Ring wearers wed pathogens to patients

Ring wearers wed pathogens to patients

Three-fourths of workers with rings contaminated

Health care workers who wear rings are far more likely to carry pathogenic bacteria on their hands than their ringless colleagues, researchers report. Colonization can occur in the area between the skin and the ring, creating a moist covered environment for bacteria to grow. Wearing gloves does not necessarily eliminate the problem, particularly since rings also have been associated with glove tears, says Robert Hayes, a microbiologist at Cook Country Hospital in Chicago. "The study was not designed to look at that, but just as your hand can become contaminated in removal of the gloves, I am sure that a ring could also," he tells Hospital Infection Control.

Hayes and colleagues found that 76% of health care workers who wore a ring had bacteria-contaminated hands, compared to 29% of workers who did not wear rings. Wearing more than one ring increased hand contamination to 94%. Further, bacteria on ringed hands were more numerous than bacteria on nonringed hands.

The study was done by a multidisciplinary group from Cook County Hospital, the Atlanta-based Centers for Disease Control and Prevention (CDC), and Rush-Presbyterian-St. Luke’s Medical Center, also in Chicago.¹ Samples were obtained from health care workers in the surgical intensive care unit at Rush, and laboratory work was completed at Cook County.

Using a glove juice technique, the researchers sampled 66 RNs a total of 282 times over 14 weeks. Selective media were inoculated with organisms from filtered glove juice. The researchers evaluated skin condition, dominant hand, the number and type of rings worn, nail length and applications, the number of patients cared for, and glove use during patient care. The hand cultures were processed to determine the number and type of microorganisms recovered and whether any were resistant to antibiotics. Indeed, two of the five most commonly recovered pathogens were antibiotic-resistant strains.

Pathogens cultured during the 282 assays included methicillin-resistant coagulase-negative staphylococci (201/282; 71%), gram-negative bacilli (42/282; 15%), Staphylococcus aureus (38/282; 14%), Candida species (33/282; 12%), and vancomycin-resistant enterococci (6/282 2%). By multivariate analysis, only ring use by the nurses remained an independent risk factor for contamination by presumably transient organisms.

Citing a lack of definitive data, the CDC left ring wearing as "an unresolved issue" in its draft hand hygiene guidelines. Whether the wearing of rings results in greater transmission of pathogens appears to be the key issue.

While contamination has been found, other studies document that the mean bacterial colony counts on hands after hand washing were similar among individuals wearing rings and those not wearing rings, the CDC stated in the draft. Further studies are needed to establish if wearing rings poses an increased risk of transmission of pathogens in health care settings, the agency concluded.

One problem is that studies that have looked at the issue have used different research techniques, making comparison of data difficult, Hayes says. "There are a lot of unresolved issues," he says. "We didn’t inoculate hands. In a lot of studies that have been performed, [researchers] inoculate before, then do their test. The data don’t necessarily follow suit."

Reference

1. Hayes RA, Trick WE, Vernon, et al. Ring use as a risk factor for hand colonization in a surgical intensive care unit. Abstract 1333. Presented at the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago; December 2001.