As a good hospitalist, you make sure your hands are clean when seeing patients. But have you thought about what's on their hands?
ACP Member Lona Mody, MD, MSc, has. As a geriatrician and an epidemiologist with an avid interest in infectious diseases, she wondered not only about whether her patients' hands were colonized with multidrug-resistant organisms but also whether their hospital rooms might be contaminated. So she led a study, published in April by Clinical Infectious Diseases, which found exactly that.
At two hospitals, Dr. Mody's research team sampled about 400 patients' dominant hands, nares, and six high-touch environment surfaces in their hospital rooms, such as toilet seats and bedside tray table tops. About 14% of patients were colonized at baseline (10% on their hands), and within 24 hours of admission, 29% of sampled surfaces harbored a multidrug-resistant organism. Molecular typing showed a high correlation between methicillin-resistant Staphylococcus aureus (MRSA) on patients' hands and room surfaces.
“I would say this was one of the first studies that looked at environment, and furthermore to match the patient strain with environmental strain,” said Dr. Mody, who is the Amanda Sanford Hickey professor of internal medicine at the University of Michigan in Ann Arbor.
ACP Hospitalist recently spoke with her about the implications of these results.
Q: What led you to study this issue?
A: Hand hygiene narrative research, programs, resources, data evaluation, policies all have largely focused on physicians, nurses, and frontline staff . . . for the last 150 years. That is rightfully so because of the potential of transmission by the clinicians. However, when we stepped back from our own research, we realized that patients, when they are in hospitals and other similar health care settings, such as postacute care facilities or nursing homes, they are not able to care for themselves. We were wondering what happens to them. Who helps them with their hand hygiene and overall hygiene?
We decided to first explore this question in our postacute care population. . . . We reported those results in a very small research letter in JAMA Internal Medicine in 2016. But we realized that we had to follow this up in hospital setting just because it's a different population. Patients are acutely ill, visit various other areas of the hospital for tests and procedures; however, they stay for a short duration.
Q: Were you surprised at these results?
A: The first thing that surprised me was, of course, that we showed that patients came in colonized or had multidrug-resistant organisms on their hands, about 10% of them. The second one that surprised me was that the correlation between the patient and the environment was strong, especially methicillin-resistant Staph aureus and vancomycin-resistant enterococci.
Q: What are the implications for hospitalists who are caring for these patients?
A: First of all, we all as physicians and clinicians have to practice good hand hygiene, period. If we are able to do so in front of our patients so that they see us practicing a good patient safety behavior, that'd be spectacular. Not only doing hand hygiene all the time, but consistently with all the indications. . . . I think it's important to understand that transmission can happen with minimal contact, so it is important that the patients then practice hand hygiene.
Hospitalists have an important role because they serve on many hospital committees as a result of their role and the amount of hours they spend in the hospital. They are sometimes physician leads on several units, so they can be advocates for patient hand hygiene programs at the unit level and at the hospital level, along with encouraging patients and their loved ones to practice hand hygiene.
Q: What are some potential ways to encourage patients and families to practice good hand hygiene?
A: We can certainly start off with education, but I would like to see more research done in this arena before recommending one strategy of patient hand hygiene versus the other. We would like to see, for example, what kinds of things patients touch when they are in the hospital, how often and when they should be washing their hands, and the activities that lead to most transmission. The second part would be to understand what kinds of programs are most cost-effective and most likely to be implemented consistently. More to come on that.
Q: How has this research affected your personal practice?
A: Whenever I see patients, I always encourage them to be mindful about washing hands and their overall hygiene when ill. I have done other research on infections for a long time, so I'm always mindful about my practice, but I do realize that physicians hold a lot of sway when they become good role models. They can change the practice of generations of trainees and patients and visitors and other clinicians that they come across by just being good role models. I feel that that is a take-home message, that physicians still are the leads in changing how we practice not only health care, but how we practice patient safety as well.