Cleanliness in context: reconciling hygiene with a modern microbial perspective
Seventeen per cent of the staff of an intensive care ward were found to have Klebsiella spp contaminating their hands, and these strains could be related to serotypes infecting or colonising patients in the ward on the same day. We identified some simple ward procedures that resulted in contamination of nurses' hands with 100-1000 klebsiellae per hand. Klebsiellae survived on artifically inoculated hands for up to 150 minutes. Handwashing with chlorhexidine hand cleanser reliably gave 98-100% reduction in hand counts, and the introduction of routine handwashing by staff before moving from one patient to the next was associated with a significant and sustained reduction in the number of patients colonised or infected with Klebsiella spp. Staff clothing was occasionally contaminated, but ward air and dust rarely contained klebsiellae.