MedicalResearch.com Interview with:
Lona Mody, MD, MS
Veterans Affairs Healthcare System, Geriatric Research, Education, and Clinical Center
Division of Geriatric and Palliative Medicine, University of Michigan Medical School,
School of Public Health
University of Michigan, Ann Arbor
MedicalResearch.com: What is the background for this study?
Dr. Mody: Hand hygiene is considered to be the most important strategy to prevent infections and spread of drug resistant organisms. Surprisingly, all strategies and efforts have predominantly involved healthcare workers and that too mainly in acute care hospitals. We are now facing a tsunami of an aging population in our hospitals, post-acute care facilities and long-term care facilities. Hand hygiene falls off when patients are hospitalized compared to when they are at home. So, we were very interested, first, in hand colonization in older patients who have recently been transferred from the acute care hospital to a post-acute care (PAC) facility for rehabilitation or other medical care before fully returning home. We were also interested in evaluating whether these organisms persisted.
MedicalResearch.com: What are the main findings?
Dr. Mody: We recruited and followed 357 patients (54.9 percent female with an average age of 76 years). The dominant hands of patients were swabbed at baseline when they were first enrolled in a post-acute care facility, at day 14 and then monthly for up to 180 days or until discharge.
The study found:
- To our surprise, nearly one-quarter (86 of 357) of patients had at least one multi-drug resistant organism on their hands when they were transferred from the hospital to the post-acute care facility
- During follow-up, 34.2 percent of patients’ hands (122 of 357) were colonized with a resistant organism and 10.1 percent of patients (36 of 357) newly acquired one or more resistant organisms.
- Overall, 67.2 percent of colonized patients (82 of 122) remained colonized at discharge from PAC.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Mody: Patients commonly carry resistant organisms on transfer from the hospital to a PAC facility and acquire more organisms during the rehabilitation stay. Today, patient hands come in contact with environmental surfaces, rehabilitation equipment, healthcare workers’ hands, and other patients. This study highlights an actionable transition time to prevent resistant organisms entering PACs from hospitals.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Mody: First, we would like to understand predictors of hand contamination in patients. For example, are functionally disabled patients more likely to have hand contamination since they need assistance to perform hand hygiene? We believe that it is critical to study, design and test effectiveness and then implement new programs that reinforce patient hand hygiene. We need to also understand factors that influence patient participation in patient safety including attitudes, effective communication skills, access to hand hygiene products as well as perception of immediate risk of infection. Will patient engagement in this area energize and improve healthcare worker hand hygiene?
MedicalResearch.com: Is there anything else you would like to add?
Dr. Mody: Increasing numbers of seniors bringing hospital superbugs through the revolving door of the PAC facilities for short stays (as opposed to living long-term) means new policies and innovations are needed to stop the superbugs from spreading more deeply into the post-acute care facilities.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Cao J, Min L, Lansing B, Foxman B, Mody L. Multidrug-Resistant Organisms on Patients’ Hands: A Missed Opportunity. JAMA Intern Med. Published online March 14, 2016. doi:10.1001/jamainternmed.2016.0142.
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Lona Mody, MD, MS (2016). Many Seniors Carry Superbugs Home From the Hospital MedicalResearch.com