|Year : 2016 | Volume
| Issue : 1 | Page : 60-62
Prevalence of bacteria contaminating the hands of healthcare workers during routine patient care: A hospital-based study
Snehlata Singh, Amit Kumar Singh
Department of Microbiology, Mayo Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
|Date of Web Publication||28-Jun-2016|
Department of Microbiology, Mayo Institute of Medical Sciences, Barabanki, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: The pathogenic bacterium on the hands of healthcare workers (HCWs) is considered as the main route of spread of nosocomial infections. The study was aimed to determine the bacterial contamination of hands of HCWs during routine patient care in a large teaching hospital. Material and Methods: This study includes a total of 200 consecutive, non-repetitive participants. Doctors, medical students, nurses and attendants from the Department of Anaesthesia and Department of Medicine of the hospital were included, who were actively providing health care. The informed consent was taken from all the participants of the study. The hand impressions of the participants were taken on 5% blood agar and processed as per guidelines. After taking the hand impressions, hand cleaning of each participant was done by standard preparation of 70% isopropyl alcohol-based hand rub. The hand impressions from the participants were again taken on 5% blood agar plates. Results: Out of 200 samples collected from HCWs, 95 (47.5%) samples showed growth of microorganisms. Most commonly isolated microorganism was Staphylococcus aureus present in 70% of nurses, 60% of students and 40% of attendants. Prevalence of Acinetobacter spp. was also found to be high among nurses (20%), followed by attendants, sweepers (16%) and doctors (4%). Conclusions: Hands of hospital staff are colonised with pathogenic bacteria, especially Gram-positive such as S. aureus. Hand hygiene is an effective method of reducing the bacterial flora on the hands of the HCWs.
Keywords: Acinetobacter spp., bacterial contamination, healthcare workers, Staphylococcus aureus
|How to cite this article:|
Singh S, Singh AK. Prevalence of bacteria contaminating the hands of healthcare workers during routine patient care: A hospital-based study. J Acad Clin Microbiol 2016;18:60-2
|How to cite this URL:|
Singh S, Singh AK. Prevalence of bacteria contaminating the hands of healthcare workers during routine patient care: A hospital-based study. J Acad Clin Microbiol [serial online] 2016 [cited 2020 Feb 19];18:60-2. Available from: http://www.jacmjournal.org/text.asp?2016/18/1/60/184764
| Introduction|| |
Healthcare-associated infections (HAIs) are a major concern in the hospitals and defined as infections that develop among patients after admission to the hospital, which was neither present nor in the incubation period at the time of hospitalisation. Such infections may become evident during their stay in the hospital or after a few days of discharge. HAIs are the major cause of morbidity and mortality of the patient and are responsible for a prolonged duration of stay which in turn increases the cost of healthcare and treatment, which is a big economic burden to the already overburdened economy of the developing countries. Several factors contribute to the occurrence and severity of these infections. These include compromised immune status of the host, invasive techniques and prevailing antimicrobial resistance of bacteria associated with hospital-acquired infections.
Hand hygiene is universally acknowledged to be the single most important measure to prevent cross-transmission of microorganism from one patient to another and preventing HAIs., It prevents transmission of pathogens through contact and faecal–oral route. It is one of the basic components of infection control programs. Hand rubbing with a waterless, alcohol-based rub-in cleanser is commonly used nowadays in hospitals instead of hand washing. Scientific evidence supports employment of hand rubs for routine hand hygiene. It is microbiologically more effective in vitro and in vivo and saves time, and preliminary data demonstrate better compliance than with hand washing.
Hand hygiene has now been recognised as one of the most effective interventions to control the transmission of infections in a hospital. The proper use of hand hygiene techniques also needs continuing education. The display of posters provided by the World Health Organisation (WHO) is an effective tool of education. In addition, continuing medical education programs for all level of health care providers are important.
The present study was undertaken to demonstrate the presence of bacterial flora on the hands of healthcare workers (HCWs) and to observe the reduction of bacteria following hand hygiene measures.
| Material and Methods|| |
This study included a total of 200 consecutive, non-repetitive HCWs, working in Chhatrapat Shivaj Subhart Hospital, Meerut, from November 2011 to April 2012. Those included were doctors (50), students (50), nurses (50) and attendants (50) from the Department of Anaesthesia and Department of Medicine of the hospital who were actively providing health care. Informed consent was taken from all the participants of the study. All HCWs filled out an identical standardised questionnaire before and after training. The study was approved by the hospital's Ethics Committee as part of the quality assurance program of the division of infection control and hospital epidemiology.
The hand impressions of the participants were taken as sample as per guidelines. During the working hours of the participants, hand impressions were taken by touching the tip of fingers and thumb of both the right and left hands onto the surface of 5% blood agar plates. After taking the hand impressions, hand cleaning of each participant was done by standard preparation of 70% isopropyl alcohol-based hand rub. The hand impressions from the participants were again taken on 5% blood agar plates.
The hand impressions on the 5% blood agar plates were inoculated in whole plate using a sterile inoculating loop as per the WHO guidelines on hand hygiene in health care. After inoculation, the plates were incubated aerobically at 37°C for 16–18 h. After obtaining the growth, the bacterial colony was counted in the both the plates of hand impressions taken before and after hand hygiene. The bacterial growths were identified as per standard protocol used for identification of bacteria in the bacteriology laboratory. The criteria used for identification of bacteria were colony morphology, Gram stain, catalase test (for Gram-positive cocci), coagulase test (for suspected Staphylococcus aureus) and other standard biochemical tests [Table 1].
|Table 1: Distribution of bacterial isolates among the hospital staff before hand hygiene|
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Detection of Methicillin resistance among Staphylococcus aureus
(Methicillin-resistant Staphylococcus aureus)
S. aureus was tested for Methicillin resistance using Cefoxitin (30 µg) disc as per the Clinical and Laboratory Standards Institute guidelines.
| Results|| |
Out of 200 samples collected from HCWs, 106 (53%) samples showed no growth while 95 (47.5%) samples showed growth of microorganisms. Thirty doctors (60%) were colonised by coagulase-negative Staphylococcus (CoNS), whereas 35 nurses (70%) and 30 students (60%) were colonised by S. aureus. Most commonly isolated microorganism was S. aureus present in 35 (70%) of nurses, 30 (60%) students and 20 (40%) attendants. Among S. aureus, 50 (52.6%) were Methicillin-resistant S. aureus (MRSA) which was present among 20 (40%) of nurses, followed by students 18 (36%), attendants 8 (16%) and doctors 4 (8%). Prevalence of Acinetobacter spp. was also found to be highest among nurses 10 (20%), followed by students 8 (16%) and doctors 2 (4%). The prevalence rate of pathogenic bacteria is highest in nurses followed by students [Table 1].
Following hand hygiene procedure, the percentage reduction of growth of microorganism was almost 100% except growth of MRSA isolate in one student.
| Discussion|| |
The number of bacteria carried on the hands is significant in persons working in a hospital environment as the environment, and patients are colonised with bacteria. The majority of the bacteria were non-pathogenic. However, these can be significant in case of an immunocompromised host where the contamination with these bacteria may lead to invasive infections. S. aureus is an important pathogen responsible for HAIs all over the world. Rarely, Gram-negative bacteria such as Klebsiella spp., Escherichia More Details coli or Acinetobacter spp. can be transient flora of the hands which may be acquired by touching contaminated surfaces or infected patients.
In the present study, 95 HCWs (47.5%) carried pathogens on the hand. S. aureus was isolated predominantly from 95 (47.5%) HCWs. Among 95 S. aureus, 50 (52.6%) were MRSA. MRSA is known to cause infections that lead to an increase in morbidity and mortality. Various studies have shown contamination of the hands of HCWs ranging from 3.78% to 25%.,,
CoNS, a resident flora, was also obtained in 74 (37%) of the HCWs. Mojtahed et al. showed 21.7% CoNS isolates as part of the microbial flora of HCWs.
Among Gram-negative bacilli, most commonly obtained isolate was Acinetobacter spp. 20 (10%) followed by Klebsiella spp. 12 (6%) and E. coli 2 (1%). Khodavaisy et al. have showed Klebsiella spp. (12.5%) as the most commonly isolated Gram-negative followed by Pseudomonas spp. and Acinetobacter spp.  Mojtahed et al. have demonstrated Pseudomonas spp. (43.9%) as the most commonly isolated transient flora followed by E. coli and others.
This study also demonstrates that the pathogens are present on hands but can be reduced effectively by proper hand hygiene. It was demonstrated that there was 95–99% reduction in the bacterial load after proper hand hygiene.
| Conclusions|| |
Hands carry normal flora in most of the persons; however, in a hospital setting, the hands of the HCWs get colonised with pathogenic bacteria most commonly MRSA. Hand hygiene is an effective method of reducing the bacterial flora on the hands of the HCWs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Widmer AF. Surgical hand hygiene: Scrub or rub? J Hosp Infect 2013;83 Suppl 1:S35-9.
Widmer AF, Rotter M, Voss A, Nthumba P, Allegranz B, Boyce J, et al. Surgical hand preparation: State-of-the-art. J Hosp Infect 2010;74:112-22.
Spruce L. Back to basics: Hand hygiene and surgical hand antisepsis. AORN J 2013;98:449-57.
Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: Advancing guideline development, reporting and evaluation in health care. CMAJ 2010;182:E839-42.
National Guideline Clearinghouse. Rockville, MD: National Guideline Clearinghouse; 1997. Guideline Summary: Perioperative Protocol. Health Care Protocol; 2012. Available from:
. [Last cited on 2014 Jun 23].
WHO Guidelines on Hand Hygiene in Health Care. Geneva: World Health Organization; 2009. p. 262. Available from:
. [Last cited on 2014 Jun 23].
Siegel JD, Rhinehart E, Jackson M, Chiarello L; The Healthcare Infection Control Practices Advisory Committee. Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings; 2007. Available from:
. [Last accessed on 2015 Dec 15].
Pittet D. Infection control and quality health care in the new millennium. Am J Infect Control 2005;33:258-67.
Duckro AN, Blom DW, Lyle EA, Weinstein RA, Hayden MK. Transfer of vancomycin-resistant enterococc via health care worker hands. Arch Intern Med 2005;165:302-7.
Widmer AF. Replace hand washing with use of a waterless alcohol hand rub? Clin Infect Dis 2000;31:136-43.
Kampf G, Kapella M. Suitability of sterillium gel for surgical hand disinfection. J Hosp Infect 2003;54:222-5.
World Health Organization. WHO Guidelines on Hand Hygiene in Health Care:First Global Patient Safety Challenge Clean Care is Safer Care. Geneva: World Health Organization; 2009. p. 14-6.
CLSI. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Third Informational Supplement; CLSI Document M100-S23. Vol. 33. Wayne: Clinical and Laboratory Standards Institute; 2013. p. 74-85.
Jenner EA, Fletcher BC, Watson P, Jones FA, Miller L, Scott GM. Discrepancy between self-reported and observed hand hygiene behaviour in healthcare professionals. J Hosp Infect 2006;63:418-22.
Mojtahed A, Khoshrang H, Taromsar MR, Leil EK, Hoorvash E. Bacterial contamination of health care worker's hands in intensive care units in Rasht. Journal of Nosocomial Infection 2014;1:36-43.
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;159:821-6.
Khodavaisy S, Nabil M, Davar B, Vahed M. Evaluation of bacterial and fungal contamination in the health care workers' hands and rings in the intensive care unit. J Prev Med Hyg 2011;52:215-8.
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