Bacterial contamination of the hands of doctors: A study in the medicine and dermatology wards.

ABSTRACT

Background: Doctors' hands are a common source of bacterial contamination. Often, these organisms are found to be virulent species with multidrug-resistance patterns. These are the sources of nosocomial infections in many patients. Aims: The present study was undertaken to find out the prevalence of bacterial contamination in the hands of doctors in the Medicine and Dermatology wards of a tertiary care hospital. Methods: The hands of 44 doctors were swabbed and cultured at entry to ward and at exit. Then, tap water and alcohol swab wash techniques were used and further swabs were done at each step. Thus, each doctor was sampled four-times for the study. The antibiotic-sensitivity pattern of the organisms was determined by the disc-diffusion method. Results: There was a significant contamination of the doctors' hands at entry (59.1%) and at exit (90.9%). Overall, Staphylococcus was the predominant organism (59% at entry and 85% at exit); coagulase-negative ones were more prevalent at entry (32%) and coagulase-positive ones were more prevalent at exit (54%). There was no difference in the hand contamination rates of junior and senior doctors. Also, the contamination rates were similar in the Medicine and Dermatology wards. Among the Gram negative organisms, Escherichia coli (4.5%), Pseudomonas (4.5%), Enterococci (13.6%) and Klebsiella (9%) were the main ones isolated. Gram negative organisms were significantly more prevalent at exit (P = 0.009) compared with their numbers at entry. Hand washing techniques reduced the contamination rates significantly, 76% with tap water wash and further 16.5% with alcohol swab. The removal rate for both groups of organisms was similar. Also, coagulase-positive and -negative Staphylococci showed equal rates of removal with hand washing (P = 0.9793). The organisms were found to be resistant to most of the commonly used antibiotics; the beta-lactam group was especially largely resistant both for Gram positive and Gram negative bacteria. Both cheaper ones like cloxacillin (50-100%) and very costly ones like cefepime (100%) were equally vulnerable to resistance. Even newer antibiotics like linezolid and vancomycin showed a significant resistance to Staphylococcus. In Gram negative organisms, drugs like ceftazidime and gentamicin showed 100% resistance. Conclusion: This study shows the high level of contamination of doctors' hands. It emphasizes the need for proper hygienic measures in day to day practice in hospitals to reduce the level of nosocomial infections. Also, it shows that most of the commonly used antibiotics will be ineffective in nosocomial infections.