HANDSCAPE "Infection control in a veterinary hospital by improving adherence to hand hygiene protocols through personal feedback on plate counts and with special attention to resistant flora and their origin (microbial resistance genes)."

Abstract

An important measure in hygiene protocols in health care settings is hand hygiene, as this reduces the number of hospital acquired infections, both in human hospitals, and also in a veterinary environment. Here, a new method to improve adherence to hand hygiene protocols in a veterinary hospital will be proposed. The aims of this project were, firstly, to determine the loading of viable bacteria on hands of people working in veterinary clinical (SATH group) and non-clinical environments (Leahurst group), and who have contact with small animals. Results showed a significant difference (p<0.0005) in bacterial loading between groups, with higher bacterial loading on hands of participants in the Leahurst group, suggesting better hand hygiene in the veterinary clinical environment. This was expected, considering the many measures already in place in that environment to ensure good compliance with hand hygiene protocols. The second aim was to determine the types of bacteria and antimicrobial resistance patterns on hands of people working in these environments. S. aureus carriage was quite common in both groups, 18.2% and 16.1% for Leahurst and SATH group respectively, but S. pseudintermedius was only isolated from hands of participants in the clinical group. MecA carriage was common in both groups (35%). ESBL carrying E. coli were only isolated from hands of participants in the Leahurst group and displayed worrying levels of resistance to other antibiotic classes as well. Presence of E. coli suggests faecal contamination, but the origin of this could not be determined. Antimicrobial susceptibility testing showed more frequent resistance to antibiotics in staphylococci isolated from the SATH group than Leahurst group. The last aim was to determine the acceptability of hand plates as a sampling method and assessment of the feedback system. Our intervention method did not have the desired effect of lower plate counts during a second round of sampling, but since most intervention methods aimed at improving hand hygiene need a multimodal approach in order to be effective, this was not very surprising. Our method is timesaving and useful for determining bacterial loading on hands of people and screening for common bacteria. Although the feedback did not have the desired effect of lowered plate counts, further research is needed to determine whether it could have the expected effect if combined with other strategies to improve hand hygiene compliance.