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Transfer of pathogens to and from patients, healthcare providers, and medical devices during care activity—a systematic review and meta-analysis

Published online by Cambridge University Press:  24 July 2018

Aline Wolfensberger ,
Lauren Clack ,
Stefan P. Kuster ,
Simone Passerini ,
Lona Mody ,
Vineet Chopra ,
Jason Mann  and
Hugo Sax
Aline Wolfensberger*
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Lauren Clack
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Stefan P. Kuster
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Simone Passerini
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Lona Mody
Affiliation:
Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
Vineet Chopra
Affiliation:
Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan Division of General Medicine, Department of Internal Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
Jason Mann
Affiliation:
Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan
Hugo Sax
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
*
Author for correspondence: Aline Wolfensberger MD, Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland. E-mail: aline.wolfensberger@usz.ch
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Abstract

Objective

The transfer of pathogens may spread antimicrobial resistance and lead to healthcare-acquired infections. We performed a systematic literature review to generate estimates of pathogen transfer in relation to healthcare provider (HCP) activities.

Methods

For this systematic review and meta-analysis, Medline/Ovid, EMBASE, and the Cochrane Library were searched for studies published before July 7, 2017. We reviewed the literature, examining transfer of pathogens associated with HCP activities. We included studies that (1) quantified transfer of pathogens from a defined origin to a defined destination surface; (2) reported a microbiological sampling technique; and (3) described the associated activity leading to transfer. For studies reporting transfer frequencies, we extracted data and calculated the estimated proportion using Freeman-Tukey double arcsine transformation and the DerSimonian-Laird random-effects model.

Results

Of 13,121 identified articles, 32 were included. Most articles (n=27, 84%) examined transfer from patients and their environment to HCP hands, gloves, and gowns, with an estimated proportion for transfer frequency of 33% (95% confidence interval [CI], 12%–57%), 30% (95% CI, 23%–38%) and 10% (95% CI, 6%–14%), respectively. Other articles addressed transfer involving the hospital environment and medical devices. Risk factor analyses in 12 studies suggested higher transfer frequencies after contact with moist body sites (n=7), longer duration of care (n=5), and care of patients with an invasive device (n=3).

Conclusions

Recognizing the heterogeneity in study designs, the available evidence suggests that pathogen transfer to HCPs occurs frequently. More systematic research is urgently warranted to support targeted and economic prevention policies and interventions.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 9 , September 2018 , pp. 1093 - 1107
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

Cite this article: Wolfensberger A, et al. (2018). Transfer of pathogens to and from patients, healthcare providers, and medical devices during care activity—a systematic review and meta-analysis. Infection Control & Hospital Epidemiology. 2018, 39, 1093–1107. doi: 10.1017/ice.2018.156

References

1. Glossary of terms. Center for Disease Control and Prevention website. https://www.cdc.gov/hantavirus/resources/glossary.html. Accessed July 2017.Google Scholar
2. Pittet, D, Dharan, S, Touveneau, S, Sauvan, V, Perneger, TV. Bacterial contamination of the hands of hospital staff during routine patient care. Arch Intern Med 1999;159:821–826.Google Scholar
3. Schabrun, S, Chipchase, L. Healthcare equipment as a source of nosocomial infection: a systematic review. J Hosp Infect 2006;63:239–245.Google Scholar
4. Longtin, Y, Schneider, A, Tschopp, C, et al. Contamination of stethoscopes and physicians’ hands after a physical examination. Mayo Clin Proc 2014;89:291–299.Google Scholar
5. Ali, S, Moore, G, Wilson, AP. Effect of surface coating and finish upon the cleanability of bed rails and the spread of Staphylococcus aureus . J Hosp Infect 2012;80:192–198.Google Scholar
6. Bardell, D. Hand-to-hand transmission of herpes simplex virus type 1. Microbios 1989;59:93–100.Google Scholar
7. Sattar, SA, Springthorpe, S, Mani, S, et al. Transfer of bacteria from fabrics to hands and other fabrics: development and application of a quantitative method using Staphylococcus aureus as a model. J Appl Microbiol 2001;90:962–970.Google Scholar
8. Mbithi, JN, Springthorpe, VS, Boulet, JR, Sattar, SA. Survival of hepatitis A virus on human hands and its transfer on contact with animate and inanimate surfaces. J Clin Microbiol 1992;30:757–763.Google Scholar
9. Cohen, B, Hyman, S, Rosenberg, L, Larson, E. Frequency of patient contact with health care personnel and visitors: implications for infection prevention. Jt Comm J Qual Patient Saf 2012;38:560–565.Google Scholar
10. Labeau, S, Vandijck, D, Rello, J, et al. Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among European intensive care nurses. J Hosp Infect 2008;70:180–185.Google Scholar
11. Moher, D, Altman, DG, Liberati, A, Tetzlaff, J. PRISMA statement. Epidemiology 2011;22:128author reply 128.Google Scholar
12. Larson, EL, Strom, MS, Evans, CA. Analysis of three variables in sampling solutions used to assay bacteria of hands: type of solution, use of antiseptic neutralizers, and solution temperature. J Clin Microbiol 1980;12:355–360.Google Scholar
13. Downs, SH, Black, N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998;52:377–384.Google Scholar
14. Ludlam, HA, Swayne, RL, Kearns, AM, et al. Evidence from a UK teaching hospital that MRSA is primarily transmitted by the hands of healthcare workers. J Hosp Infect 2010;74:296–299.Google Scholar
15. Ojajarvi, J. Effectiveness of hand washing and disinfection methods in removing transient bacteria after patient nursing. J Hyg (Lond) 1980;85:193–203.Google Scholar
16. PRISMA—transparent reportin of systematic reviews and metaanalyses. PRISMA website. http://www.prisma-statement.org/. Accessed August 4, 2017.Google Scholar
17. McHugh, ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 2012;22:276–282.Google Scholar
18. Jeske, HC, Tiefenthaler, W, Hohlrieder, M, Hinterberger, G, Benzer, A. Bacterial contamination of anaesthetists’ hands by personal mobile phone and fixed phone use in the operating theatre. Anaesthesia 2007;62:904–906.Google Scholar
19. Ray, AJ, Hoyen, CK, Taub, TF, Eckstein, EC, Donskey, CJ. Nosocomial transmission of vancomycin-resistant enterococci from surfaces. JAMA 2002;287:1400–1401.Google Scholar
20. Frazee, BW, Fahimi, J, Lambert, L, Nagdev, A. Emergency department ultrasonographic probe contamination and experimental model of probe disinfection. Ann Emerg Med 2011;58:56–63.Google Scholar
21. Ohara, T, Itoh, Y, Itoh, K. Ultrasound instruments as possible vectors of staphylococcal infection. J Hosp Infect 1998;40:73–77.Google Scholar
22. Zachary, KC, Bayne, PS, Morrison, VJ, Ford, DS, Silver, LC, Hooper, DC. Contamination of gowns, gloves, and stethoscopes with vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 2001;22:560–564.Google Scholar
23. Tschopp, C, Schneider, A, Longtin, Y, Renzi, G, Schrenzel, J, Pittet, D. Predictors of heavy stethoscope contamination following a physical examination. Infect Control Hosp Epidemiol 2016;37:673–679.Google Scholar
24. Duckro, AN, Blom, DW, Lyle, EA, Weinstein, RA, Hayden, MK. Transfer of vancomycin-resistant enterococci via health care worker hands. Arch Intern Med 2005;165:302–307.Google Scholar
25. Snyder, GM, Thom, KA, Furuno, JP, et al. Detection of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on the gowns and gloves of healthcare workers. Infect Control Hosp Epidemiol 2008;29:583–589.Google Scholar
26. Ilmarinen, T, Auvinen, E, Hiltunen-Back, E, Ranki, A, Aaltonen, LM, Pitkaranta, A. Transmission of human papillomavirus DNA from patient to surgical masks, gloves and oral mucosa of medical personnel during treatment of laryngeal papillomas and genital warts. Eur Arch Otorhinolaryngol 2012;269:2367–2371.Google Scholar
27. Grabsch, EA, Burrell, LJ, Padiglione, A, O’Keeffe, JM, Ballard, S, Grayson, ML. Risk of environmental and healthcare worker contamination with vancomycin-resistant enterococci during outpatient procedures and hemodialysis. Infect Control Hosp Epidemiol 2006;27:287–293.Google Scholar
28. Morgan, DJ, Liang, SY, Smith, CL, et al. Frequent multidrug-resistant Acinetobacter baumannii contamination of gloves, gowns, and hands of healthcare workers. Infect Control Hosp Epidemiol 2010;31:716–721.Google Scholar
29. Morgan, DJ, Rogawski, E, Thom, KA, et al. Transfer of multidrug-resistant bacteria to healthcare workers’ gloves and gowns after patient contact increases with environmental contamination. Crit Care Med 2012;40:1045–1051.Google Scholar
30. Roghmann, MC, Johnson, JK, Sorkin, JD, et al. Transmission of methicillin-resistant Staphylococcus aureus (MRSA) to healthcare worker gowns and gloves during care of nursing home residents. Infect Control Hosp Epidemiol 2015;36:1050–1057.Google Scholar
31. Bache, SE, Maclean, M, Gettinby, G, Anderson, JG, MacGregor, SJ, Taggart, I. Quantifying bacterial transfer from patients to staff during burns dressing and bed changes: implications for infection control. Burns 2013;39:220–228.Google Scholar
32. Loftus, RW, Muffly, MK, Brown, JR, et al. Hand contamination of anesthesia providers is an important risk factor for intraoperative bacterial transmission. Anesth Analg 2011;112:98–105.Google Scholar
33. Heid, F, Bender, C, Gervais, H, Schmeck, J, Kohnen, W, Noppens, R. Microbial contamination of anesthetic syringes in relation to different handling habits. Am J Infect Control 2016;44:e15–e17.Google Scholar
34. Olsen, RJ, Lynch, P, Coyle, MB, Cummings, J, Bokete, T, Stamm, WE. Examination gloves as barriers to hand contamination in clinical practice. JAMA 1993;270:350–353.Google Scholar
35. Pessoa-Silva, CL, Dharan, S, Hugonnet, S, et al. Dynamics of bacterial hand contamination during routine neonatal care. Infect Control Hosp Epidemiol 2004;25:192–197.Google Scholar
36. Tenorio, AR, Badri, SM, Sahgal, NB, et al. Effectiveness of gloves in the prevention of hand carriage of vancomycin-resistant Enterococcus species by health care workers after patient care. Clin Infect Dis 2001;32:826–829.Google Scholar
37. Rock, C, Thom, KA, Masnick, M, Johnson, JK, Harris, AD, Morgan, DJ. Frequency of Klebsiella pneumoniae carbapenemase (KPC)-producing and non-KPC-producing Klebsiella species contamination of healthcare workers and the environment. Infect Control Hosp Epidemiol 2014;35:426–429.Google Scholar
38. Sanderson, PJ, Weissler, S. Recovery of coliforms from the hands of nurses and patients: activities leading to contamination. J Hosp Infect 1992;21:85–93.Google Scholar
39. WHO guidelines on hand hygiene in health care. World Health Organization website. http://apps.who.int/iris/bitstream/10665/44102/1/9789241597906_eng.pdf. Accessed July 29, 2017.Google Scholar
40. Pittet, D, Allegranzi, B, Sax, H, et al. Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis 2006;6:641–652.Google Scholar
41. Grayson, ML, Russo, PL, Cruickshank, M, et al. Outcomes from the first 2 years of the Australian National Hand Hygiene Initiative. Med J Aust 2011;195:615–619.Google Scholar
42. Otter, JA, Yezli, S, French, GL. The role played by contaminated surfaces in the transmission of nosocomial pathogens. Infect Control Hosp Epidemiol 2011;32:687–699.Google Scholar
43. Hayden, MK, Blom, DW, Lyle, EA, Moore, CG, Weinstein, RA. Risk of hand or glove contamination after contact with patients colonized with vancomycin-resistant Enterococcus or the colonized patients’ environment. Infect Control Hosp Epidemiol 2008;29:149–154.Google Scholar
44. Stiefel, U, Cadnum, JL, Eckstein, BC, Guerrero, DM, Tima, MA, Donskey, CJ. Contamination of hands with methicillin-resistant Staphylococcus aureus after contact with environmental surfaces and after contact with the skin of colonized patients. Infect Control Hosp Epidemiol 2011;32:185–187.Google Scholar
45. Boyce, JM, Potter-Bynoe, G, Chenevert, C, King, T. Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications. Infect Control Hosp Epidemiol 1997;18:622–627.Google Scholar
46. Guerrero, DM, Nerandzic, MM, Jury, LA, Jinno, S, Chang, S, Donskey, CJ. Acquisition of spores on gloved hands after contact with the skin of patients with Clostridium difficile infection and with environmental surfaces in their rooms. Am J Infect Control 2012;40:556–558.Google Scholar
47. WIlson, JA, Loveday, HP, Hoffman, PN, Pratt, RJ. Uniform: an evidence review of the microbiological significance of uniforms and uniform policy in the prevention and control of healthcare-associated infections. Report to the Department of Health (England). J Hosp Infect 2007;66:301–307.Google Scholar
48. Jullian-Desayes, I, Landelle, C, Mallaret, MR, Brun-Buisson, C, Barbut, F. Clostridium difficile contamination of health care workers’ hands and its potential contribution to the spread of infection: review of the literature. Am J Infect Control 2017;45:51–58.Google Scholar
49. Kwok, YLA, Gralton, J, McLaws, ML. Face touching: a frequent habit that has implications for hand hygiene. Am J Infect Control 2015;43:112–114.Google Scholar
50. Casewell, M, Phillips, I. Hands as route of transmission for Klebsiella species. Br Med J 1977;2:1315–1317.Google Scholar
51. Grunwald, MH, Amichai, B, Shemer, A. Fingertip contamination after a brief touch of tinea capitis lesions caused by Microsporum canis . Br J Dermatol 2015;172:291–292.Google Scholar
52. Hamburger, M Jr.. Transfer of beta hemolytic streptococci by shaking hands. Am J Med 1947;2:23–25.Google Scholar
53. Heid, F, Bender, C, Gervais, H, Schmeck, J, Kohnen, W, Noppens, R. Microbial contamination of anesthetic syringes in relation to different handling habits. Am J Infect Control 2016;44:e15–e17.Google Scholar
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