The emphasis on hand hygiene in hospitals as a way of reducing the spread of superbugs has traditionally been focused on health care providers' handwashing habits.
The emphasis on hand hygiene in hospitals as a way of reducing the spread of superbugs has traditionally been focused on health care providers’ handwashing habits.
However, patients should also be reminded about the importance of handwashing, since they’re becoming more active in health systems and thus exposed to more multidrug-resistant organisms (MDRO).
A recent research letter published in JAMA Internal Medicine showed how patient hand hygiene has been overlooked as a strategy to reduce superbugs.
Study author Lona Mody, MD, MSc, told Pharmacy Times about the following 3 ways health-system pharmacists can get involved in coaching patients about hand hygiene:
1. Pharmacists can provide a simple infographic on common indications for hand hygiene, such as when the patient’s hands are visibly dirty or have come into contact with something potentially contaminated.
2. Pharmacists can also target recently discharged patients who have functional disability, wounds, catheters, and feeding tubes.
3. A hand hygiene station near a pharmacy can be beneficial. Next to the station, pharmacists can place a sign that says, “Ask your pharmacist about hand hygiene.”
Dr. Mody noted that hand hygiene has always been a challenge in health care settings, but most research has focused on health care workers, so her study team decided to examine patients instead.
“Patients want to be active, much more then in past,” Dr. Mody explained. “However, when people leave their room often, they’re more likely to touch other areas of a health facility’s environment, health care workers, and other patients—increasing chances of acquiring MDRO.”
Dr. Mody’s research looked at the baseline, new acquisition, and duration of MDRO on patients’ hands. Those involved in the study were newly admitted to post-acute care facilities from acute care hospitals. Six post-acute care facilities in Detroit and southeast Michigan were involved in the study.
The newly admitted patients gave consent to have their dominant hand sampled. The researchers took samples of their palm, fingers, and around the nails at baseline, day 14, monthly for up to 180 days or until discharge.
More than 350 patients were followed for 806 visits. More than half of the patients were women, and they had a mean age of around 75 years.
The researchers discovered that 24% of the patients had MDRO on their hands at discharge from an acute care hospital and at admission to the post-acute care facility.
At baseline, vancomycin-resistant Enterococcus (VRE) was found in 13.7% of patients, methicillin-resistant Staphylococcus (MRSA) was found in 10.9%, and Gram-negative bacilli resistant to ceftazidime, ciprofloxacin, or imipenem (RGNB) was found in 2.8% of patients.
During follow-up, 34.2% of patients were colonized with MDRO, and around 10% of patients had acquired 1 or more new MDRO.
Around 7%, 6.3%, and 3.1% of patients had newly acquired VRE, MRSA, and RGNB, respectively. The researchers noted that MRSA and VRE colonization was more likely to be persistent than RGNB.
Around 67% of patients whose hands showed evidence of MDRO still had colonization at discharge.
The researchers concluded that current quality measures don’t adequately address patient hand hygiene, and they noted that patient handwashing hasn’t been a routine practice in hospitals.
“Increasing numbers of seniors bringing hospital superbugs through the revolving door of the post-acute care facilities for short stays (as opposed to living long term) means new policies and innovations are needed to stop the superbugs from spreading more deeply into the post-acute care facilities, or for that matter in acute care hospitals, and going into the community,” Dr. Mody told Pharmacy Times.