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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 ([email protected]).
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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.

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