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Bacteria, bacteria, everywhere: the role of gloves, handwashing and

environment in a microbiology laboratory

Conference Paper · April 2010

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 Bacteria, bacteria, everywhere: the role of gloves,
handwashing and environment in a microbiology laboratory
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Poster 991

T.Y. Tan,1 S.Y. Ng,1 W.T. Teh,1 S.K. Ng,1 L.C. Eng,1 B.C. Ng,2 S.X.Y. Chan2 Presented at:
1 20th ECCMID, 10th - 13th April 2010
Division of Laboratory Medicine, Changi General Hospital, Singapore Vienna, Austria
2 School of Life Sciences and Chemical Technology, Ngee Ann Polytechnic, Singapore

Introduction Results Results (continued)

The extent of glove usage in microbiology laboratories remains
somewhat ill-defined. Some authorities suggest the use of gloves at all
times,1 while others advocate use of gloves only when handling
specimens.2 The aims of this study were to:
a) investigate the effect of glove usage on hand contamination
b) document the effectiveness of hand hygiene
c) document the extent of bacterial contamination on commonly used
Bacterial contamination on hands
MRSA and Enterobacteriaceae were isolated from the hands of
technologists, primarily from cultures at the end of the working period.
Salmonella spp. and P. aeruginosa were not isolated from any hands.
Risk for hand acquisition of MRSA or Enterobacteriaceae, stratified by glove usage
Meticillin-resistant S. aureus
60
Bacterial contamination of the environment
Total bacterial density was highest on tap handles, followed by telephone
handsets. Of potential pathogens, only MRSA was commonly detected
(highest density on telephone surfaces, followed by computer keyboards).
P. aeruginosa and Enterobacteriaceae were occasionally isolated from
Enterobacteriaceae environmental surfaces, but Salmonella spp. was not encountered.
60

laboratory surfaces and MRSA

No MRSA
ENBA
No ENBA
Bacterial isolated from environmental surfaces in the laboratory
50 50
d) differentiate contamination by commensal bacteria and potential 50 50
Waste discard Waste discard

bacterial pathogens. Bactec door

handle
Bactec door
handle
40 40 Tap water Tap water

All handle
MRSA handle

Hand-episodes

Hand-episodes
Photocopier Photocopier

Bacteria
Setting for the study 30 30

20
Bench Top

Microscope
Bench Top

Microscope

20 20 CO2 Incubator CO2 Incubator

The clinical microbiology laboratory serves an 800-bedded acute-care 14 Incubator Door

Knob
Incubator Door
Knob

hospital and processed 100,000 microbiology specimens in 2009. 10

6
10 Phone Keypad Phone Keypad

3
Reported bacterial isolates for 2009 included 3,544 S. aureus (41% 1 2 Phone Handle Phone Handle

0 0 Keyboard Keyboard
meticillin-resistant), 6,857 Enterobacteriaceae (29% cefotaxime- With gloves Without gloves With gloves Without gloves
0 10 20 30 40 50 0 0.02 0.04 0.06 0.08 0.1 0.12 0.14 0.16

resistant), 1,209 P. aeruginosa and 148 Salmonella spp. Risk of bacterial acquisition for persons not using gloves: Concentration of bacteria (cfu/cm2) Concentration of bacteria (cfu/cm2)

MRSA 15.3 p < 0.05

Enterobacteriaceae 1.6 p = not significant
Discussion
Materials And Methods Key to abbreviations: MRSA = meticillin-resistant S. aureus; ENBA = Enterobacteriaceae

Staphylococcus aureus is the most commonly distributed bacterial

Bacterial culture was performed from the hands of 12 laboratory
technologists prior to commencing work, after working in the
laboratory for 21/2 hours, and after standard handwashing with a
chlorhexidine-based detergent. Staff were divided into two groups:
those who used gloves at all times during work, and those who did not.
Commonly touched surfaces in the laboratory were also randomly
sampled by swabbing a defined surface area during the middle of the
working day. Laboratory benches were routinely disinfected at the end
of each day with a phenolic-based disinfectant.
Handwashing pathogens on the hands of laboratory workers and laboratory surfaces.
Prior to handwashing, 12 hand samples showed the presence of MRSA Other studies have reported extensive contamination with Enterococcus
or Enterobacteriaceae. Total bacterial viable counts showed substantial spp.,3 but this is the first study to systematically examine the risk of
decrease after handwashing, and levels of bacterial pathogens fell acquiring other potentially pathogenic bacteria.
below the detectable limit (<100 cfu/ml) following handwashing. The use of gloves protects staff against MRSA acquisition, but not for
Change in total viable count, prior to and after handwashing
Enterobacteriaceae. However, because of low isolation rates for
50
Salmonella spp. and P. aeruginosa during the study, we are not able to
After work, before handwashing
reliably exclude a similar protective effect for these bacteria. Effective
45
After work, after handwashing handwashing demonstrated a reduction in bacteria isolated from hands,
40

Bacterial counts from hands were performed using a glove-juice including those contaminated with potential pathogens. The use of
35

sampling technique, and bacterial counts from surfaces were alcohol gels may be an alternative.4
no. of hand episodes

performed by eluting swabs in 1 ml of 0.9% saline. Culture was

30
This study was not designed to stratify the risks of acquiring bacteria on
performed semi-quantitatively on chromogenic agar for presumptive
25
hands based on activity of staff. Further data would be required to
identification of meticillin-resistant Staphylococcus aureus (MRSA), 20
determine the risks for laboratory workers dealing with bacterial cultures
Salmonella spp., Enterobacteriaceae and Pseudomonas aeruginosa. 15 compared with those that are only exposed to environmental acquisition
Total viable counts were performed on trypticase soy agar with 5% 10 of bacteria.
sheep blood. Identification of S. aureus and P. aeruginosa were 5
REFERENCES:
confirmed by standard laboratory methods. No futher speciation was 0 1 WHO | Laboratory Biosafety Manual - Third Edition [Internet]. [date unknown];[cited 2010 Feb 22 ] Available from:
http://www.who.int/csr/resources/publications/biosafety/WHO_CDS_CSR_LYO_2004_11/en/
<100 101-1,000 1,000-10,000 10,000-100,000
performed for Enterobacteriaceae. total viable count (cfu/ml)
2
3
Sewell D. Laboratory-acquired infections: Are microbiologists at risk? Clinical Microbiology Newsletter 2006;28(1):1-6.
Collins SM, et al. Contamination of the Clinical Microbiology Laboratory with Vancomycin-Resistant Enterococci and Multidrug- Resistant
Enterobacteriaceae: Implications for Hospital and Laboratory Workers. Journal of Clinical Microbiology 2001 Oct;39(10):3772-3774.
4 Alp E, Haverkate D, Voss A. Hand hygiene among laboratory workers. Infection Control Hospital and Epidemiology 2006 Sep;27(9):978-
980.

This study was funded by a grant from the National Medical Research Council, Singapore