Bacterial contamination of the hands of intensive care unit staff during respiratory tract care: preliminary results

Abstract

Introduction: Optimal care of the respiratory tract (RT) is critical to prevent ventilator-associated pneumonia in ICU. The dynamics of microbial cross-transmission by the hands of health care workers (HCW) during RT care is currently unknown. Objectives: To study the level of HCWs' hand contamination during RT care. Methods: Structured observations of RT care sequences were conducted by trained external observers. At the beginning and the end of each care sequence observed, imprints of the 5 fingertips of the dominant hand, with and without gloves, were taken on blood agar plates. Bacterial colony-forming units (CFUs) were quantified after 18 hrs of incubation at 35degreeC. The primary outcome was the number of CFU/plate at the end of the care sequence and before performing hand hygiene, expressed as medians and interquartile range. Results: A total of 207 structured observations were performed: nasal care (n=31), nasal care with fixing of the naso-gastric tube (NGT;n=31), oral care with water (n=29), oral care with chlorhexidine (CHX;n=50), fixing of respiratory tube (n=33) and endo-tracheal aspiration (n=33). Hand hygiene compliance before aseptic care was 70%. Gloves were used for 94.2% of care sequences and a gloves' contamination >10 CFUs before care was observed in 24.2% of care sequences. When considering RT care activities with