Health Care Workers’ Hands Spread VRE
Abstract & Commentary
David J. Pierson, MD, Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, is Editor for Critical Care Alert.
Synopsis: This careful molecular epidemiologic study showed that, despite contact isolation, VRE was transferred to health care workers’ hands from environmental sources and the intact skin of VRE-colonized patients in 10 percent of contacts.
Source: Duckro AN, et al. Arch Intern Med. 2005;165:302-307.
In this study from Rush University Medical Center in Chicago, Duckro and colleagues carried out a careful molecular epidemiologic study of the transmission of vancomycin-resistant enterococci (VRE) to the hands of health care workers from both intact skin areas of VRE-colonizes patients and various environ mental surfaces in the patient’s vicinity. The study was done in a 21-bed medical ICU. They cultured sites on the intact skin of 22 patients who were colonized with VRE, as determined by rectal swab cultures. They also cultured environmental sites in the patient’s vicinity such as bedding bed rails, sphygmomanometer cuffs, and infusion pumps.
Cultures were obtained before and after routine care by 98 health care workers, using careful, standardized, quantitative culture techniques. Health care workers touched 151 previously VRE-negative sites after touching a site that was VRE-positive. Of these 151 initially negative sites, 16 (10.6%) became VRE-positive after contact. The sites for which transfer occurred most often were patients’ antecubital fossae and blood pressure cuffs. On the basis of their findings, Duckro et al suggest that decontaminating the environment may be important, in addition to hand hygiene and other current measures, in controlling the spread of VRE in the hospital.
Comment by David J. Pierson, MD
The findings of this study are consistent with the model for VRE transmission shown in the Figure. Duckro et al point out that their results highlight the importance of the ICU patient’s environment and intact skin surfaces—even when not visibly contaminated—in the spread of VRE. They suggest that measures to reduce such transmission may need to go beyond careful hand hygiene and changing gloves between patients (which also need to be consistently carried out). The Centers for Disease Control and Prevention recommends frequent cleaning of "high-touch surfaces." This study suggests the possibility that intensifying such cleaning—through routine, supervised cleaning of designated environmental surfaces in the patient’s room—may be helpful, and that the benefit might apply to other organisms in addition to VRE. Duckro et al also suggest that degerming the skin with a daily medicated bath could add in the effort to reduce the nosocomial spread of VRE.
In this study from Rush University Medical Center in Chicago, Duckro and colleagues carried out a careful molecular epidemiologic study of the transmission of vancomycin-resistant enterococci (VRE) to the hands of health care workers from both intact skin areas of VRE-colonizes patients and various environ mental surfaces in the patients vicinity.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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