Microbes recovered from hands can be divided into two categories: transient and resident organisms. Transient microorganisms tend to colonize the superficial layers of skin and while they are amenable to removal by washing hands with plain (i.e., non-antimicrobial) soap and water, they are responsible for most HAIs. Resident organisms are attached to deeper layers of the skin and while they are more resistant to removal, they are less likely to be associated with HAIs.
The number of transient and resident organisms may vary greatly among HCP, yet it is often relatively constant for any one individual.15 Transient organisms are acquired during:
The hands of HCP may also become persistently colonized with transient pathogenic organisms (e.g., S. aureus, gram-negative bacilli, or yeast), which subsequently may be transmitted to patients. It is of note that organisms are transferred in much larger numbers from wet hands than from hands that have been thoroughly dried.16 The transmission of healthcare-associated pathogens from one patient to another via the hands of HCP must meet 4 criteria:1,3
To prevent or reduce the risk of occupational exposure, the standard of care mandates that HCP wear gloves.1,3,17 However, gloves do not provide complete protection against cross-infection. Bacterial flora colonizing patients have been recovered from the hands of ≥30% of HCP who wore gloves during patient contact.18,19 The acquisition of hepatitis B, hepatitis C, and herpes simplex viruses (HSV-1) by HCP wearing gloves has also been documented.2,20,21
It is also of note that at least 70% of the population shed HSV-1 asymptomatically at least once a month, many individuals shed the virus >6 times a month, and the virus can survive for several hours in a variety of fluids, on dental charts, and environmental surfaces.22 Since pathogens can be transmitted via small defects in gloves or by contamination of the hands during glove removal, wearing gloves does not eliminate the need for appropriate hand hygiene practices.18-21,23