Hand hygiene.pdf

Most of the foodstuffs consumed in the outbreak were hand made, thus suggesting inadequate
hand hygiene. Noskin and colleagues 88 in a study using VRE showed that a 5-second
handwash with water alone produced no change in contamination, and 20% of the initial
inoculum was recovered on unwashed hands. In the same study, a 5-second wash with
two soaps did not remove the organisms completely, with approximately a 1% recovery; a
30-seconds wash with either soap was necessary to remove the organisms completely from
the hands 88 .
5.5 CROSS-TRANSMISSION OF ORGANISMS BY CONTAMINATED
HANDS
There are several studies showing cross-transmission of organisms by hands. Factors that
influence the transfer of microorganisms from surface to surface and affect cross-contamination
rates are type of organism, source and destination surfaces, moisture level and size of
inoculum. Harrison and colleagues 98 showed that contaminated hands could contaminate a
clean paper towel dispenser and vice versa. The transfer rates ranged from 0.01% to 0.64%
and 12.4% to 13.1%, respectively.
A study by Barker and colleagues 99 showed that fingers contaminated with norovirus could
sequentially transfer virus to up to seven clean surfaces, and from contaminated cleaning
clothes to clean hands and surfaces. Contaminated HCWs’ hands have been associated with
endemic HCAIs 100,101 . Sartor et al. 101 provided evidence that endemic Serratia marcescens
was transmitted from contaminated soap to patients via the hands of HCWs. During an
outbreak investigation of Serratia liquefaciens, bloodstream infections and pyrogenic reactions
in a hemodialysis centre, pathogens were isolated from extrinsically contaminated vials
of medication resulting from multiple dose usage, antibacterial soap, and hand lotion 102 .
Duckro and colleagues 103 showed that VRE could be transferred from contaminated environment
or patients’ intact skin to clean sites via hands.
Several HCAI outbreaks have been associated with contaminated HCWs’ hands 104-106 .
El Shafie and colleagues 106 investigated an outbreak of multidrug-resistant A. baumannii
and documented identical strains from patients, hands of staff and the environment. The
outbreak was terminated when remedial measures were taken. Contaminated HCWs’ hands
were clearly related to outbreaks among surgical 104 and neonatal 105 patients.
Finally, several studies have shown that pathogens can be transmitted from out-of-hospital
sources to patients via the hands of personnel. For example, an outbreak of postoperative
S. marcescens wound infections was traced to a contaminated jar of exfoliant cream in a
nurse’s home. An investigation suggested that the organism was transmitted to patients via
the hands of the nurse, who wore artificial fingernails 107 . In another outbreak, Malassezia
pachydermatis was probably transmitted from a nurse’s pet dogs to infants in an intensive
care nursery via the hands of the nurse 108 .