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For decades, hospitals have been trying to get their hands washed by doctors, nurses and other people and to prevent the spread of germs.
But a new study suggests that they might also want to extend their efforts to their patients.
Fourteen percent of the 399 hospital patients tested in the study had antibiotic-resistant bacteria "superbug" on their hands or nostrils very early in their hospital stay, research reveals. And nearly a third of the tests for detecting such bacteria on objects that patients routinely touch in their room, such as the nurse call button, have come back positive.
Another six percent of patients who did not have multidrug-resistant organisms, or MDROs, on their hands at the beginning of their hospitalization had a positive test for them later during their stay. One-fifth of the objects tested in their bedroom also had similar superbugs.
The research team cautioned that the presence of MDRO on patients or objects in their room does not necessarily mean that patients will have antibiotic-resistant bacteria. And they note that the hands of health workers remain the main mode of transmission of microbes to patients.
"The speech on hand hygiene is largely focused on doctors, nurses and other front-line staff, and all policies and performance measures are focused on it, and rightly so. "said Lona Mody, MD, M.Sc., a geriatrician at the University of Michigan, an epidemiologist and patient safety researcher who led the research team. "But our results argue in favor of a treatment of MDRO transmission also involving patients."
Study the spread
Mody and his colleagues report in the new document Clinical Infectious Diseases that of the six patients in their study who developed a superbugs infection called MRSA while at the hospital all had positive tests for MRSA on the hands and surfaces of hospital wards.
In addition to MRSA, an abbreviation for methicillin-resistant Staphylococcus aureus, the study looked for superbugs called ERVs (vancomycin-resistant enterococci) and a group called RGNB, resistant Gram-negative bacteria. Due to the overconsumption of antibiotics, these bacteria have acquired the ability to resist attempts to treat infections with drugs that have already killed them.
Mody notes that the study suggests that a large number of MDROs observed in patients are also observed in their room early in their stay, suggesting that transmission to the surface of the chamber is rapid. She leads the Infection Prevention and Aging Research Group at U-M Medical School and the VA Ann Arbor Health System.
In addition, since many patients arrive at the hospital through the emergency room and may be tested elsewhere before arriving in their room, it will be important to study the patient. And ecology of MDROs in these areas as well, she says.
"This study highlights the importance of hand washing and environmental cleaning, especially in health care settings where the immune system is compromised," says Katherine Reyes, infectious disease physician, lead author of the report. Henry Ford health system researchers involved in the study. "This step is crucial not only for health care providers, but for patients and their families, germs are on our hands, you do not need to see to believe it, and they travel. these germs are not washed, they pbad easily from person to person and from objects to person and make people sick. "
Learn more about the study
The team made more than 700 visits to general hospital inpatient rooms at two hospitals, attempting to enroll them in the study and to collect samples of their body and often affected area as soon as possible. . They were not able to test the rooms prior to the arrival of patients and did not test patients who had undergone surgery, or who were in intensive care or in the same ward. other types of units.
Using genetic fingerprinting techniques, they sought to determine whether the strains of MRSA bacteria present on the patients' hands were the same as those present in their chambers. They found the two matched in almost all cases, suggesting that there was a transfer between the patient and him. The technique does not distinguish the meaning of the transfer, whether it is from one patient to another in the room or from one patient to the other.
Procedures for cleaning hospital rooms between patients, particularly when a patient has been diagnosed with an MDRO infection, have improved over the years, explains Mody, and research has shown that they were effective when used systematically. Persistent contamination of past patients may not have been a major factor.
But the question of exactly where patients have recovered MDROs found on their bodies and transmitted to surfaces in their rooms is not addressed in the current study and would be an important step on the basis of these results.
Why are MDROs important?
According to Mody, it is also important to note that hospitalized patients do not stay in their rooms: current practice encourages them to get up and walk down the halls as part of their healing of many diseases, and they can be transported in other regions. from the hospital for testing and procedures.
During their journey, they can take MDRO drugs from other patients and staff and leave them on surfaces that they touch.
So, even if a relatively healthy person has an MDRO on the skin and his immune system can fight it if it gets into his body, a more vulnerable person in the same hospital can catch him and get sick. The researchers are studying the possibility of examining MDRO drugs in patients belonging to other types of hospital units and likely to be more susceptible to infections.
Patients and staff can also be colonized by MDROs in ambulatory care facilities that have become the core of US health care, including emergency care centers, independent imaging and surgery centers, etc. .
Mody and colleagues present new data on MDROs in skilled nursing homes at a conference on infectious diseases in Europe in the coming days. They have shown that privacy curtains – often used to separate patients staying in the same room or to protect them from view when they dress or are examined – are also often colonized by superbugs.
"Infection prevention is everyone's business," says Mody, a professor of internal medicine at the U-M School of Medicine. "We are all in the same boat, no matter where you are, in a medical environment or not, this study reminds you to wash your hands often, using good techniques – especially before and after food preparation, before eating, after meals, using the toilet, and before and after taking care of someone who is sick, to protect themselves and others. "
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Besides Mody and Reyes, the study team includes lead authors and infectious disease doctor HFHS, Marcus Zervos, doctors, UM and VAAAHS physicians, Saint Sanjay and Vineet Chopra, UM infectious disease specialists. , Laraine Washer and Keith Kaye, members of the UM Kristen Gibson geriatric research team, Marco Cbadone and Julia Mantey; Jie Cao, bioinformatics student at U-M, Sarah Altamimi and Mary Perri, members of the HFHS team, and Hugo Sax, head of infection control and hospital epidemiology at the University Hospital Zurich, Switzerland. Mody, Kaye, Saint and Chopra are members of the U-M Institute for Health Policy and Innovation and the U-M / VA Patient Safety Improvement Program.
The study was funded by the Centers for Disease Control and Prevention, BAA 200-2016-91954
Reference: Clinical Infectious Diseases, DOI: 10.1093 / cid / ciz092
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