Inadequate Hand-Washing Again Found Among Health Care Workers

From the WebMD Archives

Nov. 15, 1999 (Minneapolis) -- The message for health care workers is clear: wash your hands. But according to a new study, that frequent order from mom has been lost on some hospital staff who work with kidney dialysis patients. The results were announced recently at a national meeting of the American Society of Nephrology (ASN) in Miami Beach, Fla.

Kidney failure is growing by 6% a year in the U.S., leading the world in the number of new cases, according to data from the ASN. In 1997, more than 79,000 Americans developed complete kidney failure, bringing the total number of Americans treated for kidney failure to more than 360,000. People with total kidney failure require dialysis treatments -- or a kidney transplant -- to stay alive.

Dialysis is a medical procedure that uses special equipment to filter the blood of impurities, a function that can no longer be performed by the failed kidneys. Dialysis treatments require health care workers to have contact with blood and body fluids, therefore strict hand-washing is important.

"What we found [in this study] is that inadequate hygiene among hospital staff may be linked to the spread of a drug-resistant bacteria among dialysis patients," lead author Jerome I. Tokars, MD, MPH, tells WebMD. "This poses serious health risks to patients whose kidneys have failed."

The study examined patients from seven outpatient hemodialysis centers in the U.S. Approximately 5-14% of patients tested positive for drug-resistant bacteria. In addition, final results showed that patients who had been admitted to the hospital within six months prior to the study were more likely to have the drug-resistant bacteria.

The bacteria in question are called enterococci and are usually harmless germs found in the intestines. In some instances, they can invade the body and cause bacterial infections. To make matters worse, a few strains of enterococci in the U.S. are now resistant to antibiotics, according to the researchers. While these bacteria are common in many dialysis units, Tokars says he expects them to be more common in patients with certain risk factors such as intravenous drug use, recent hospitalization, or a disability requiring a home attendant.

Tokars, who is a medical epidemiologist with the Hospital Infections Program at the CDC in Atlanta, says that finding this drug-resistant bacteria at all of the medical centers studied suggests that the problem may be widespread.

"Infection control precautions should be used during care of all hemodialysis patients to prevent bacteria transmission," he says. "These bacteria can be spread from patient to patient, generally on the hands of health care workers, and their growth is promoted by receipt of antimicrobial agents." Specifically, Tokars says that dialysis patients should expect to see their caregivers wear gloves and wash hands between patients.

"Researchers will continue to study the spread of [antibiotic] resistance in dialysis patients, Tokars says. He adds that the CDC has recently begun a surveillance system to monitor and control infection rates.