associated With Intermittent Otitis Externa in a Healthcare Worker

Zawacki¹,

OʼRourke

Potter-Bynoe³

et al. 2004

Infect. Control Hosp. Epidemiol.

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“…Of the control subjects 4 % had Enterobacteriaceae on their hands compared to 1-5 % of nurses. There are many reports of hand carriage of aerobic Gram-negative rods by health care workers; however, the vast majority of these have been carried out during the investigation of outbreaks of nosocomial infection (Buxton et al 1978;Knittle, Eitzman & Baer, 1975;Lowbury & Fox, 1954;Mayhall et al 1979;Parry et al 1980;Selwyn, 1965;Shulman, Terry & Hough, 1971). In the studies carried out in the endemic situation (Ayliffe et al 1979;Brown & Baublis, 1977;Bruun & Solberg, 1973;Casewell & Phillips, 1977;Larson, Strom & Evans, 1980;McBride et al 1972McBride et al , 1974Polk & Lopex, 1972;Salzman, Clark & Klemm, 1968) sampling techniques have varied and often speciation of the bacteria isolated was not performed.…”

Section: Discussionmentioning

confidence: 99%

Hand carriage of aerobic Gram-negative rods by health care personnel

Adams

Marrie

1982

J. Hyg.

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SUMMARYA quantitative culture technique (hand washed in a glove containing broth for 30 s) was used to determine the frequency ofhand carriage ofaerobic Gram-negative rods by various groups of health care workers and 104 control subjects. Overall, 31 % of health care workers carried aerobic Gram-negative rods on their hands compared to 59 % of control subjects (P < 0-001). Enterobacter agglomerans accounted for 40 % of the isolates, and other Enterobacter spp. 7 %. Other organisms included Acinetobacter calcoaceticus 21 %, Serratia spp. 11 %, Klebsiella spp. 10 %, Moraxella spp. 3 %, Pseudomonas spp. 3 %, Proteus spp. 1V5 %, Escherichia coli 1 %; Morganella morganii, Citrobacter freundii, Aeromonas sp. and an isolate that was not speciated accounted for 0 5 % each. We conclude that endemic hand carriage ofaerobic Gram-negative rods by health care personnel is common, but significantly less than that of control subjects. Enterobacter agglomerans is found so frequently on the hands of control subjects that it must be considered part of the normal hand flora.

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“…Previous reports (Salzman, Clark & Klemm, 1967;Knittle, Eitzmann & Baer, 1975;Curie et al 1978;Haverkorn & Michel, 1979; Riser, Noone, & Howard, 1980;Casewell, 1980) have stressed the importance of hand carriage of klebsiellase by hospital staff in transmission of infection. showed that klebsiella, which were not gentamicin-resistant, could survive for up to 150 min on the hands of volunteers.…”

Section: Introductionmentioning

confidence: 99%

Variation in skin and environmental survival of hospital gentamicin-resistant enterobacteria

Gibson

Buckles

1981

J. Hyg.

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SUMMARYDuring a period when 245 patients were infected by or harboured gentamicinresistant enterobacteria, random sampling showed hand carriage in 33 % of affected patients but in only 5 % of attendant staff. Only klebsiellae were isolated from the latter. Recovery was commoner from the hands of bed-ridden patients or faecal carriers and significantly more frequent for klebsiellae (37 %) and enterobacter (33 %) than citrobacter (5-6 %) and E. coli (5-0 %). Similarly, survival on forearms of volunteers was much longer for klebsiellae and enterobacter than for citrobacter or E. coli (means respectively were 70, 45, 10 and 13 min), and on dry surfaces (means respectively were 28, 26, 3 and 7 h). Klebsiellae were isolated from 17 of the 56 dry environmental surfaces sampled. The presence of plasmid resistance determinants had no effect on survival times, either on the skin or following drying onto formica surfaces. On dry surfaces 9-5 % of E. coli but only 1-3 % of klebsiellae lost resistance to gentamicin. These findings accord well with recent experience in which gentamicin-resistant klebsiellae have been involved to a much greater extent than other resistant enterobacteria in hospital infection.

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Role of hand contamination of personnel in the epidemiology of gram-negative nosocomial infections

Cited by 168 publications

References 6 publications

An Outbreak of Pseudomonas aeruginosa Pneumonia and Bloodstream Infection Associated With Intermittent Otitis Externa in a Healthcare Worker

An Outbreak of Pseudomonas aeruginosa Pneumonia and Bloodstream Infection Associated With Intermittent Otitis Externa in a Healthcare Worker

Hand carriage of aerobic Gram-negative rods by health care personnel

Variation in skin and environmental survival of hospital gentamicin-resistant enterobacteria

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