Has the Time Come to Recommend the Use of Alcohol-Based Hand Rub to Hospitalized Patients?

Abstract

This paper describes the transmission of methicillin-resistant Staphylococcus aureus (MRSA) by a colonized patient who had not been screened on admission to the University Clinic of Respiratory and Allergic Diseases, Slovenia, because no risk factors could be identified at that time. A 56-year-old woman (case patient 1) was placed in the same room with 2 other patients. A sputum sample was collected because of her clinical presentation of lower respiratory tract infection on day 4. Two days later, MRSA was detected in the sputum. Because case patient 1 had stayed with undetected MRSA colonization for more than 3 days in the same room with the 2 other patients, screening of these 2 patients was performed and consisted of nasal and throat swab samples. The nasal swab sample of one patient (case patient 2) was positive for MRSA, whereas the screening samples of the other patient were negative. The isolates recovered from both colonized patients were susceptible to clindamycin and erythromycin. Molecular typing of both isolates showed a relatively indistinguishable banding pattern. After interviewing case patient 1 a second time, it was found that she was in contact with an MRSA carrier before she was admitted to the hospital. She also revealed that she helped case patient 2 repeatedly (e.g., by assisting her with drinking, arranging pillows, and turning her in bed). All healthcare workers who were in contact with both colonized patients were screened and none had been colonized. Because this was the second case of probable direct patient-to-patient transmission in the hospital, an educational leaflet was prepared on hand hygiene for patients wherein the use of alcohol-based hand rub during their stay in the hospital is recommended.