A new study has revealed that the hands and nostrils of some hospital patients have tested positive for multidrug-resistant organism (MDROs) very soon after they were admitted, which could indicate that certain patients are already carrying infectious bacteria on their bodies prior to arrival, rather than picking it up during their time in the hospital.
“Hand hygiene narrative has largely focused on physicians, nurses and other front-line staff, and all the policies and performance measurements have centered on them, and rightfully so,” said lead researcher Lona Mody, M.D., M.Sc., University of Michigan geriatrician, epidemiologist and patient safety researcher. “But our findings make an argument for addressing transmission of MDROs in a way that involves patients, too.”
The research, published April 13 in Clinical Infectious Diseases, and summarized in the university’s health blog, found almost one-third of the hi-touch objects tested in patient rooms (e.g., nurse call button) tested positive for “superbug” antibiotic-resistant bacteria. Among the nearly 400 hospital patients tested, 14 percent also tested positive for the bacteria in their nostrils and on their hands very shortly after they were admitted, reported Kara Gavin from the U-M Institute for Healthcare Policy and Innovation (IHPI). Later in their hospital stay, an additional 6 percent of the patients who didn’t test positive earlier for MDROs on their hands did, along with one-fifth of the objects from their rooms. Also, six patients developed MRSA during their stay, and all had tested positive for MRSA on their hands, as did the surfaces in their rooms.
“Using genetic fingerprinting techniques, they looked to see if the strains of MRSA bacteria on the patients’ hands were the same as the ones in their rooms,” wrote Gavin. “They found the two matched in nearly all cases — suggesting that transfer to and from the patient was happening. The technique is not able to distinguish the direction of transfer, whether it’s from patient to objects in the room or from those objects to patients.”
Mody added that since the pathogens were identified so early after admission that transmission to room surfaces appears to be rapid. Also, it is important to note, said Mody, that since many patients are admitted to a hospital room after an ER visit, the ecology of MDROs in those areas need to be considered as well.
Nonetheless, the practices and products that environmental services departments use to clean and decontaminate patient rooms, surgical rooms and other areas – implementing EVS bundles for example – has improved a great deal in recent years, especially when it comes to cleaning places where patients with infections are receiving care. This could indicate that surfaces contaminated from previous patients may not be the main culprit in the spread of pathogens.
Questions remain, said Gavin, regarding where and how exactly these hospital patients in the study ended up catching and spreading the MDROs. Researchers hope to use these results to conduct further investigations to find the answer(s).
