The Ever Increasing Reservoirs of Infection in the Health Care Environment - Time for a Sixth Moment of Hygiene.

Objectives: The study was carried out to determine the extent and type of contamination of the hands and accessories of staff from different settings and also to determine the phenotypic similarity between the isolates recovered from the same staff.

Design: Prospective cross-sectional study.

Setting: Tertiary care center.

Participants: Health care workers (HCWs') and administrative staff.

Methods: Samples were collected and processed for bacteriology from the dominant hand, mobiles, aprons, stethoscopes and computer keyboards of 280 staff working in different settings after consent. Isolates were identified and antimicrobial susceptibility testing was carried out. A comparison of data sets was performed using chi square test. p value < 0.05 was considered significant.

Results: 817 samples were screened, 616 yielded growth. Contamination rate was found to be 75%. Of the 1254 isolates recovered, Gram positive and gram negative accounted for 80% and 18% respectively. Hands and accessories of HCWs from clinical settings showed significant contamination with potential pathogens as compared to the non-clinical settings. (p<0.0001) All computer keyboards and stethoscopes used by ICU doctors were contaminated. MRSA was recovered only from clinical settings. Two salmonella isolates were isolated from apron of laboratory health care workers. In 102 staff, similar isolates were recovered from hand and any accessory.

Conclusions: The risk of contamination of any accessory with potential pathogens is high in the clinical setting. The five moments of hand hygiene should be strengthened. A policy for decontamination of all accessories should be formulated.