title: An evaluation of hand hygiene in an intensive care unit: Are visitors a potential vector for pathogens?
abstract: Patients in an intensive care unit (ICU) are frequently immunocompromised and might be highly susceptible to infection. Visitors to an ICU who do not adequately clean their hands could carry pathogenic organisms, resulting in risk to a vulnerable patient population. This observational study identifies pathogens carried on the hands of visitors into an ICU and investigates the effect of hand hygiene. Two observers, one stationed outside and one inside the ICU, evaluated whether visitors performed hand hygiene at any of the wall-mounted alcohol-based hand sanitizer dispensers prior to reaching a patient's room. Upon reaching a patient's room, the dominant hand of all of the participants was cultured. Of the 55 participating visitors, 35 did not disinfect their hands. Among the cultures of those who failed to perform hand hygiene, eight cultures grew Gram-negative rods and one grew methicillin-resistant Staphylococcus aureus. Of the cultures of the 20 individuals who performed hand hygiene, 14 (70%) had no growth on the cultures, and the remaining six (30%) showed only the usual skin flora. The visitors who do not perform hand hygiene might carry pathogens that pose a risk to ICU patients.
authors.affiliation: UM-JMH Center for Patient Safety, Department of Anesthesiology, University of Miami Miller School of Medicine, Institute, 4th floor (R-370A), 1611 NW 12th Ave, Miami, FL 33136, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, CRB 1067, 1120 NW 14th Street, Miami, FL 33136, USA. Electronic address: dbirnbach@miami.edu.
authors.forename: David J
authors.initials: DJ
authors.lastname: Birnbach
authors.affiliation: UM-JMH Center for Patient Safety, Department of Anesthesiology, University of Miami Miller School of Medicine, Institute, 4th floor (R-370A), 1611 NW 12th Ave, Miami, FL 33136, USA. Electronic address: lrosen@med.miami.edu.
authors.forename: Lisa F
authors.initials: LF
authors.lastname: Rosen
authors.affiliation: UM-JMH Center for Patient Safety, Department of Anesthesiology, University of Miami Miller School of Medicine, Institute, 4th floor (R-370A), 1611 NW 12th Ave, Miami, FL 33136, USA. Electronic address: mfitzpatrick@med.miami.edu.
authors.forename: Maureen
authors.initials: M
authors.lastname: Fitzpatrick
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, CRB 1067, 1120 NW 14th Street, Miami, FL 33136, USA. Electronic address: karheart@med.miami.edu.
authors.forename: Kristopher L
authors.initials: KL
authors.lastname: Arheart
authors.affiliation: Institute for Health and Society, Department of Medicine, Medical College of Wisconsin, P.O. Box 26509, Milwaukee, WI 53226-0509, USA. Electronic address: smunozprice@mcw.edu.
authors.forename: L Silvia
authors.initials: LS
authors.lastname: Munoz-Price
mesh_terms: D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D003428:Cross Infection / Q000517:prevention & control*; D004202:Disinfectants / Q000008:administration & dosage; D004363:Drug Utilization; D006225:Hand / Q000382:microbiology; D063373:Hand Hygiene; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D014789:Visitors to Patients
chemical_list: D004202:Disinfectants
keywords: Community-acquired infection; Hand hygiene; Healthcare-associated infection; Intensive care unit; Patient safety