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Assessing the Likelihood of Hand-to-Hand Cross-Transmission of Bacteria: An Experimental Study

Published online by Cambridge University Press:  22 February 2017

Fernando Bellissimo-Rodrigues ,
Daniela Pires ,
Hervé Soule ,
Angèle Gayet-Ageron  and
Didier Pittet
Fernando Bellissimo-Rodrigues
Affiliation:
Infection Control Programme and WHO Collaborating Centre on Patient Safety - Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland Social Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
Daniela Pires
Affiliation:
Infection Control Programme and WHO Collaborating Centre on Patient Safety - Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland Department of Infectious Diseases, Centro Hospitalar Lisboa Norte and Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
Hervé Soule
Affiliation:
Infection Control Programme and WHO Collaborating Centre on Patient Safety - Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Angèle Gayet-Ageron
Affiliation:
Infection Control Programme and WHO Collaborating Centre on Patient Safety - Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Didier Pittet*
Affiliation:
Infection Control Programme and WHO Collaborating Centre on Patient Safety - Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
*
Address correspondence to Professor Didier Pittet, MD, MS, Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland (didier.pittet@hcuge.ch).
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Abstract

BACKGROUND

Although the hands of healthcare workers (HCWs) are implicated in most episodes of healthcare-associated infections, the correlation between hand contamination and the likelihood of cross-transmission remains unknown.

METHODS

We conducted a laboratory-based study involving pairs of HCWs. The hands of a HCW (transmitter) were contaminated with Escherichia coli ATCC 10536 before holding hands with another HCW (host) for 1 minute. Meanwhile, the unheld hand of the transmitter was sampled. Afterward, the host’s held hand was also sampled. Each experiment consisted of 4 trials with increasing concentrations of E. coli (103–106 colony-forming units [cfu]/mL). The primary outcome was the likelihood of transmission of at least 1 cfu from transmitter to host. We used a mixed logistic regression model with a random effect on the subject to assess the association between transmission and bacterial count on the transmitter’s hands.

RESULTS

In total, 6 HCWs performed 30 experiments and 120 trials. The bacterial counts recovered from host hands were directly associated with the bacterial counts on transmitter hands (P<.001). The probability of cross-transmission was 8.22 higher (95% confidence interval [CI], 0.98–68.8) when transmitter hand bacterial count was >1 and ≤3 log10 cfu compared to ≤1 log10. When transmitter contamination was <1 log10 cfu, no cross-transmission was detected.

CONCLUSION

There is a direct relationship between the bacterial burden on HCWs hands and the likelihood of cross-transmission. Under the described conditions, at least 1 log10 cfu must be present on HCW hands to be potentially transmitted. Further studies are needed at the low contamination range.

Infect Control Hosp Epidemiol 2017;38:553–558

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 5 , May 2017 , pp. 553 - 558
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

a

Authors of equal contribution.

PREVIOUS PRESENTATION: These data were presented in part (no. 2016-A-2528) at the American Society of Microbiology (ASM) Microbe 2016 Congress in Boston, Massachusetts, on the June 18, 2016.

References

REFERENCES

1. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015;385:117–171.Google Scholar
2. Willmott, M, Nicholson, A, Busse, H, MacArthur, GJ, Brookes, S, Campbell, R. Effectiveness of hand hygiene interventions in reducing illness absence among children in educational settings: a systematic review and meta-analysis. Arch Dis Child 2016;101:42–50.Google Scholar
3. Liu, L, Johnson, HL, Cousens, S, et al; Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012;379:2151–2161.CrossRefGoogle ScholarPubMed
4. Pittet, D, Hugonnet, S, Harbarth, S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet 2000;356:1307–1312.Google Scholar
5. Boyce, JM, Pittet, D, Healthcare Infection Control Practices Advisory Committee, HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in the Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep 2002;51:1–45.Google ScholarPubMed
6. WHO guidelines on hand hygiene in health care: first global patient safety challenge Clean Care is Safer Care. World Health Organization website. http://www.ncbi.nlm.nih.gov/books/NBK144013/. Published 2009. Accessed July 20, 2016.Google Scholar
7. A Guide to the implementation of the WHO multimodal hand hygiene improvement strategy. Geneva, Switzerland: World Health Organization, Patient Safety, 2009.Google Scholar
8. Allegranzi, B, Gayet-Ageron, A, Damani, N, et al. Global implementation of WHO’s multimodal strategy for improvement of hand hygiene: a quasi-experimental study. Lancet Infect Dis 2013;13:843–851.Google Scholar
9. Luangasanatip, N, Hongsuwan, M, Limmathurotsakul, D, et al. Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. BMJ 2015;351:h3728.Google Scholar
10. WHO model list of essential medicines, 18th list, 2013. World Health Organization website. http://apps.who.int/iris/bitstream/10665/93142/1/EML_18_eng.pdf. Published 2013. Accessed March 5, 2015.Google Scholar
11. Willmott, M, Nicholson, A, Busse, H, MacArthur, GJ, Brookes, S, Campbell, R. Effectiveness of hand hygiene interventions in reducing illness absence among children in educational settings: a systematic review and meta-analysis. Arch Dis Child 2016;101:42–50.Google Scholar
12. Bifulco, M, Capunzo, M, Marasco, M, Pisanti, S. The basis of the modern medical hygiene in the medieval Medical School of Salerno. J. Maternal Fetal Neonatal Med 2015;28:1691–1693.CrossRefGoogle ScholarPubMed
13. Stewardson, A, Pittet, D. Ignác Semmelweis-celebrating a flawed pioneer of patient safety. Lancet 2011;378:22–23.CrossRefGoogle ScholarPubMed
14. Pittet, D, Allegranzi, B, Sax, H, et al. WHO Global Patient Safety Challenge, World Alliance for Patient Safety. Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis 2006;6:641–652.CrossRefGoogle ScholarPubMed
15. Sax, H, Allegranzi, B, Uçkay, I, Larson, E, Boyce, J, Pittet, D. ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 2007;67:9–21.Google Scholar
16. Loftus, RW, Koff, MD, Burchman, CC, et al. Transmission of pathogenic bacterial organisms in the anesthesia work area. Anesthesiology 2008;109:399–407.Google Scholar
17. Jabbar, U, Leischner, J, Kasper, D, et al. Effectiveness of alcohol-based hand rubs for removal of Clostridium difficile spores from hands. Infect Control Hosp Epidemiol 2010;31:565–570.CrossRefGoogle ScholarPubMed
18. Waters, V, Larson, E, Wu, F, et al. Molecular epidemiology of gram-negative bacilli from infected neonates and health care workers’ hands in neonatal intensive care units. Clin Infect Dis 2004;38:1682–1687.Google Scholar
19. Del Campo, R, Sánchez-Díaz, AM, Zamora, J, et al. Individual variability in finger-to-finger transmission efficiency of Enterococcus faecium clones. Microbiologyopen 2014;3:128–132.Google Scholar
20. Lingaas, E, Fagernes, M. Development of a method to measure bacterial transfer from hands. J Hosp Infect 2009;72:43–49.Google Scholar
21. 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.CrossRefGoogle ScholarPubMed
22. Ehrenkranz, NJ, Alfonso, BC. Failure of bland soap handwash to prevent hand transfer of patient bacteria to urethral catheters. Infect Control Hosp Epidemiol 1991;12:654–662.Google Scholar
23. 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
24. Rotter, M, Sattar, S, Dharan, S, Allegranzi, B, Mathai, E, Pittet, D. Methods to evaluate the microbicidal activities of hand-rub and hand-wash agents. J Hosp Infect 2009;73:191–199.CrossRefGoogle ScholarPubMed
25. European Committee for Standardization. European Norm 1500: Chemical Disinfectants and Antiseptics. Hygienic Handrub. Test method and requirements (phase 2/step 2). Version 2013. University of Iowa Computational Epidemiology Research website. https://compepi.cs.uiowa.edu/uploads/Wiki/ScrubScrubRevolution/en1500.pdf. Published 2013. Accessed January 5, 2017.Google Scholar
26. American Society for Testing and Materials (ASTM). Designation: E2755–10. Standard test method for determining the bacteria-eliminating effectiveness of hand sanitizer formulations using hands of adults. West Conshohocken, PA: ASTM International.Google Scholar
27. Real, LA, Biek, R. Infectious disease modeling and the dynamics of transmission. Curr Top Microbiol Immunol 2007;315:33–49.Google Scholar
28. Chowell, G, Nishiura, H, Viboud, C. Modeling rapidly disseminating infectious disease during mass gatherings. BMC Med 2012;10:159.Google Scholar
29. Hsu, Y-W, Yu, C-Y. Hand surface area estimation formula using 3D anthropometry. J Occup Environ Hyg 2010;7:633–639.Google Scholar
30. Bellissimo-Rodrigues, F, Soule, H, Gayet-Ageron, A, Martin, Y, Pittet, D. Should alcohol-based handrub use be customized to healthcare workers’ hand size? Infect Control Hosp Epidemiol 2016;37:219–221.CrossRefGoogle ScholarPubMed
31. Brankston, G, Gitterman, L, Hirji, Z, Lemieux, C, Gardam, M. Transmission of influenza A in human beings. Lancet Infect Dis 2007;7:257–265.Google Scholar
32. Bridges, CB, Kuehnert, MJ, Hall, CB. Transmission of influenza: implications for control in health care settings. Clin Infect Dis 2003;37:1094–1101.Google ScholarPubMed
33. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L, and the Healthcare Infection Control Practices Advisory Committee. Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Centers for Disease Control and Prevention website. http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf. Published 2007. Accessed January 5, 2017.Google Scholar
34. Pandemic Influenza Risk Management WHO Interim Guidance. World Health Organization website. http://www.who.int/influenza/preparedness/pandemic/GIP_PandemicInfluenzaRiskManagementInterimGuidance_Jun2013.pdf?ua=1. Published 2013. Accessed August 10, 2016.Google Scholar
35. Dharan, S, Hugonnet, S, Sax, H, Pittet, D. Comparation of waterless hand antisepsis agents at short application times: raising the flag of concern. Infect Control Hosp Epidemiol 2003;24:160–164.Google Scholar