How clean hospitals can reduce antibiotic resistance and save lives

A new paper in Evolution, Medicine, and Public Health, published by Oxford University Press, indicates that antibiotic resistance may result from poor hygiene practices in hospitals or other medical facilities.

Proper hand hygiene in clinical work is a cornerstone of patient safety, but compliance is still poor. This is even though hand hygiene is simple, safe, and cheap. Antibiotics save lives and make much of modern medicine possible. But bacteria that evolve resistance so that they are no longer killed by antibiotics threaten those medical gains, particularly when they spread from patients in healthcare settings.

When a patient takes antibiotics, that inhibits any drug-sensitive bacteria in the body. If that patient carries bacteria resistant to antibiotics, that’s an environment where they can thrive. Good hygiene, in both health care and the community, is central to infection control. This is well known. But what’s less clear is how hygiene (or other transmission control measures) affects the evolution of antibiotic resistance.

Researchers here addressed whether hygiene weakens the effect of antibiotic pressure on resistance evolution. The authors first developed a mathematical model of resistance to predict how good or poor hygiene might affect how rapidly resistant bacteria increase in abundance due to antibiotic treatment.

Then they tested this model against antibiotic resistance information from the European Centre for Disease Prevention and Control. Data collected at 691 long-term care facilities in 19 European countries in 2013 suggest that this is the case. Countries where staff at such facilities made better use of alcohol-based hand rubs saw  less enrichment of antibiotic-resistant bacteria, here resistant E. coli bacteria, for their antibiotic use.   

This indicates that staff keeping hospitals and other facilities like nursing homes clean, using training and procedures, will prevent patients from acquiring resistant bacteria from others – and thereby prevent the explosive amplifications that accelerate the spread of drug-resistant diseases.

“Health care hygiene is a cornerstone of good clinical practice, said the paper’s lead author, Kristofer Wollein Waldetoft. “It’s also key to the management of antibiotic resistance by protecting patients from the acquisition of resistant strains. The importance of hygiene, especially hand hygiene, is well appreciated by health care professionals, but compliance has nonetheless been shown to be poor. There is thus opportunity to improve on this important, yet simple, aspect of resistance management.”

The paper, “Hygiene may attenuate selection for antibiotic resistance by changing microbial community structure,” is available (at midnight on January 17^th) at: https://doi.org/10.1093/emph/eoac038.

Direct correspondence to: 
Kristofer Wollein Waldetoft
Center for Microbial Dynamics and Infection 
Georgia Institute of Technology
310 Ferst Dr NW
Atlanta, GA 30332 
kristofer.wolleinwaldetoft@biology.gatech.edu

To request a copy of the study, please contact:
Daniel Luzer 
daniel.luzer@oup.com