Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection.

Abstract

OBJECTIVE:

To assess the effect of a multifaceted hand hygiene culture-change program on health care worker behaviour, and to reduce the burden of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infections.

DESIGN AND SETTING:

Timetabled introduction of interventions (alcohol/chlorhexidine hand hygiene solution [ACHRS], improved cleaning of shared ward equipment, targeted patient decolonisation, comprehensive "culture change" package) to five clinical areas of a large university teaching hospital that had high levels of MRSA.

MAIN OUTCOME MEASURES:

Health care worker hand hygiene compliance; volume of ACHRS used; prevalence of patient and health care worker MRSA colonisation; environmental MRSA contamination; rates of clinical MRSA infection; and rates of laboratory detection of ESBL-producing Escherichia coli and Klebsiella spp.

RESULTS:

In study wards, health care worker hand hygiene compliance improved from a pre-intervention mean of 21% (95% CI, 20.3%-22.9%) to 42% (95% CI, 40.2%-43.8%) 12 months post-intervention (P < 0.001). ACHRS use increased from 5.7 to 28.6 L/1000 bed-days. No change was observed in patient MRSA colonisation or environmental colonisation/contamination, and, except in the intensive care unit, colonisation of health care workers was unchanged. Thirty-six months post-intervention, there had been significant reductions in hospital-wide rates of total clinical MRSA isolates (40% reduction; P < 0.001), patient-episodes of MRSA bacteraemia (57% reduction; P = 0.01), and clinical isolates of ESBL-producing E. coli and Klebsiella spp (90% reduction; P < 0.001).

CONCLUSIONS:

Introduction of ACHRS and a detailed culture-change program was effective in improving hand hygiene compliance and reducing nosocomial MRSA infections, despite high-level MRSA endemicity.

• Authors: Paul D R Johnson, Rhea Martin, Laurelle J Burrell, Elizabeth A Grabsch, Susan W Kirsa, Jason O'Keeffe, Barrie C Mayall, Deidre Edmonds, Wendy Barr, Christopher Bolger, Humsha Naidoo, M Lindsay Grayson
• Journal: The Medical journal of Australia (Med J Aust) Vol. 183 Issue 10 Pg. 509-14 (Nov 21 2005) ISSN: 0025-729X [Print] Australia
• PMID: 16296963 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Infective Agents, Local
• Ethanol
• Chlorhexidine

Topics

• Anti-Infective Agents, Local (therapeutic use)
• Bacteremia (prevention & control)
• Chlorhexidine (therapeutic use)
• Cross Infection (prevention & control)
• Equipment Contamination (prevention & control)
• Equipment and Supplies, Hospital (microbiology)
• Escherichia coli (drug effects, isolation & purification)
• Ethanol (therapeutic use)
• Follow-Up Studies
• Guideline Adherence
• Hand Disinfection (methods)
• Hospital Units
• Humans
• Intensive Care Units
• Klebsiella (drug effects, isolation & purification)
• Methicillin Resistance
• Personnel, Hospital
• Staphylococcal Infections (prevention & control)
• Staphylococcus aureus (drug effects, isolation & purification)
• beta-Lactam Resistance