Healthcare workers who ignore the constant admonition to wash their hands between patients may inadvertently spread multidrug-resistant superbugs while drawing a citation from a visiting Joint Commission surveyor.

As employee health professionals frequently remind, hand hygiene also protects the worker and, by extension, his or her family.

In a recent study, researchers looked at the role healthcare workers play in transmitting carbapenem-resistant Enterobacteriaceae (CRE) to patients. CRE can be resistant to virtually all available antibiotics and is life-threatening to immunocompromised patients. The study setting was an academic healthcare center with regular CRE perirectal screening in high-risk units. They found that patients who acquired CRE were more likely to receive care from workers treating a CRE patient, suggesting the classic scenario of cross-transmission.

“These data support the importance of hand hygiene and cohorting measures for CRE patients to reduce transmission risk,” they concluded.1

In a related matter, as part of its enforcement of patient safety goals, The Joint Commission (TJC) is assessing hand hygiene compliance during 2018 accreditation surveys.

“Beginning Jan. 1, 2018, any observation by surveyors of individual failure to perform hand hygiene in the process of direct patient care will be cited as a deficiency resulting in a Requirement for Improvement (RFI) under the Infection Prevention and Control (IC) chapter for all accreditation programs,” TJC recently announced. The observations can be made at any point during the survey visit.

“Our surveyors are trained so that during our onsite surveys, they follow the care of the patient in conducting what we call an individual patient tracer,” said Mary Brockway, MS, RN, director of clinical research and standards in TJC Division of Healthcare Quality Evaluation. “So that allows them to observe the clinical staff providing direct patient care throughout the survey. Patient care is fluid, but any failure to wash hands prior to providing care will be cited.”

However, surveyors are not likely to correct or question a healthcare worker not following hand hygiene protocols.

“We’re there to help organizations improve, and conducting the survey is part of that process,” she says. “We would not normally confront a healthcare worker about not washing their hands, but we may explore further with several workers about their handwashing programs. How is the access to sinks and soaps? Have they been educated? Those types of things. We would follow up with the organization to do this as we are doing the survey process.”

Those that receive an RFI citation may have the situation assessed again on a subsequent survey, Brockway says.


1. Grabowski ME, Kang H, Wells KM, et al. Provider Role in Transmission of Carbapenem-Resistant Enterobacteriaceae. Infect Control Hosp Epidemiol 2017;38:1329–1334.