A study of newly admitted patients at two hospitals in Michigan found that patients with severe functional dependence were more likely to harbor multidrug-resistant organisms (MDROs) on their hands and less likely to be able to clean them independently, researchers reported today in Infection Control & Hospital Epidemiology.
The secondary analysis of 399 general medicine patients enrolled over a 6-month period in 2017 was conducted by researchers at Michigan Medicine, who were using data collected through the Patient Hand Hygiene Project Initiative to assess the correlation between patient functional dependence and hand contamination with MDROs. They found that odds of any MDRO contamination were more than two-and-a-half times higher (odds ratio [OR], 2.63; 95% confidence interval [CI], 1.21 to 5.72) among the 56 patients considered severely dependent, which was defined as a score of 4 or higher on the Katz Activities of Daily Living (ADL) scale, compared with the 298 patients considered functionally independent.
Higher risk of room contamination
Among the MDROs identified, severe dependence was associated with higher rates of hand contamination with methicillin-resistant Staphylococcus aureus (MRSA; OR, 3.78; 95% CI, 1.39 to 10.23) and vancomycin-resistant Enterococcus (OR, 5.55; 95% CI, 1.09 to 28.22) but not resistant gram-negative bacteria. Patients with feeding dependence had the highest odds of hand contamination with MDROs (OR 4.76; 95% CI, 1.54–14.71), followed by continence, dressing, and toileting.
Analysis of high-touch surfaces in patient rooms also found that the risk of MRSA contamination was higher in the rooms of severely dependent patients (OR, 2.60; 95% CI, 1.16 to 5.82).
The study authors say the findings could help inform targeted hand hygiene initiatives.
"Targeting high-risk populations and developing personalized interventions based on patients' functionality is important," they wrote. "Future studies should develop and test such interventions that take into account a patient's ability to perform hand hygiene and across various healthcare settings."