Images in Clinical Medicine
The Hands Give It Away
N Engl J Med 2009; 360:e3January 15, 2009
- Article
A 24-year-old man who had quadriplegia due to a traumatic spinal cord injury was found on routine surveillance cultures to have methicillin-resistant Staphylococcus aureus (MRSA) colonization of his anterior nares. He had no history of MRSA infection or colonization. To assess the potential implications of the patient's MRSA carriage for infection control, an imprint of a health care worker's ungloved hand was obtained for culture after the worker had performed an abdominal examination of the patient. The MRSA colonies grown from this handprint on the plate (CHROMagar Staph aureus), which contained 6 μg of cefoxitin per milliliter to inhibit methicillin-susceptible S. aureus, are pink and show the outline of the worker's fingers and thumb (Panel A). With the use of a polymerase-chain-reaction assay, the mecA gene, which confers methicillin resistance, was amplified from nares and imprint isolates. After the worker's hand had been cleaned with alcohol foam, another hand imprint was obtained, and the resulting culture was negative for MRSA (Panel B). These images illustrate the critical importance of hand hygiene in caring for patients, including those not known to carry antibiotic-resistant pathogens.
Curtis J. Donskey, M.D.
Brittany C. Eckstein, B.S.
Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106- Citing Articles (2)
Citing Articles
1
Girolamo Mattioli, Edoardo Guida, Giovanni Montobbio, Alessio Pini Prato, Marcello Carlucci, Armando Cama, Silvio Boero, Maria Beatrice Michelis, Elio Castagnola, Ubaldo Rosati, Vincenzo Jasonni. (2012) Near-miss events are really missed! Reflections on incident reporting in a department of pediatric surgery. Pediatric Surgery International
CrossRef2
Michael Y. Lin, Mary K. Hayden. (2010) Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus: Recognition and prevention in intensive care units. Critical Care Medicine 38, S335-S344
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