Leaving the patient zone: infection issues

Speaking at the Infection Prevention Society’s annual conference, Dr Ginny Moore, research scientist, University College London Hospitals NHS Foundation Trust, pointed out that pathogens commute to patients through a variety of routes, but transmission via healthcare workers’ hands is still considered the most significant source of contamination. “Healthcare workers’ hands become contaminated through a number of ways,” she explained. “The healthcare worker (HCW) may be colonised by a particular pathogen and an absent minded rub of the nose or a hand through their hair may contaminate the hands. Similarly, contact with a colonised or infected patient may result in high numbers of bacteria being transferred to the hands of the carer and carried to another bed space, bay or ward; then readily transferred to other patients. The colonised or infected patient may also contaminate their own environment such as the bed or bedside table.” Studies have shown the ease in which bacteria can be picked up from environmental surfaces on the hands of HCWs and then, if not removed, transferred to other patients, Dr Moore explained. She demonstrated that these transmission pathways can become increasingly complicated (Fig. 1). She pointed out that the easiest way to break even the most complicated transmission pathway is to perform adequate hand hygiene before patient contact. However, performing hand hygiene after patient contact is also important to minimise the number of bacteria on the hands and ultimately to minimise bacterial counts transferred between patients. It should also help to reduce the transfer of bacteria to environmental surfaces. Dr Moore added that colonised or infected patients continue to contaminate their own environment, so hand hygiene should also be performed after touching the near-patient environment. The ‘moments’ when the transmission pathway can be broken form the basis of the World Health Organization’s ‘Five moments of hand hygiene’. This states that hand hygiene should be performed:

1 Before patient contact.
2 Before performing a clean/aseptic procedure.
3 After exposure to body fluids.
4 After patient contact.
5 After touching the patient’s surroundings.

 Despite high profile campaigns, hand hygiene is still often poorly performed, Dr Moore commented. Reasons given by HCWs for failing to wash their hands include: lack of facilities and skin irritation; some report feeling ‘protected’ when wearing gloves and because of this, fail to change gloves between patients; and others admit that they forget to wash their hands when they are busy. Researchers have found that work load and ward type are key factors in hand hygiene compliance, therefore. “The more hand hygiene opportunities there are, the more likely it is that hand hygiene opportunities will be missed,” commented Dr Moore.