Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-27T16:01:26.276Z Has data issue: false hasContentIssue false
  • English
  • Français

Dynamics of Bacterial Hand Contamination During Routine Neonatal Care

Published online by Cambridge University Press:  02 January 2015

Carmem Lúcia Pessoa-Silva ,
Sasi Dharan ,
Stéphane Hugonnet ,
Sylvie Touveneau ,
Klara Posfay-Barbe ,
Riccardo Pfister  and
Didier Pittet
Carmem Lúcia Pessoa-Silva
Affiliation:
Infection Control Program, Department of Internal Medicine, University of Geneva Hospitals, Geneva, Switzerland
Sasi Dharan
Affiliation:
Infection Control Program, Department of Internal Medicine, University of Geneva Hospitals, Geneva, Switzerland
Stéphane Hugonnet
Affiliation:
Infection Control Program, Department of Internal Medicine, University of Geneva Hospitals, Geneva, Switzerland
Sylvie Touveneau
Affiliation:
Infection Control Program, Department of Internal Medicine, University of Geneva Hospitals, Geneva, Switzerland
Klara Posfay-Barbe
Affiliation:
Department of Pediatrics, University of Geneva Hospitals, Geneva, Switzerland
Riccardo Pfister
Affiliation:
Department of Pediatrics, University of Geneva Hospitals, Geneva, Switzerland
Didier Pittet*
Affiliation:
Infection Control Program, Department of Internal Medicine, University of Geneva Hospitals, Geneva, Switzerland
*
Infection Control Program, Department of Internal Medicine, University of Geneva Hospitals, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To evaluate the dynamics of bacterial contamination of healthcare workers' (HCWs) hands during neonatal care.

Setting:

The 20-bed neonatal unit of a large acute care teaching hospital in Geneva, Switzerland.

Methods:

Structured observation sessions were conducted. A sequence of care began when the HCW performed hand hygiene and ended when the activity changed or hand hygiene was performed again. Alcohol-based handrub was the standard procedure for hand hygiene. An imprint of the five fingertips of the dominant hand was obtained before and after hand hygiene and at the end of a sequence of care. Regression methods were used to model the final bacterial count according to the type and duration of care and the use of gloves.

Results:

One hundred forty-nine sequences of care were observed. Commensal skin flora comprised 72.4% of all culture-positive specimens (n = 360). Other microorganisms identified were Enterobacteriaceae (n = 55, 13.8%); Staphylococcus aureus (n = 10, 2.5%); and fungi (n = 7,1.8%). Skin contact, respiratory care, and diaper change were independently associated with an increased bacterial count; the use of gloves did not fully protect HCWs' hands from bacterial contamination.

Conclusions:

These data confirm that hands become progressively contaminated with commensal flora and potential pathogens during neonatal care, and identify activities at higher risk for hand contamination. They also reinforce the need for hand hygiene after a sequence of care, before starting a different task, and after glove removal.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 3 , March 2004 , pp. 192 - 197
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Larson, EL. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251–269.CrossRefGoogle ScholarPubMed
2.Conly, JM, Hill, S, Ross, J, Lertzman, J, Louie, TJ. Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates. Am J Infect Control 1989;17:330–339.CrossRefGoogle Scholar
3.Doebbeling, BN, Stanley, GL, Sheetz, CT, et al. Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. N Engl J Med 1992;327:88–93.Google Scholar
4.Welliver, RC, McLaughlin, S. Unique epidemiology of nosocomial infection in a children's hospital. American Journal of Diseases of Children 1984;138:131–135.Google Scholar
5.Ford-Jones, EL, Mindorff, CM, Langley, JM, et al. Epidemiologic study of 4,684 hospital-acquired infections in pediatric patients. Pediatr Infect Dis J 1989;8:668–675.CrossRefGoogle Scholar
6.Burgner, D, Dalton, D, Hanlon, M, Wong, M, Kakakios, A, Isaacs, D. Repeated prevalence surveys of paediatric hospital-acquired infection. J Hosp Infect 1996;34:163–170.Google Scholar
7.Girard, R, Fabry, J, Meynet, R, Lambert, DC, Sepetjan, M. Costs of nosocomial infection in a neonatal unit. J Hosp Infect 1983;4:361–366.CrossRefGoogle Scholar
8.Leroyer, A, Bedu, A, Lombrail, P, et al. Prolongation of hospital stay and extra costs due to hospital-acquired infection in a neonatal unit. J Hosp Infect 1997;35:37–45.Google Scholar
9.Mahieu, LM, Buitenweg, N, Beutels, P, De Dooy, JJ. Additional hospital stay and charges due to hospital-acquired infections in a neonatal intensive care unit. J Hosp Infect 2001;47:223–229.Google Scholar
10.Daschner, F. Analysis of bacterial infections in a neonatal intensive care unit. J Hosp Infect 1983;4:90–91.Google Scholar
11.Hoogkamp-Korstanje, JA, Cats, B, Senders, RC, van Ertbruggen, I. Analysis of bacterial infections in a neonatal intensive care unit. J Hosp Infect 1982;3:275–284.Google Scholar
12.Raymond, J, Aujard, Y, Group, ES. Nosocomial infections in pediatric patients: a European, multicenter prospective study. Infect Control Hosp Epidemiol 2000;200:260–263.CrossRefGoogle Scholar
13.Sohn, AH, Garrett, DO, Sinkowitz-Cochran, RL, et al. Prevalence of nosocomial infections in neonatal intensive care unit patients: results from the first national point-prevalence survey. J Pediatr 2001;139:821–827.CrossRefGoogle ScholarPubMed
14.Gaynes, RP, Edwards, JR, Jarvis, WR, Culver, DH, Tolson, JS, Martone, WJ. Nosocomial infections among neonates in high-risk nurseries in the United States. Pediatrics 1996;98:357–361.CrossRefGoogle ScholarPubMed
15.Townsend, TR, Wenzel, RP. Nosocomial bloodstream infections in a newborn intensive care unit: a case-matched control study of morbidity, mortality and risk. Am J Epidemiol 1981;114:73–80.CrossRefGoogle Scholar
16.Ehrenkranz, RA, Younes, N, Lemons, JA, et al. Longitudinal growth of hospitalized very low birth weight infants. Pediatrics 1999;104:280–289.CrossRefGoogle ScholarPubMed
17.Pessoa-Silva, CL, Myasaki, CH, de Almeida, F, Kopelman, B, Raggio, RL, Wey, SB. Neonatal late-onset bloodstream infection: attributable mortality, excess of length of stay and risk factors. Eur J Epidemiol 2001;17:715–720.Google Scholar
18.Boyce, JM, Pittet, D. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 2002;51(RR16):1–44.Google Scholar
19.Harbarth, S, Pittet, D, Grady, L, et al. Interventional study to evaluate the impact of an alcohol-based hand gel in improving hand hygiene compliance. Pediatr Infect Dis J 2002;21:489–495.Google Scholar
20.Wendt, C. Hand hygiene: comparison of international recommendations. J Hosp Infect 2001;48(suppl):S23–S28.CrossRefGoogle ScholarPubMed
21.Fox, MK, Langner, SB, Wells, RW. How good are hand washing practices? Am JNurs 1974;74:1676–1678.Google ScholarPubMed
22.Larson, E, Lusk, E. Evaluating handwashing technique. J Adv Nurs 1985;10:547–552.CrossRefGoogle ScholarPubMed
23.Pittet, D, Hugonnet, S, Harbarth, S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356:1307–1312.Google Scholar
24.Pittet, D, Dharan, S, Touveneau, S, Sauvan, V, Perneger, TV. Bacterial contamination of the hands of hospital staff during routine patient care. Arch Intern Med 1999;159:821–826.Google Scholar
25.McFarland, LV, Mulligan, ME, Kwok, RY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204–210.Google Scholar
26.Tenorio, AR, Badri, SM, Sahgal, NB, et al. Effectiveness of gloves in the prevention of hand carriage of vancomycin-resistant Enterococcus species by health care workers after patient care. Clin Infect Dis 2001;32:826–829.Google Scholar
27.Doebbeling, BN, Pfaller, MA, Houston, AK, Wenzel, RP. Removal of nosocomial pathogens from the contaminated glove: implications for glove reuse and handwashing. Ann Intern Med 1988;109:394–398.Google Scholar
28.Olsen, RJ, Lynch, P, Coyle, MB, Cummings, J, Bokete, T, Stamm, WE. Examination gloves as barriers to hand contamination in clinical practice. JAMA 1993;270:350–353.Google Scholar
29.Patterson, JE, Vecchio, J, Pantelick, EL, et al. Association of contaminated gloves with transmission of Acinetobacter calcoaceticus var. anitra-tus in an intensive care unit. Am J Med 1991;91:479–483.Google Scholar
30.Ojajarvi, J. Effectiveness of hand washing and disinfection methods in removing transient bacteria after patient nursing. J Hyg (Lond) 1980;85:193–203.Google Scholar
31.Samore, MH, Venkataraman, L, DeGirolami, PC, Arbeit, RD, Karchmer, AW. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med 1996;100:32–40.Google Scholar
32.Boyce, JM, Potter-Bynoe, G, Chenevert, C, King, T. Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications. Infect Control Hosp Epidemiol 1997;18:622–627.CrossRefGoogle ScholarPubMed
33.Pessoa-Silva, CL, Toscano, CM, Moreira, BM, et al. Infection due to extended-spectrum beta-Iactamase-producing Salmonella enterica subsp. enterica serotype infantis in a neonatal unit. J Pediatr 2002;141:381–387.CrossRefGoogle Scholar
34.American Society for Testing and Materials. Standard E1174-00: standard test method for evaluation of effectiveness of health care personnel or consumer handwash formulations. In: Annual Book of ASTM Standards. Washington, DC: American Society for Testing and Materials; 2001.Google Scholar