Antimicrobial resistance patterns of colonizing flora on nurses' hands in the neonatal intensive care unit

Mechanisms of emerging resistance associated with non-antibiotic antimicrobial agents: a state-of-the-art review

Although the development of resistance by microorganisms to antimicrobial drugs has been recognized as a global public health concern, the contribution of various non-antibiotic antimicrobial agents to the development of antimicrobial resistance (AMR) remains largely neglected. The present review discusses various chemical substances and factors other than typical antibiotics, such as preservatives, disinfectants, biocides, heavy metals and improper chemical sterilization that contribute to the development of AMR. Furthermore, it encompasses the mechanisms like co-resistance and co-selection, horizontal gene transfer, changes in the composition and permeability of cell membrane, efflux pumps, transposons, biofilm formation and enzymatic degradation of antimicrobial chemicals which underlie the development of resistance to various non-antibiotic antimicrobial agents. In addition, the review addresses the resistance-associated changes that develops in microorganisms due to these agents, which ultimately contribute to the development of resistance to antibiotics. In order to prevent the indiscriminate use of chemical substances and create novel therapeutic agents to halt resistance development, a more holistic scientific approach might provide diversified views on crucial factors contributing to the persistence and spread of AMR. The review illustrates the common and less explored mechanisms contributing directly or indirectly to the development of AMR by non-antimicrobial agents that are commonly used.

Antimicrobial Resistance Following Prolonged Use of Hand Hygiene Products: A Systematic Review

Background: This systematic review aimed to establish whether antimicrobial resistance (AMR) occurs following prolonged use of antimicrobial hand hygiene (HH) products, and, if so, in what magnitude. Methods: Key bibliographic databases were searched to locate items on HH use and AMR development from database inception to December 2020. Records were screened and full texts of all potentially eligible articles were retrieved and checked for inclusion. The following data from the included studies were abstracted: type of HH product used, including the name of antimicrobial agent, study setting, country, study year, duration of use and development of AMR including the organisms involved. Quality assessment was done using the Newcastle-Ottawa Scale (NOS). Results: Of 339 full-text articles assessed for eligibility, only four heterogeneous United States (US) studies conducted in the period between 1986 and 2015 were found eligible, and included. One hospital-based study showed evidence of AMR following long term use of HH products, two studies conducted in household settings showed no evidence of AMR, and another experimental study showed partial evidence of AMR. The overall certainty of the evidence was moderate. Conclusion: Prolonged use of HH products may cause AMR in health care settings, but perhaps not in other settings.

Assessing the Potential for Unintended Microbial Consequences of Routine Chlorhexidine Bathing for Prevention of Healthcare-associated Infections

Chlorhexidine gluconate (CHG) is an antiseptic that is widely used in healthcare due to its excellent safety profile and wide spectrum of activity. Daily bathing with CHG has proven to be effective in the prevention of healthcare-associated infections and multidrug-resistant pathogen decolonization. Despite the proven benefits of CHG use, there remain concerns and unanswered questions about the potential for unintended microbial consequences of routine CHG bathing. This review aims to explore some of these questions.

Antibiotic ResistanceCan Be Enhanced in Gram-Positive Species by Some Biocidal Agents Used for Disinfection

Some biocidal agents used for disinfection have been described to enhance antibiotic resistance in Gram-negative species. The aim of this review was therefore to evaluate the effect of 13 biocidal agents at sublethal concentrations on antibiotic resistance in Gram-positive species. A MEDLINE search was performed for each biocidal agent on antibiotic tolerance, antibiotic resistance, horizontal gene transfer, and efflux pump. Most data were reported with food-associated bacterial species. In cells adapted to benzalkonium chloride, a new resistance was most frequently found to ampicillin (seven species), cefotaxime and sulfamethoxazole (six species each), and ceftazidime (five species), some of them with relevance for healthcare-associated infections such as Enterococcus faecium and Enterococcus faecalis. With chlorhexidine, a new resistance was often found to imipenem (ten species) as well as cefotaxime, ceftazidime, and tetracycline (seven species each). Cross-resistance was also found with triclosan and ceftazidime (eight species), whereas it was very uncommon for didecyldimethylammonium chloride or hydrogen peroxide. No cross-resistance to antibiotics has been described after low level exposure to glutaraldehyde, ethanol, propanol, peracetic acid, octenidine, povidone iodine, sodium hypochlorite, and polyhexanide. Preference should be given to disinfectant formulations based on biocidal agents with a low or no selection pressure potential.

Hand hygiene compliance and accuracy in a university dental teaching hospital

Objective

This study aimed to evaluate compliance with guidelines on hand hygiene by examining five handwashing categories in postgraduate year (PGY) dentists at a university teaching hospital and to evaluate the accuracy rates of handwashing.

Methods

Through direct observation, trained PGY dentists were monitored throughout their daily care routine of before contact with patients, before using an instrument, after contact with patients, upon direct exposure to patients’ fluids, and while touching the patients’ surrounding area. Hand hygiene opportunities were considered complete in each category. A total of 16,597 hand hygiene opportunities across 37 individuals were observed from July to October 2012 and from September to October 2013.

Results

The overall handwashing compliance rate was 34.7%. The handwashing compliance rate was higher during work in oral surgery services (92.8%) than during work in general clinical practice (34.2%). The accuracy rate of handwashing was also higher during work in oral surgery services (87.5%) than during work in general clinical practice (51.0%). Similar results were obtained across all five handwashing categories.

Conclusions

Handwashing compliance and accuracy rates are low in PGY dentists. More education and continuous monitoring are suggested to improve handwashing compliance, as well as the correct handwashing procedures for dentists.

Characterization of 26 Staphylococcus warneri isolates from orthopedic infections

Staphylococcus warneri is a coagulase negative Staphylococcus (CNS) commonly present in the flora of human epithelia and mucosal membranes. Over the last two decades, similarly to other CNS species, S. warneri has been reported as a new emerging pathogen, capable of causing serious infections usually in association with the presence of implant materials, but, at times, even in the absence of a foreign body and in patients considered immunocompetent. At present, there is still a lack of scientific data on the pathogenesis and epidemiology of this species. The present study investigated a collection of 26 clinical isolates derived from orthopedic infections, some associated with implant materials and others not. Automated ribotyping showed the existence of 5 distinct ribogroups. Except for the least numerous ribogroup consisting of a single isolate, all other ribogroups included at least one strain obtained from an infection not associated with implant materials, suggesting that putative virulence factors necessary for infections even in the absence of a foreign body could be transversal to most ribogroup categories. Orthopedic infections were found to involve S. warneri strains with low antibiotic resistance potential, differing in this respect from the strains isolated at neonatal intensive care units, where this species has been described to figure among the principal causative agents and exhibit an alarming profile of antibiotic resistance.

Integrated measures for prevention of invasive Candida infections in preterm infants in a Chinese neonatal intensive care unit

BACKGROUND

The increasing incidence of invasive Candida infections (ICIs) in preterm infants in the neonatal intensive care unit (NICU) of Xinhua Hospital aroused our concern. We undertook a retrospective study to evaluate the efficacy of different preventive measures for ICI in preterm infants.

METHODS

Preterm infants with gestational age (GA) <33 weeks admitted between 2010 and 2013 were divided into 3 groups according to the preventive measures applied in different periods: the control group (CG), fluconazole group (FG), and integrated measures group (IMG). We analyzed the incidence of ICI and distribution of fungal pathogens in these 3 groups, and also evaluated the efficiency of various measures in preventing ICIs in preterm infants.

RESULTS

The study sample comprised 261 preterm infants born at <33 weeks GA, including 94 in the CG, 99 in the FG, and 68 in the IMG. The differences among the groups were not significant at baseline. ICI developed in 41 of the 261 infants (15.7%). The incidence of ICI varied significantly among the groups: 22.3% in the CG (21/94), 18.2% in the FG (18/99), and only 2.9% in the IMG (2/68) (P = .003). ICI was less frequent in the IMG compared with the CG (P <.001) and the FG (P = .003).

CONCLUSIONS

The integrated measures approach is meaningful for the prevention of ICIs in preterm infants in NICUs with many patients but inadequate medical resources in some developing countries.

Multicenter Study of Hand Carriage of Potential Pathogens by Neonatal ICU Healthcare Personnel

A multicenter surveillance study was performed to determine the rates of hand carriage of potential pathogens among healthcare personnel in four neonatal intensive care units. Staphylococcus aureus, enterococci, and gram-negative bacilli were recovered from 8%, 3%, and 2% of 1000 hand culture samples, respectively.

Infection control: Knowledge and compliance among Saudi undergraduate dental students

OBJECTIVE

This study aimed to assess the level of knowledge, attitudes, and practices regarding infection control procedures among undergraduate dental students.

METHODS

This was a questionnaire-based cross-sectional survey. A self-administered questionnaire consisting of questions on students' vaccination status as well as knowledge and attitudes regarding infection control was sent to 600 undergraduate dental students in the fourth, fifth, and sixth year of the Al-Farabi College for Dentistry and Nursing, Riyadh, Saudi Arabia. The collected data were analyzed using SPSS software. The significance level was set at P<0.05.

RESULTS

The response rate was 85% (512 out of 600). While the vast majority of students (90%) had been vaccinated against hepatitis, only 37.4% have been assessed for anti-HBs. A total of 98.8% and 90.8% reported always wearing gloves and masks, respectively, during dental procedures. The use of protective eyewear was reported by only 29.2%. A significantly higher proportion of sixth-year students showed a positive attitude toward the treatment of patients with infectious diseases than other students of lower academic years. Approximately one-third of students reported having one or more occupational injuries while treating their patients.

CONCLUSION

Although the students had good knowledge and attitudes regarding infection control, the compliance and practice levels regarding the same were low. Such findings highlight the necessity of continued infection-control education of Saudi dental students.

Knowledge, Attitudes, and Practice of Infection Control among Dental Students at Sana'a University, Yemen

BACKGROUND

The aim of this study was to evaluate knowledge, attitudes, and practices regarding infection control procedures among senior dental students.

MATERIALS AND METHODS

A questionnaire-based cross-sectional survey was conducted among 145 4(th)- and 5(th)-year dental students at the Faculty of Dentistry, Sana'a University, Yemen. The self-administered questionnaire was comprised of 20 open- and close-ended items regarding barrier techniques, vaccination status, infection control practices, and awareness. Data were analyzed with a Chi-square test. A P ≤ 0.05 was considered significant.

RESULTS

The response rate was 72% (145 out of 204 potential respondents). Overall, 71.7% of the students had been vaccinated for hepatitis B and only 9.5% were tested for post-hepatitis B virus immunization serology. While the vast majority (96.6%) reported always wearing gloves for all dental procedures, the use of face masks and eyewear were reported by only 53.8% and 14.0% of students, respectively, with no significant difference between genders and year of study (P > 0.05). A significantly higher percentage of 5(th)-year students (58.9%) showed positive attitudes toward the treatment of patients with infectious diseases, as compared to only 31.0% of 4(th) year students (P < 0.01). A great number of students (62%) reported non-sterile occupational percutaneous and mucous injuries while treating their patients.

CONCLUSIONS

These unsatisfactory findings highlight the necessity of continued infection control education in order to improve knowledge, attitudes, and practices regarding infection control among dental students at Sana'a University.

Epidemiology of Enterococci in a Neonatal Intensive Care Unit

We performed an epidemiological investigation of a 62-bed neonatal intensive care unit in response to 2 infants with clinical cultures positive for vancomycin-resistant enterococci (VRE). Surveillance cultures detected 11 infants colonized with VRE. Surveillance triggered by even a single clinical culture positive for VRE may be justified in the neonatal intensive care unit, because a single culture result may represent a large hidden reservoir of VRE-colonized infants.

Compliance with infection control practices in an university hospital dental clinic

Aim: Compliance with infection control practices is the key to quality care and excellence in dentistry. Infection control remains one of the most cost-beneficial interventions available. However, implementing control procedures requires full compliance of the whole dental team. The aim of our study was to measure the compliance in daily clinical practice.

Methods: The compliance with infection control practices in dentistry by dental health care personnel (DHCP) in a German university dental clinic was observed during clinical work. In addition, a survey was conducted to assess the individual knowledge about infection control procedures. Contamination of the workplace during invasive dental procedures was tested, as well.

Results: A total of 58 invasive dental treatments implying close contacts between HCWs and patients were scrutinized. All HCWs (100%) wore gloves during dental work, but in some cases (female dentists: 14.3%; dental assistants: 28.6%) gloves were neither changed nor hands were disinfected between different activities or patient contacts (female dentists: 68.6%; male dentists: 60.9%; dental assistants: 93%). Only 31.4% of female and 39.1% of male dentists carried out adequate hygienic hand disinfection after removing gloves. Male dentists wore significantly more often (100%) protective eyewear compared to 77.1% of female dentists (p<0.05). In addition, most of female dentists (62.9%) and dental assistants (80.7%) wore jewelry during dental procedures.

Conclusion: Despite the knowledge of distinct hygiene procedures only a small percentage of dental staff performs hygiene practices according to recommended guidelines. Strict audit is clearly needed in the dental setting to ensure compliance with infection control guidelines to prevent transmission of pathogens. Our results provide insights for the development of a targeted education and training strategy to enhance compliance of dental staff especially of dental assistants with infection control procedures.

Three distinct two-component systems are involved in resistance to the class I bacteriocins, Nukacin ISK-1 and nisin A, in Staphylococcus aureus

Staphylococcus aureus uses two-component systems (TCSs) to adapt to stressful environmental conditions. To colonize a host, S. aureus must resist bacteriocins produced by commensal bacteria. In a comprehensive analysis using individual TCS inactivation mutants, the inactivation of two TCSs, graRS and braRS, significantly increased the susceptibility to the class I bacteriocins, nukacin ISK-1 and nisin A, and inactivation of vraSR slightly increased the susceptibility to nukacin ISK-1. In addition, two ABC transporters (BraAB and VraDE) regulated by BraRS and one transporter (VraFG) regulated by GraRS were associated with resistance to nukacin ISK-1 and nisin A. We investigated the role of these three TCSs of S. aureus in co-culture with S. warneri, which produces nukacin ISK-1, and Lactococcus lactis, which produces nisin A. When co-cultured with S. warneri or L. lactis, the braRS mutant showed a significant decrease in its population compared with the wild-type, whereas the graRS and vraSR mutants showed slight decreases. Expression of vraDE was elevated significantly in S. aureus co-cultured with nisin A/nukacin ISK-1-producing strains. These results suggest that three distinct TCSs are involved in the resistance to nisin A and nukacin ISK-1. Additionally, braRS and its related transporters played a central role in S. aureus survival in co-culture with the strains producing nisin A and nukacin ISK-1.

The Environmental Cost of Misinformation: Why the Recommendation to Use Elevated Temperatures for Handwashing is Problematic

Multiple government and health organizations recommend the use of warm or hot water in publications designed to educate the public on best practices for washing one's hands. This is despite research suggesting that the use of an elevated water temperature does not improve handwashing efficacy, but can cause hand irritation. There is reason to believe that the perception that warm or hot water is more effective at cleaning one's hands is pervasive, and may be one factor that is driving up unnecessary energy consumption and greenhouse gas emissions. We examine handwashing practices and beliefs about water temperature using a survey of 510 adults in the United States. The survey included measures of handwashing frequency, duration, the proportion of time an elevated temperature was used, and beliefs about water temperature and handwashing efficacy. We also estimate the energy consumed and resultant carbon dioxide equivalent emissions (CO₂eq) in the U.S. due to the use of elevated temperatures during handwashing. Participants used an elevated temperature 64% of the time, causing 6.3 million metric tons (MMt) of CO₂eq which is 0.1% of total annual emissions and 0.3% of commercial and residential sector emissions. Roughly 69% of the sample believed that elevated temperatures improve handwashing efficacy. Updating these beliefs could prevent 1 MMt of CO₂eq annually, exceeding the total emissions from many industrial sources in the U.S. including the Lead and Zinc industries. In addition to causing skin irritation, the recommendation to use an elevated temperature during handwashing contributes to another major threat to public health-climate change. Health and consumer protection organizations should consider advocating for the use of a "comfortable" temperature rather than warm or hot water.

Candida spp. isolated from inpatients, the environment, and health practitioners in the Pediatric Unit at the Universitary Hospital of the Jundiaí Medical College, State of São Paulo, Brazil

INTRODUCTION

This study aimed to isolate and identify Candida spp. from the environment, health practitioners, and patients with the presumptive diagnosis of candidiasis in the Pediatric Unit at the Universitary Hospital of the Jundiaí Medical College, to verify the production of enzymes regarded as virulence factors, and to determine how susceptible the isolated samples from patients with candidiasis are to antifungal agents.

METHODS

Between March and November of 2008 a total of 283 samples were taken randomly from the environment and from the hands of health staff, and samples of all the suspected cases of Candida spp. hospital-acquired infection were collected and selected by the Infection Control Committee. The material was processed and the yeast genus Candida was isolated and identified by physiological, microscopic, and macroscopic attributes.

RESULTS

The incidence of Candida spp. in the environment and employees was 19.2%. The most frequent species were C. parapsilosis and C. tropicalis among the workers, C. guilliermondii and C. tropicalis in the air, C. lusitanae on the contact surfaces, and C. tropicalis and C. guilliermondii in the climate control equipment. The college hospital had 320 admissions, of which 13 (4%) presented Candida spp. infections; three of them died, two being victims of a C. tropicalis infection and the remaining one of C. albicans. All the Candida spp. in the isolates evidenced sensitivity to amphotericin B, nystatin, and fluconazole.

CONCLUSIONS

The increase in the rate of hospital-acquired infections caused by Candida spp. indicates the need to take larger measures regarding recurrent control of the environment.

Evaluation of handwashing behaviors and analysis of hand flora of intensive care unit nurses

PURPOSE

The aim of this study was to evaluate the handwashing behaviors of intensive care nurses based on personal statements, and to identify the microorganisms represented in the hand flora preshift and postshift.

METHODS

This prospective study was performed with 60 intensive care nurses between January and December 2008, at a training and research hospital at a university in Turkey. Samples were taken from the hands of the nurses for bacteriological culture, using the bag-broth method, at the beginning and end of the shift. The samples were cultured aerobically and the colonies that grew were counted and identified. The nurses completed a self-report questionnaire, and their answers were evaluated.

RESULTS

The frequency of handwashing by participants during each shift was 32.8±13.9. Overall, 65% of the nurses preferred alcohol-based antiseptic solutions for handwashing, 95% used paper towels to dry their hands, and 98.3-100% of the nurses washed their hands after performing care procedures. The Escherichia coli and coagulase negative Staphylococcus species were found to be at significantly higher levels in the postshift hand culture samples when compared to the preshift hand culture sample values. Enterobacter cloacae was the only species found in the postshift hand culture samples of the nurses.

CONCLUSIONS

The number of colonies of the microorganisms in the hand flora of the nurses increased postshift. The handwashing behavior of intensive care nurses must be improved as they nurse critical patients.

Hand contamination of anesthesia providers is an important risk factor for intraoperative bacterial transmission

BACKGROUND

We have recently shown that intraoperative bacterial transmission to patient IV stopcock sets is associated with increased patient mortality. In this study, we hypothesized that bacterial contamination of anesthesia provider hands before patient contact is a risk factor for direct intraoperative bacterial transmission.

METHODS

Dartmouth-Hitchcock Medical Center is a tertiary care and level 1 trauma center with 400 inpatient beds and 28 operating suites. The first and second operative cases in each of 92 operating rooms were randomly selected for analysis. Eighty-two paired samples were analyzed. Ten pairs of cases were excluded because of broken or missing sampling protocol and lost samples. We identified cases of intraoperative bacterial transmission to the patient IV stopcock set and the anesthesia environment (adjustable pressure-limiting valve and agent dial) in each operating room pair by using a previously validated protocol. We then used biotype analysis to compare these transmitted organisms to those organisms isolated from the hands of anesthesia providers obtained before the start of each case. Provider-origin transmission was defined as potential pathogens isolated in the patient stopcock set or environment that had an identical biotype to the same organism isolated from hands of providers. We also assessed the efficacy of the current intraoperative cleaning protocol by evaluating isolated potential pathogens identified at the start of case 2. Poor intraoperative cleaning was defined as 1 or more potential pathogens found in the anesthesia environment at the start of case 2 that were not there at the beginning of case 1. We collected clinical and epidemiological data on all the cases to identify risk factors for contamination.

RESULTS

One hundred sixty-four cases (82 case pairs) were studied. We identified intraoperative bacterial transmission to the IV stopcock set in 11.5 % (19/164) of cases, 47% (9/19) of which were of provider origin. We identified intraoperative bacterial transmission to the anesthesia environment in 89% (146/164) of cases, 12% (17/146) of which were of provider origin. The number of rooms that an attending anesthesiologist supervised simultaneously, the age of the patient, and patient discharge from the operating room to an intensive care unit were independent predictors of bacterial transmission events not directly linked to providers.

CONCLUSION

The contaminated hands of anesthesia providers serve as a significant source of patient environmental and stopcock set contamination in the operating room. Additional sources of intraoperative bacterial transmission, including postoperative environmental cleaning practices, should be further studied.

Coagulase-negative staphylococcal skin carriage among neonatal intensive care unit personnel: from population to infection

Coagulase-negative staphylococci (CoNS) are a major cause of sepsis in neonatal intensive care units (NICU) worldwide. Infecting strains of these commensal bacteria may originate from NICU personnel. Therefore, we studied the characteristics of CoNS isolates from NICU personnel and compared them to those of isolates from the general population and from sepsis patients. Furthermore, we studied the epidemiological effect on CoNS carriage of NICU personnel after a period of absence. In our study, we isolated CoNS from the thumbs of NICU personnel every 2 weeks during the summer of 2005 and sampled personnel returning from vacation and a control group from the general population. Furthermore, we collected sepsis isolates from this period. Isolates were tested for antibiotic resistance, mecA and icaA carriage, biofilm production, and genetic relatedness. We found that mecA and icaA carriage as well as penicillin, oxacillin, and gentamicin resistance were significantly more prevalent in CoNS strains from NICU personnel than in community isolates. Similar trends were observed when postvacation strains were compared to prevacation strains. Furthermore, genetic analysis showed that 90% of the blood isolates were closely related to strains found on the hands of NICU personnel. Our findings revealed that CoNS carried by NICU personnel differ from those in the general population. Hospital strains are replaced by community CoNS after a period of absence. NICU personnel are a likely cause for the cross-contamination of virulent CoNS that originate from the NICU to patients.

[Investigation of in vitro and in vivo efficacy of a novel alcohol based hand rub, MR06B7]

Alcohol based hand rubs have been used for hand hygiene in health-care settings. Compared with hand scrubbing, using suitable alcohol based hand rub provides several advantages like usability in a ward with no tap, requiring less time and mildly-irritating. Alcohol provides immediate activity, but poor virucidal activity against certain viruses including norovirus. It is important to develop further improved alcohol based hand rubs which have characteristics of sufficient effectiveness, skin-safe and extended spectrum to non-enveloped viruses for infection control. In the study, in vitro microbicidal evaluations and in vivo efficacy evaluation study were investigated to clarify the characteristics of a novel hand antiseptic MR06B7 composed of additives with synergetic activities. MR06B7 showed bactericidal activity of more than 5 Log(10) reduction within 15 sec against 20 challenged strains. MR06B7 also demonstrated potent fungicidal activities at exposure time of 30 sec (more than 4 Log(10) reduction). Against all test viruses including non-enveloped viruses (adenovirus, feline calicivirus, murine norovirus and poliovirus), MR06B7 had excellent virucidal activity to reduce the titer of viability to the limit of detection within 30 sec exposure (more than 4 Log(10) reduction), whereas 83%(v/v) ethanol indicated the inadequate effectiveness. On the clinical study conducted in accordance with standard method for Healthcare Personnel Handwash of American Society for Testing and Materials, MR06B7 showed excellent immediate antimicrobial activity. The result surpassed the critical indices set forth in the FDA's Tentative Final Monograph. These findings suggest MR06B7 which satisfies most requirements of efficacy qualifications including potent virucidal activity against non-enveloped viruses may contribute to accomplish advanced infection control in clinical practice.

Rate of Compliance with Hand Hygiene by Dental Healthcare Personnel (DHCP) within a Dentistry Healthcare First Aid Facility

OBJECTIVES

To evaluate the compliance with the opportunities of hand hygiene by dentistry school healthcare professionals, as well as the higher choice products.

METHODS

Through direct observation, the oral healthcare team-professors, oral and maxillofacial surgery residents, graduation students-for daily care were monitored: before performing the first treatment of the shift, after snacks and meals, and after going to the bathroom (initial opportunities) as well as between patients' care, and after ending the shift (following opportunities).

RESULTS

The professors' category profited 78.4% of all opportunities while residents and graduation students did not reach 50.0% of compliance. Statistically significant data (P

CONCLUSIONS

Although gloves were worn in all procedures, we concluded that the hygiene compliance by these professionals was under the expectation.

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Key Words

• Cross-transmission
• Dentistry school
• Hand hygiene
• Infection control

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Affiliation(s)

Marcília Batista de Amorim-Finzi MSc, Department of Microbiology, Federal University of Uberlandia, Uberlandia-MG, Brazil
Mauro Vieira Cezar Cury Federal University of Uberlandia, Faculty of Dentistry, Uberlandia-MG, Brazil
Cláudio Rodrigues R. Costa Federal University of Uberlandia, Faculty of Dentistry, Uberlandia-MG, Brazil
Angelis Costa dos Santos Federal University of Uberlandia, Faculty of Dentistry, Uberlandia-MG, Brazil
Geraldo Batista de Melo PhD, Associate Professor, Department of Microbiology, Federal University of Uberlandia, Uberlandia-MG, Brazil

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