One in four seniors is bringing along stowaways from the hospital to their next stop: superbugs on their  hands.

Older people often need extra time in a post-acute care (PAC) facility for rehabilitation after common procedures such as hip and knee replacements. So in a new study, my team focused on these types of patients — those who have recently been admitted to the hospital for a medical or surgical issue and temporarily need extra medical care in a PAC facility before fully returning home.

Moreover, seniors continue to acquire new superbugs, or multidrug-resistant organisms (MRDOs), during their stay at post-acute care facilities, according to our study published today in a JAMA Internal Medicine research letter.

We've been educating healthcare workers for decades about hand hygiene, and it's time to include patients in their own hand hygiene performance and education.

Our PATHWAYS project team studied 357 such seniors who were admitted directly from the hospital toa PAC facility in Southeast Michigan. Surprisingly, we found that one-quarter of these patients had at least one multidrug-resistant organism (MDRO), or superbug, on their hands at enrollment.

We tested these patients' hands after two weeks and then monthly, for up to six months or until their discharge home from the post-acute care facility. During the follow-up visits, we found that not only did these organisms persist, but more seniors acquired new superbugs on their hands — up from one in four to more than one in three.

A high level of MDROs on patient hands increases the chance that these superbugs will be transmitted to other frail patients and healthcare workers. Frequent antibiotic use in post-acute care patients also raises the probability that MDROs introduced to a post-acute care facility will flourish.

A change in culture

Patients want to be active, much more than in the past. Wish lists for post-acute care facilities now include activities, group dinners and other social life enhancements.

However, when people leave their room often, they're more likely to touch other areas of a health facility's environment, healthcare workers and other patients — increasing chances of acquiring an MDRO. Increasing numbers of seniors bringing hospital superbugs through the revolving door of the PAC facilities for short stays (as opposed to living long term) means new policies and innovations are needed to stop the superbugs from spreading more deeply into the post-acute care facilities.

Adapting staff lessons to patients

Although hand hygiene education is a key part of our health system's employee orientation, patient hand washing is not a routine practice in hospitals. We need to build on the innovative educational tools we've already developed with adult learning theories and bring them to patients. Improving hand hygiene in patients and staff will improve the health of both.

One strategy includes physically showing the superbugs that grow on people's hands, by swabbing them and then processing them in the lab. People are always surprised when they see how much can grow on their hands — and effectiveness of clearing these organisms by simply washing hands appropriately. Furthermore, families and volunteers can be involved in encouraging and helping their patients perform hand hygiene.

Several other items from our TIP study toolkit could also be adapted to a patient audience, including:

• Educational posters about hand hygiene
• Educational modules and trivia questions about hand hygiene
• An infection preventionist on-site to ensure availability of hand hygiene products, including personal-use alcohol gel

In the past, we used to think infection control was the job of the health employee, but hand hygiene is everybody's business. Can engaging and educating patients in their own hand hygiene enhance healthcare personnel hand hygiene? We would not be surprised.