Study of intensive care units: Hand hygiene also important for patients

Prof. Petra Gastmeier, Charité, Berlin, intensive care, compliance, hygiene measures, surveillance

Hand hygiene can save lives. What is second nature for medical staff today could also become a habit for patients and their relatives – because clean hands can prevent nosocomial infections. Researchers in the US have examined the hands of intensive care patients for relevant pathogens. Among the pathogens detected, several multi-resistant organisms were identified.

The fight against nosocomial infections does not stop at the hands of doctors, nurses and therapists, but continues at the hands of patients. Several studies have already examined the extent of pathogen contamination of patients’ hands. Researchers at the Cleveland Clinic Lerner College of Medicine in Ohio recently focused their investigations on patients in the intensive care unit. They wanted to know which pathogens, and above all, which multi-resistant organisms gather on patients’ palms.1

Multi-resistant organisms found in handprint

For this purpose, the researchers took handprints of 56 intensive care patients using specially prepared agar plates. The plates were incubated for about 24 hours. Of the 56 patients, 47 had normal skin flora.

However, among the other nine patients, at least one pathogen type could be detected on their palms. On the skin of four of these patients, at least one type of multi-resistant organism was found. These included MRSA (methicillin-resistant Staphylococcus aureus), which was detected twice and VRE (vancomycin-resistant enterococci) was found once.

Overall, contamination with multi-resistant organisms was lower than in previous studies of patients’ hands. The researchers attributed this to the unique environment and germ-control strategies in intensive care units, where the surfaces of objects and medical equipment are more frequently disinfected than most other hospital areas.

Patients’ hands neglected in studies of “clean hands”?

Nevertheless, according to the authors of the study, the topic of patients’ hands in the context of hand hygiene in the health care system remains of general importance, but is currently not yet reflected in most guidelines. The World Health Organisation (WHO), for example, has not yet issued any recommendations on the subject of patients’ hands. However, the US Centers for Disease Control and Prevention (CDC) have produced detailed instructions on hand hygiene for patients. A publication (in German) by Germany’s Robert Koch Institute (RKI) confirms the knowledge gap on the patient side. There is frequently a lack of knowledge about hand disinfection, ranging from details of disinfection measures for staff, and including necessary protective measures for the patients themselves.

This is why local or national initiatives, such as Germany’s “Clean Hands Campaign” (Aktion Saubere Hände, ASH) seek to address and involve patients to a greater extent. Here patient involvement, along with an open dialogue between health professionals and patients, are essential for ensuring patient safety. Just as it is already commonplace for patients to ask questions about medication, this behaviour would also be welcome regarding hand hygiene. Patient should feel that they are part of the team and able to talk openly about hand disinfection.


  1. Multidrug-resistant organisms on patients hands in an ICU setting, Dunn et al., Infection Control & Hospital Epidemiology, accessed on 8 april 2020
Ask our team
Sign up for our newsletter.