Evaluation of Patients' Skin Flora Based on the Difference in Underlying Diseases and Care Environments

Okada, Junko

Thursday, July 14, 2011

Junko Okada, RN, BS, MS
Department of Adult Nursing, Japanese Red Cross Hiroshima College of Nursing, HIroshima, Japan
Hitomi Tsuda, ICN
National Hospital Organization Hiroshima-Nishi Medical Center, HIroshima, Japan
Yukiko Yamamizu, ICN
Hiroshima Red Cross Hospital & Atomic-bomb Surviers Hospital, HIroshima, Japan
Kiyoko Fukai, PhD, RN, PHN
Graduate School of Health Sciences, Okayama University, Okayama, Japan

Learning Objective 1: The learner will be able to get a relationship between various types of disease and care environments and contamination of patients’ hands.

Learning Objective 2: The learner will be able to get the effects of hand hygiene on patients.

Objective: The hands are the main route of infection. Nevertheless, less attention has been paid to patients’ hand hygiene and little has been known about the degree of contamination among patients. This study describes a relationship between various types of disease and care environments and contamination of patients’ hands, and further evaluates the effects of hand hygiene on such patients.

Methods: Samples were collected from 240 individuals who gave informed consent to participate in the study: patients with hematologic disease (n=45) and postoperative patients (n=48); outpatients receiving hemodialysis (n=48); cancer chemotherapy (n=55); and individuals living in nursing homes (n=44). All the subjects performed hand hygiene. Before and after hand hygiene, samples of bacteria were collected from the palm of the hand onto agar media, and the number of bacteria was counted and the strain of bacteria was identified. Then, smear samples were collected from the contralateral palm and adenosine triphosphate (ATP) levels were measured.

Results: After hand hygiene, the number of bacterial colonies and ATP levels were significantly reduced in all the groups. The number of bacteria was reduced by more than 60% (hematologic group and hemodyalysis group), and by 48% (chemotherapy group) and 38% (nursing home group). Before hand hygiene, MRSA was detected in 30 subjects, except for hematologic group. However, 19 of these subjects became MRSA negative after hand hygiene.

Conclusion: These results show that the degree of hand contamination tends to be influenced by, and vary with underlying diseases and care environments, and that hand contamination could be reduced by encouragement of hand hygiene. In addition, since those with higher risk of infection among all the subjects received a lower degree of hand contamination, it is suggested that they adhere well to hand hygiene.

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