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Hospital Rooms, Not Just Patients, Can Spread Pathogen Contamination

DURHAM, NC – Nurses sometimes neglect protocols that help reduce pathogen transmission, such as hand-washing or wearing gloves, when they interact with patients without actually touching them.

A new study presented at IDWeek, the annual meeting of the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), and the Pediatric Infectious Diseases Society (PIDS), demonstrates why that is a bad idea.

Duke Health researchers report that hospital rooms, and not just the patients in them, can spread germs through contact with healthcare personnel.

"This study is a good wake-up call that healthcare personnel need to concentrate on the idea that the healthcare environment can be contaminated," explained lead author Deverick Anderson, MD, an associate professor of medicine at Duke University School of Medicine. "Any type of patient care, or even just entry into a room where care is provided, truly should be considered a chance for interacting with organisms that can cause disease."

The goal of the study, according to the researchers, was to better understand how pathogens travel between the "transmission triangle" in a healthcare setting: patients, the environment where care is administered, and the healthcare provider.

To achieve that, the study team took cultures from the sleeves, pockets, and midriffs of new surgical scrubs of 40 ICU nurses at Duke University Hospital at the beginning and end of each shift. At the same time, cultures were also collected from the bodies of all of the nurses’ 167 patients during 120 12-hour shifts, as well as patient room contents such as beds, bedrails, and supply carts.

Overall, 2,185 cultures were collected from the nurses' clothing, 455 from patients, and 2,919 from patients' rooms.

Using molecular analysis, researchers confirmed 12 instances where at least one of five pathogens known to cause difficult-to-treat infections was transmitted from the patient or the room to the scrubs. Six incidents each involved transmission from patient to nurse and room to nurse, while another 10 transmissions were from the patient to the room.

No nurse-to-patient or nurse-to-room transmissions were found, however.

Pockets and sleeves of the scrubs were most likely to be contaminated, as were the bed rails in the rooms, according to the analysis.

"I think sometimes there's the misconception that if, for instance, a nurse is just talking to patients and not actually touching them, that it might be okay to skip protocols that help reduce pathogen transmission, like washing hands or wearing gloves," Anderson said. "The study's results demonstrate the need for caution whenever healthcare providers enter a patient room, regardless of the task they're completing."

These results were also significant, he emphasized, because previous studies on pathogen transmission focused mainly on the patient-to-nurse interaction. This study, on the other hand, demonstrated the room itself should be approached with equal consideration and caution.