Hand Hygiene Must Be Essential Part of HCW Training, Expert Urges

In a letter to the editor of Infection Control and Hospital Epidemiology, Angelo Rossini, MD, MPH, of Fondazione Santa Lucia rehabilitation hospital in Rome, describes his study of methicillin-resistant Staphylococcus aureus (MRSA) colonization among healthcare workers (HCWs) and the use of contact precautions in daily patient-care activities.

Every healthcare worker enrolled in the study was asked to complete a questionnaire asking them about their routine activities and use of contact precautions during daily activities. A single-use cotton swab, immersed in sterile 0.9 percent NaCl, was used to collect samples from the anterior vestibule of both nares of healthcare workers for culture. Rossini reports that bacterial growth was evaluated at 24 and 48 hours for bacterial colonies belonging to S. aureus; he found an overall MRSA colonization rate of 3.1 percent. Among the 129 screened healthcare workers, just four nurses' aides tested positive for MRSA colonization; no MRSA colonization was found among other healthcare professionals, including doctors, nurses, therapists, and other medical staff members such psychologists and dietitians."

Rossini notes, "MRSA colonization among HCWs is not routinely studied in Italian rehabilitation hospitals. However, our rates of MRSA colonization appear to be similar to those found in other studies of HCW colonization in Italy. Recent studies in Italy on a similar number of HCWs in a large teaching hospital and a nursing home have reported MRSA colonization rates of 1.5 percent and 5.8 percent, respectively. HCWs' adherence with contact precautions was evaluated by use of a questionnaire. Because no statistically significant differences were found among the different groups of HCWs, it can be supposed that the high rate of MRSA colonization in the nurses' aides group (16 percent ) is probably due to both misuse of gloves and poor compliance with correct procedures for hand hygiene, which can result in the transmission of MRSA."

Rossini adds, "In the curricula of nurses' aides, more emphasis needs to be placed on hand hygiene training and on improving adherence to hand hygiene practice. In fact, in Italy, nurses' aides are supposed to receive 1,000 hours of educational training before they can work in a healthcare setting; however, only a few of those hours are devoted to understanding the WHO guidelines for hand hygiene and implementation surveillance tools. "

Reference: Rossini A. Healthcare Workers with Methicillin-Resistant Staphylococcus aureus Colonization and the Use of Contact Precautions in Daily Activities with Patients in an Italian Rehabilitation Hospital: The Importance of Hand Hygiene Training. Infect Control Hosp Epidemiol 2010;31:10971098.