A comprehensive hand hygiene approach to reducing MRSA health care-associated infections

Jt Comm J Qual Patient Saf. 2009 Apr;35(4):180-5. doi: 10.1016/s1553-7250(09)35024-2.


Background: Methicillin-resistant Staphylococcus aureus (MRSA) infections are the most common health care-associated infections (HAI) in the acute care setting. The major mode of transmission from patient to patient is through bedside care providers via contaminated hands. After individual projects within Novant Health proved to be ineffective, with any gains in hand hygiene compliance being short-lived, a program was implemented to address unsatisfactory hand hygiene compliance rates. Published studies have associated improvements in hand hygiene compliance with decreases in HAIs.

Methods: A comprehensive systemwide program was developed with major program support from the education, marketing, clinical improvement, and clinical care departments. The key drivers of the program were the use of alcohol-based hand sanitizer and the system's dedication of resources to collect and report the compliance data. Monthly compliance rates were collected by two dedicated compliance monitors, and the results were shared across the system. In addition, MRSA HAI rates were followed for all the acute care facilities.

Results: Hand hygiene compliance rates increased from a baseline compliance of 49% to 98% for December 2008, with sustained rates greater than 90% since November 2006. More importantly, MRSA rates decreased from 0.52 HAIs per 1,000 patient days in 2005 to 0.24 HAIs per 1,000 patient days by year-end 2008.

Discussion: Understanding hand hygiene compliance is a simple matter of observing caregiver behavior during each hand hygiene opportunity and recording the actions taken. The improvements in hand hygiene compliance translated into a real decrease in the number of hospital-acquired MRSA infections.

MeSH terms

  • Guideline Adherence
  • Hand Disinfection / standards*
  • Humans
  • Infection Control / standards*
  • Inservice Training
  • Methicillin-Resistant Staphylococcus aureus*
  • Organizational Case Studies
  • Outcome Assessment, Health Care
  • Personnel, Hospital / education
  • Practice Guidelines as Topic
  • Social Marketing
  • Staphylococcal Infections / prevention & control*