Health care worker hand contamination at critical moments in outpatient care settings.
The delivery of health care in outpatient settings has steadily increased over the past 40 years. The risk of infection in these settings is considered to be low. However, the increasing severity of illness and complexity of care in outpatient settings creates a need to reexamine the transmission of pathogens in this setting.



Seventeen health care workers from 4 wound care facilities were sampled during 46 patient care encounters to determine the presence of health care-associated pathogens (ie, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, multidrug-resistant Acinetobacter species, and Clostridium difficile) on their hands at key moments of care.



Health care workers acquired at least 1 pathogen on their hands during 28.3% of all patient care encounters. Hands sampled before a clean or aseptic procedure and hands sampled after body fluid exposure risk were each contaminated in 17.4% of instances. Hand contamination occurred in 19.6% of instances where health care workers wore gloves during care compared with 14.6% when health care workers were ungloved.



Contamination of health care workers' hands presents a significant risk of pathogen transmission in outpatient settings. Gloving education, hand hygiene solutions at the point of care, and hand hygiene surveillance are important solutions for reducing transmission of pathogenic organisms.
GOJO Industries, Inc, Akron, OH. Electronic address: binghamj@gojo.com.
James
J
Bingham
Summa Health System, Akron, OH.
Ginnie
G
Abell
GOJO Industries, Inc, Akron, OH.
LeAnne
L
Kienast
LJL Consulting, Akron, OH.
Lorie
L
Lerner
GOJO Industries, Inc, Akron, OH.
Brittney
B
Matuschek
Cleveland Clinic Akron General, Akron, OH.
Wanda
W
Mullins
Center for Biofilm Engineering, Department of Mathematical Sciences, Montana State University, Bozeman, MT.
Albert
A
Parker
Summa Health System, Akron, OH.
Nancy
N
Reynolds
Salisbury IP Consulting, LLC, Akron, OH.
Diane
D
Salisbury
University Hospitals Portage Medical Center, Ravenna, OH.
Joan
J
Seidel
Infection Prevention Consultant, Vermilion, OH.
Elizabeth
E
Young
GOJO Industries, Inc, Akron, OH.
Jane
J
Kirk
D000553:Ambulatory Care; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification*; D006225:Hand / Q000382:microbiology*; D006282:Health Personnel; D006801:Humans; D017053:Infection Control / Q000379:methods; D017758:Infectious Disease Transmission, Patient-to-Professional
Ambulatory care; Glove; Hand hygiene; Standard precautions; WHO 5 Moments; Wound care