The n e w e ng l a n d j o u r na l of m e dic i n e

images in clinical medicine

The Hands Give It Away

A B

A 
24-year-old man who had quadriplegia
ICM AUTHOR Donskey
due to a traumatic RETAKE
spi- Curtis J. Donskey, M.D.
1st
nal cord injury was found on routine surveillance
REG F FIGURE a&b cultures to have methicil-
2nd Brittany C. Eckstein, B.S.
lin-resistant Staphylococcus aureusCASE
(MRSA)TITLEcolonization of his anterior Revised
nares.
3rd
Cleveland Veterans Affairs Medical Center
He had no history of MRSA infection or colonization.
EMail
To assess Linethe potential
4-C implica- Cleveland, OH 44106
Enon ARTIST: mst SIZE
tions of the patient’s MRSA carriage for FILL
infection control, anH/T imprintH/T
Combo
of a health
39p6 care
worker’s ungloved hand was obtained for culture after the worker
AUTHOR, PLEASE NOTE:
had performed an
abdominal examination of the patient. The MRSA
Figure colonies
has been grown
redrawn and from
type has beenthis
reset. hand-
print on the plate (CHROMagar Staph aureus), whichPlease check carefully.
contained 6 μg of cefoxitin per
milliliter to inhibit methicillin-susceptible S. aureus,
JOB: 36003 are pink and show 1-15-09
ISSUE: 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 nega-
tive for MRSA (Panel B). These images illustrate the critical importance of hand
hygiene in caring for patients, including those not known to carry antibiotic-resis-
tant pathogens.
Copyright © 2009 Massachusetts Medical Society.

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