title: Dynamics of bacterial hand contamination during routine neonatal care.
abstract: OBJECTIVE
  To evaluate the dynamics of bacterial contamination of healthcare workers' (HCWs) hands during neonatal care.
  
  
  METHODS
  The 20-bed neonatal unit of a large acute care teaching hospital in Geneva, Switzerland.
  
  
  METHODS
  Structured observation sessions were conducted. A sequence of care began when the HCW performed hand hygiene and ended when the activity changed or hand hygiene was performed again. Alcohol-based handrub was the standard procedure for hand hygiene. An imprint of the five fingertips of the dominant hand was obtained before and after hand hygiene and at the end of a sequence of care. Regression methods were used to model the final bacterial count according to the type and duration of care and the use of gloves.
  
  
  RESULTS
  One hundred forty-nine sequences of care were observed. Commensal skin flora comprised 72.4% of all culture-positive specimens (n = 360). Other microorganisms identified were Enterobacteriaceae (n = 55, 13.8%); Staphylococcus aureus (n = 10, 2.5%); and fungi (n = 7, 1.8%). Skin contact, respiratory care, and diaper change were independently associated with an increased bacterial count; the use of gloves did not fully protect HCWs' hands from bacterial contamination.
  
  
  CONCLUSIONS
  These data confirm that hands become progressively contaminated with commensal flora and potential pathogens during neonatal care, and identify activities at higher risk for hand contamination. They also reinforce the need for hand hygiene after a sequence of care, before starting a different task, and after glove removal.
authors.affiliation: Infection Control Program, Department of Internal, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Carmem Lúcia
authors.initials: CL
authors.lastname: Pessoa-Silva
authors.forename: Sasi
authors.initials: S
authors.lastname: Dharan
authors.forename: Stéphane
authors.initials: S
authors.lastname: Hugonnet
authors.forename: Sylvie
authors.initials: S
authors.lastname: Touveneau
authors.forename: Klara
authors.initials: K
authors.lastname: Posfay-Barbe
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pfister
authors.forename: Didier
authors.initials: D
authors.lastname: Pittet
mesh_terms: D000438:Alcohols / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D015169:Colony Count, Microbial; D041381:Diapers, Infant / Q000382:microbiology; D004866:Equipment Contamination; D017575:Gloves, Protective / Q000382:microbiology; D019983:Guideline Adherence; D006225:Hand / Q000382:microbiology*; D006235:Hand Disinfection / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000592:standards*; D017757:Infectious Disease Transmission, Professional-to-Patient; D007363:Intensive Care Units, Neonatal; D010564:Personnel, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D012044:Regression Analysis; D012867:Skin / Q000382:microbiology; D013557:Switzerland
chemical_list: D000438:Alcohols; D000891:Anti-Infective Agents, Local