TORONTO - They say a picture is worth a thousand words, but one produced by infection control experts at a U.S. hospital screams just three.
"Wash Your Hands."
The image, of the superbugs hitchhiking on a health-care worker's hand after the worker treated a patient, is stark proof of the role inadequate hand hygiene plays in the spread of infections in hospitals.
Published Wednesday in the New England Journal of Medicine, the picture shows the clear outline of a hand on a plate of growth medium. The impression of the fingers, thumb and top of the palm are created by thriving colonies of Staphylococcus aureus bacteria that grew after the worker pressed his or her right hand into the growth medium.
"It is a very dramatic illustration of the fact that when health-care workers care for patients in hospital and touch them -- as they should -- their hands are liable to pick up the organisms that are on the patients that they're looking after," said Dr. Andrew Simor, an infectious diseases expert at Toronto's Sunnybrook Health Sciences Centre who was asked to comment on the image.
"And in a hospital setting, that often includes antibiotic-resistant organisms."
In fact, testing showed the colonies of bacteria in the photograph weren't just run-of-the-mill Staph. They were MRSA -- methicillin-resistant versions of the bugs that can cause hard-to-treat wound and bloodstream infections and pneumonia.
Beside that picture is a plate devoid of growing bacteria. It's the image of what happened -- or didn't -- when the health-care worker cleaned his or her hand with alcohol foam and then pressed it onto a second plate of growth medium.
The health-care worker had been caring for a 24-year-old quadriplegic man who was not known to be carrying MRSA. Because the man hadn't been identified as a carrier of MRSA, hospital staff caring for him weren't required to don the gown and gloves used with patients known to be carrying or infected with the nasty bacteria.
Dr. Curtis Donskey, head of infection control at the Cleveland Veterans Affairs Medical Center, submitted the pictures to the journal. The work was part of his team's ongoing effort to get health-care workers to understand the risk they pose if they don't wash their hands between patients.
"Almost every hospital in the country has a program where they're doing what we're doing, trying to get people to comply and do a good job with hand hygiene," he said in an interview from Cleveland, Ohio.
"It's frustrating that our compliance is still not 100 per cent, or 80 per cent.... I think a lot of people have tried for years to figure out new ways to get people to be more compliant."
Donskey's hospital uses images like this one in their system-wide computer screensaver in the hopes that visible proof that bugs do hitch rides will inspire better hand hygiene.
But he admitted it's an uphill battle.
"If you ask health-care workers, what they probably say is that they do wash their hands. It's somebody else who's not washing their hands," Donskey said.
"There's no good explanation for it. I think people should be looking at these types of images and all the studies that have been done and washing their hands."
Simor said that in Canada, hospitals routinely screen patients to see if they are carrying antibiotic-resistant bacteria and flag positive cases so that health-care workers can take the necessary precautions. But some U.S. hospitals have resisted screening, arguing there's no proof the cost and effort actually leads to lower infection rates.
But infection control teams in hospitals on both sides of the border -- and farther afield as well -- share the battle of trying to get health-care workers to practise proper hand hygiene.
In fact, one of Simor's colleagues conducted a similar study a few years ago.
Dr. Donald Redelmeier got "a friendly, non-confrontational youth volunteer" -- his then 13-year-old son -- to roam the halls of the hospital asking staff if they wanted to see what was growing on their hands.
If they said yes, they pressed a hand into a plate of growth medium and wrote their email address on the lid placed over it. Once the bacteria grew -- and it grew -- pictures of the plates were sent back to the personnel.
In some cases people were tested more than once. Redelmeier said by looking at the dates, they were able to see if repeat performers had learned the lesson of the first hand print. There was perhaps modest improvement, he said, but nothing extraordinary.
Redelmeier himself was even startled by the bacteria his plate grew, noticing that while he'd done a good job cleaning the palms of his hands, he needed to pay more attention to the fingertips.
"That was an epiphany for me as an individual," he admitted.
