Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-24T02:34:36.745Z Has data issue: false hasContentIssue false

Emergence of Resistant Staphylococci on the Hands of New Graduate Nurses

Published online by Cambridge University Press:  02 January 2015

Jeannie P. Cimiotti*
Affiliation:
Columbia University School of Nursing, New York, New York
Fann Wu
Affiliation:
Columbia University Medical Center, New York, New York
Phyllis Della-Latta
Affiliation:
Columbia University Medical Center, New York, New York
Mirjana Nesin
Affiliation:
Weill Cornell Medical College, New York, New York
Elaine Larson
Affiliation:
Columbia University School of Nursing, New York, New York
*
617 W. 168th Street, New York, NY 10032

Abstract

Objective:

To describe the aerobic microbial flora on the hands of experienced and new graduate nurses over time.

Design:

A prospective cohort design that examined the relationship between duration of employment in an intensive care unit (ICU) and the microbial flora on the hands of experienced and new graduate nurses during a 23-month period.

Setting:

A 50-bed, level III-IV neonatal ICU in New York City.

Participants:

Twelve experienced nurses and 9 new graduate nurses working full time in the NICU.

Intervention:

One hundred fifty samples were obtained from the clean, dominant hands of the nurses. Cultures were performed at baseline and then quarterly for each experienced and new graduate nurse. Baseline and final cultures of Staphylococcus epidermidis were further examined using pulsed-field gel electrophoresis.

Results:

At baseline, a significantly larger proportion of the experienced nurses had methicillin-resistant, coagulase-negative staphylococci isolated from their hands compared with the new graduate nurses (95% and 33%, respectively; P = .0004). For a second culture, performed 1 to 4 months later, there were no longer significant differences between the two groups (82% and 54%, respectively; P = .12). By the last culture, all staphylococcal isolates were methicillin resistant in both groups of nurses; 3 were methicillin-resistant S. aureus.

Conclusions:

Colonization with methicillin-resistant staphylococci occurred after brief exposure to the hospital environment, despite the use of antiseptic hand hygiene agents. Furthermore, at final culture, the two groups shared one dominant hospital-acquired strain of S. epidermidis.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Hay, RJ, Adriaans, BM. Bacterial infections. In: Champion, RH, Burton, JL, Burns, DA, Breathnach, SM, eds. Rook/Wilkinson/Ebling Textbook of Dermatology, ed. 6. Maiden, MA: Blackwell Science; 1998:10971142.Google Scholar
2.Horn, WA, Larson, EL, McGinley, KJ, Leyden, JJ. Microbial flora on the hands of health care personnel: difference in composition and antibacterial resistance. Infect Control Hosp Epidemiol 1988;9:189193.Google Scholar
3.Duncan, WC, McBride, ME, Knox, JM. Bacterial flora: the role of environmental factors. J Invest Dermatol 1969;52:479484.CrossRefGoogle ScholarPubMed
4.Bonassoli, LA, Svidzinski, TIE. Influence of the hospital environment on yeast colonization in nursing students. Med Mycol 2002;40:311313.Google Scholar
5.Strausbaugh, LJ, Sewell, DL, Ward, TT, Pfaller, MA, Heitzman, T, Tjoelker, R. High frequency of yeast carriage on hands of hospital personnel. J Clin Microbiol 1994;32:22992300.CrossRefGoogle ScholarPubMed
6.Larson, EL, Hughes, CA, Pyrek, JD, Sparks, SM, Cagatay, EU, Bartkus, JM. Changes in bacterial flora associated with skin damage on hands of health care personnel. Am J Infect Control 1996;26:513521.Google Scholar
7.National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. Wayne, PA: National Committee for Clinical Laboratory Standards; 2003. Approved standard M7-A6.Google Scholar
8.Olive, DM, Bean, P. Principles and applications of methods for DNA-based typing of microbial organisms. J Clin Microbiol 1999;36:16611669.CrossRefGoogle Scholar
9.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:22332239.Google Scholar
10.Lee, YL, Cesario, T, Lee, R, et al.Colonization by Staphylococcus species resistant to methicillin or quinolone on the hands of medical personnel in a skilled-nursing facility. Am J Infect Control 1995;22:346351.Google Scholar
11.McBride, ME, Montes, LF, Fahlberg, WJ, Knox, JM. Microbial flora of nurses' hands. Int J Dermatol 1974;13:197204.Google Scholar
12.Duncan, IBR, Collins, AM, Neelin, EM, Roy, TE. Nasal carriage of Staphylococcus pyogenes by student nurses. CMAJ 1957;77:10011009.Google Scholar
13.Cespedes, C, Miller, M, Quagliarello, B, Vavagiakis, P, Klein, RS, Lowy, FD. Differences between Staphylococcus aureus isolates from medical and nonmedical hospital personnel. J Clin Microbiol 2002;40:25942597.Google Scholar
14.Namura, S, Nishijima, S, Toshiaki, H, Yasuo, A. Staphylococcus aureus isolated from nostril anteriors and subungual spaces of the hand: comparative study of medical staff, patients, and controls. J Dermatol 1995;22:175180.Google Scholar
15.Remington-Perdreau, F, Stefanik, D, Peters, G, et al.Methicillin-resistant Staphylococcus haemolyticus on the hands of health care workers: a route of transmission or a source? J Hasp Infect 1995;31:195203.Google Scholar
16.Guenthner, SH, Hendley, JO, Wenzel, RP. Gram-negative bacilli as non-transient flora on the hands of hospital personnel. J Clin Microbiol 1987;25:488490.Google Scholar
17.Larson, EL. Persistent carriage of gram-negative bacteria on hands. Am J Infect Control 1981;9:112119.Google Scholar
18.Milisavljevic, V, Wu, F, Larson, E, Della-Latta, P, Saiman, L. Strain relat-edness of Staphylococcus epidermidis isolates recovered from neonates and healthcare workers in a neonatal intensive care unit. Presented at the Annual Meeting of the Pediatric Academic Societies; May 3-6, 2003; Seattle, WA.Google Scholar
19.Oie, S, Hosokawa, I, Kamiya, A. Contamination of room door handles by methicillin-sensitive/methicillin-resistant Staphylococcus aureus. J Hosp Infect 2002;51:140143.Google Scholar
20.Bures, S, Fishbain, JT, Uyehara, CFT, Parker, JM, Berg, BW. Computer keyboards and faucet handles as reservoirs of nosocomial pathogens in the intensive care unit. Am J Infect Control 2000;28:465471.Google Scholar
21.Wright, IMR, Orr, H, Porter, C. Stethoscope contamination in the neonatal intensive care unit. J Hosp Infect 1995;29:6568.Google Scholar
22.Zembrzuska-Sadkowska, E. The danger of infections of the hospitalized patients with the microorganisms present in preparations and in the hospital environment. Acta Pol Pharm 1995;52:173178.Google Scholar
23.Neely, AN, Maley, MP. Survival of enterococci and staphylococci on hospital fabrics and plastic. J Clin Microbiol 2000;38:724726.Google Scholar
24.Hedin, G. Staphylococcus epidermidis: hospital epidemiology and the detection of methicillin resistance. Scand J Infect Dis 1993;90(suppl):159.Google Scholar
25.Sultana, B, Cimiotti, J, Aiello, A, Sloan, D, Larson, E. Effect of age and race on skin condition and bacterial counts on hands of neonatal ICU nurses. Heart Lung 2003;32:283289.Google Scholar
26.Allen, KD, Anson, JJ, Parsons, LA, Frost, NG. Staff carriage of methicillin-resistant Staphylococcus aureus (EMRSA 15) and the home environment: a case report. J Hosp Infect 1997;35:307311.Google Scholar