Everyone knows that it’s crucial for doctors and nurses to wash their hands in an effort to prevent the spread of infection in healthcare facilities. But what about the patients? A new study shows that patients leave hospitals carrying superbugs on their hands.
According to a research letter in JAMA Internal Medicine published Monday, patients are far less likely to pay attention to hand hygiene in healthcare facilities. The study’s focus was on patients in inner-city Detroit, Michigan and tracked those who transferred from hospitals to post-acute care facilities, such as skilled-nursing facilities, rehabilitation centers, hospice and long-term care hospitals.
Shockingly, the study revealed that nearly 25% of these adult patients left the hospital literally carrying a superbug in their hands. Superbugs are defined as viruses, bacteria or other microbial life that is resistant to many types of medication. The study also showed that roughly 10% of those patients in post-acute care settings got another superbug while there. About 67% of patients discharged from these settings still carried the superbugs even if they hadn’t become symptomatic.
This study adds to growing body of research regarding hand hygiene and patients’ roles in transmitting infections. Oddly, and perhaps counter-intuitively, the research shows that being in a healthcare facility can increase the odds of patients becoming ill. It looks like there may be some truth to the old joke about “Hospitals being horrible places to be when you’re sick.”
The authors of the paper have an answer to the problem, though: finding strategies to get patients to wash their hands more often. It’s long been believed that disease transmission in healthcare facilities was largely caused by nurses and doctors going from patient to patient providing care. That’s precisely why the focus has been on increased hand hygiene for medical professionals.
According to Leah Binder, president of the Leapfrog Group, a nonprofit that assesses patient safety at hospitals, not that many facilities focus on making patient hand hygiene a priority. She said the recently published paper “really requires an immediate response” from patient safety advocates.
She continued, “We have to revise hand hygiene policies to include patients. One of the main strategies on hand hygiene is to make it easy to wash hands. Most hospitals have either sinks or dispensers near the door of every room, so that it’s very easy for a provider walking in to immediately wash their hands. Do we make it easy for patients to wash their hands? I doubt it.”
Aside from potentially bedside hand-sanitizer dispensers, Binder suggests visible signage reminding patients to wash their hands.
One of the challenges to such efforts, according to Lona Mody, professor of internal medicine at the University of Michigan-Ann Arbor and the study’s corresponding author is that many of these patients carry the superbugs, but never become ill. They are, in a way, modern-day Typhoid Mary’s, carrying and transmitting the superbugs to others but never getting sick themselves. Mody recommends more research into this Typhoid Mary effect: the relationship between carrying the superbugs and becoming sick.
Louise Dembry, professor of medicine, infectious diseases and epidemiology at Yale University and president of the Society for Healthcare Epidemiology of America said that, while it’s easier to spread the superbugs when their on your hands, patients are likely to have them on other parts of their skin or even in their gut.
Binder added that patient in post-acute care facilities are more vulnerable to infection, having just been released from hospitals where they required higher levels of care. “I find it not difficult to imagine” that many of these patients will eventually contract serious infections.
Binder’s opinion seems to be supported by Dembry, who said that the spread of infection is far easier in post-acute care settings than in hospitals because patients are more ambulatory and likely to interact with each other. They’re also more likely to touch everything: furniture, medical equipment, door knobs and other surfaces that the superbugs can use to find new hosts. This, Dembry insists, not only increases the odds of spreading the superbugs, but also increases the need for more stringent patient hand hygiene protocols.
However, Dembry said that hand hygiene isn’t the ultimate fix for superbug transmission in post-acute care facilities. The facilities themselves: furniture, door knobs, medical tools and machines all must be kept sanitized. She also recommends encouraging a change in patient culture such that patients become comfortable asking each other if they’ve washed their hands, as well as avoiding contact with others if they or the others are infectious.
Mody pointed out that hospitals and other healthcare facilities are more and more often graded on patient care and that should include efforts to promote patient hand hygiene. For example, she said, “If an institution has a program that enhances patient hand hygiene, the quality of that place should be considered higher.”