title: Effectiveness of hand hygiene depends on the patient's health condition and care environment.
abstract: OBJECTIVE
  The present authors examined how patient hand contamination was associated with underlying disease and treatment environment in order to determine effective hand hygiene methods.
  
  
  METHODS
  Samples were collected from inpatients (45 with hematological malignancies, 48 postoperative), outpatients (48 undergoing hemodialysis, 55 on chemotherapy), and 44 individuals living in nursing homes. All participants provided informed consent for study participation. All subjects performed hand hygiene. Before and after hand hygiene, samples of bacteria were collected from the palm of the hand onto agar media. Bacteria were counted and bacterial strains were identified. The authors then collected smear samples from the contralateral palm and measured adenosine triphosphate (ATP) levels.
  
  
  RESULTS
  Patient hand contamination was the highest in hemodialysis patients, followed by residents of nursing homes, postoperative patients, patients with cancer receiving chemotherapy, and patients of hematological malignancies. Regardless of the underlying disease and treatment environment, patients were able to reduce the number of bacterial colonies and ATP by proper hand hygiene. Compared with wet wipes, hand washing seemed to remove bacteria more effectively. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in 30 subjects, none of whom were patients of hematological malignancies. Of these, 19 tested negative for MRSA after performing proper hand hygiene.
  
  
  CONCLUSIONS
  Patient hand contamination is affected by underlying disease and care environment, but can be reduced by encouraging proper hand washing. Proper patient hand hygiene can reduce MRSA on patients' hands, and thus may serve as an effective tool for prevention of healthcare-associated infections.
authors.affiliation: Japanese Red Cross Hiroshima College of Nursing, Hatsukaichi, Japan. ojunko@jrchcn.ac.jp.
authors.forename: Junko
authors.initials: J
authors.lastname: Okada
authors.affiliation: Hiroshima Red Cross Hospital and Atomic-bomb Survivers Hospital, Hiroshima, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Yamamizu
authors.affiliation: Graduate School of Health Sciences, Okayama University, Okayama, Japan.
authors.forename: Kiyoko
authors.initials: K
authors.lastname: Fukai
mesh_terms: D000255:Adenosine Triphosphate / Q000032:analysis; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D015169:Colony Count, Microbial; D003428:Cross Infection; D006225:Hand / Q000382:microbiology; D063373:Hand Hygiene / Q000592:standards*; D019337:Hematologic Neoplasms / Q000382:microbiology; D006801:Humans; D007297:Inpatients; D009735:Nursing Homes; D006435:Renal Dialysis
chemical_list: D000970:Antineoplastic Agents; D000255:Adenosine Triphosphate
keywords: hand contamination; hand hygiene; inpatients; outpatients; skin flora of hands