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

Med J Aust. 2005 Nov 21;183(10):509-14. doi: 10.5694/j.1326-5377.2005.tb07151.x.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • 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
  • Escherichia coli / isolation & purification
  • Ethanol / therapeutic use*
  • Follow-Up Studies
  • Guideline Adherence
  • Hand Disinfection / methods*
  • Hospital Units
  • Humans
  • Intensive Care Units
  • Klebsiella / drug effects
  • Klebsiella / isolation & purification
  • Methicillin Resistance*
  • Personnel, Hospital
  • Staphylococcal Infections / prevention & control*
  • Staphylococcus aureus / drug effects
  • Staphylococcus aureus / isolation & purification
  • beta-Lactam Resistance

Substances

  • Anti-Infective Agents, Local
  • Ethanol
  • Chlorhexidine