MDROs Found on Patients' Hands in Post-Acute Care Facilities

Patients commonly bring multidrug-resistant organisms (MDROs) on their hands when they are discharged from a hospital to a post-acute care facility and then they acquire more MDROs during their time there, according to an article published online by JAMA Internal Medicine.

MDROs are increasingly prevalent at post-acute care facilities because of contact between healthcare workers, the environment and patients, who are encouraged to be mobile outside their rooms. Patients' hands come into contact with surfaces, healthcare workers' hands and other patients in these post-acute care facilities.

Lona Mody, MD, MSc, of the University of Michigan Medical School in Ann Arbor, Mich., and coauthors evaluated baseline, new acquisitions and duration of MDROs on the hands of patients newly admitted to post-acute care facilities from acute-care hospitals.

The study followed 357 patients (54.9 percent female with an average age of 76 years). The dominant hands of patients were swabbed at baseline when they were enrolled in a post-acute care facility, at day 14 and then monthly for up to 180 days or until discharge.

The study found:
- Nearly one-quarter (86 of 357) of patients had at least one MDRO on their hands when they were discharged from the hospital to the post-acute care facility.
- During follow-up, 34.2 percent of patients' hands (122 of 357) were colonized with an MDRO and 10.1 percent of patients (36 of 357) newly acquired one or more MDROs.
- Overall, 67.2 percent of MDRO-colonized patients (82 of 122) remained colonized at discharge

"Patient handwashing is not a routine practice in hospitals," says Mody, who is also U-M's Amanda Sanford Hickey Collegiate Professor of Internal Medicine and a member of U-M's Institute for Healthcare Policy and Innovation. "We need to build on the overarching principles we've already developed with adult learning theories and bring them to patients."

One strategy includes physically showing the superbugs that grow on people's hands, by growing them in the lab.

"People are always surprised when they see how much can grow on their hands- and how they can effectively clear these organisms by simply washing hands appropriately," Mody says.

Mody and her team developed a toolkit for PACs to use in training employees to control infections, called the TIP study toolkit. It could also be adapted to a patient audience, including

• Educational posters about hand hygiene

• Educational modules and trivia questions about hand hygiene

• An infection preventionist on-site to ensure availability of hand hygiene products, including alcohol gel for personal use 

"Owing to PAC [post-acute care] patients' increased mobility and interaction with the environment, healthcare workers and other patients, we believe that it is even more important to implement routines that enforce washing of patients' hands than in the acute care setting," the study concludes.

Additional authors are Jie Cao, MPH, Lillian Min, MD, MPH, Bonnie Lansing, LPN, and Betsy Foxman, PhD, all from U-M.

Reference: JAMA Intern Med. Published online March 14, 2016. doi:10.1001/jamainternmed.2016.0142.

Source:  JAMA Network Journals