Patients’ Hands in ICUs Pose Hygienic Risk

We’ve long known and reported on the need for proper hand hygiene among healthcare workers, but it seems that that vigilance should be extended to patients in intensive care units (ICUs), according to a research brief in Infection Control & Hospital Epidemiology.

Investigators with the Cleveland Clinic Lerner College of Medicine say that their findings demonstrate “that ICU patients’ hands may harbor pathogenic bacteria,” providing further evidence of the importance of patient hand hygiene in the fight against hospital-acquired infections (HAIs). The findings mirror other recent studies about patients’ hands, except this one focused solely on patients in the ICU. 

“We aimed to determine the prevalence of patient hand contamination with MDROs [multidrug resistant organisms] and other pathogenic bacteria in the ICU setting,” the research brief states. 

Investigators collected 56 patients’ hand imprints over 10 weeks in this randomized, double-blinded crossover study. The imprints were obtained on a nonselective tryptic soy agar handprint plate. The plate contained 0.01% lecithin and 0.5% polysorbate 80. The investigators detected bacterial colonies that included methicillin- resistant Staphylococcus aureus (MRSA) Methicillin-sensitive Staphylococcus aureus (MSSA), and vancomycin-resistant enterococci (VRE). Most of the patients (47 of 56) had normal skin flora, but 9 had at least 1 pathogen on the hand: 4 had at least 1 MDRO, 2 had MRSA, and 1 had VRE. 

Investigators noted that the prevalence of MDROs seemed to be lower in their study than in previous studies. That may be because “of our focus on ICU patients, who underwent daily chlorhexidine bathing per protocol. Previous studies have also demonstrated a potential relationship between patient hand contamination and contamination of high-touch room surfaces.” 

Despite the emphasis on hand hygiene in healthcare overall, “current best practice recommendations do not provide a strong guidance regarding patient hand hygiene,” the study states. 

In addition, agar hand plates were used to assess bacterial contamination instead of the glove juice technique. The handprint method can only detect bacteria on the surface of the hand while the glove juice technique recovers microbes from the entire hand.