Comparative efficacy of commercially available alcohol-based hand rubs and World Health Organization-recommended hand rubs: Formulation matters

Reply to Widmer and Tschudin-Sutter

“…7 In hospitals where MRSA is endemic, screening (targeted or universal) reduced infection rates and was cost saving compared with a policy of no screening. 3,4 Universal MRSA screening strategies were more effective but also more cost-intensive than targeted screening. 4,6,7 In a retrospective review of a 3-year MRSA screening program that was implemented from 2006 to 2009 in the United Kingdom, only 7 extra MRSA cases were detected using universal screening compared with targeted screening, and in 1 month, universal screening generated 4,200 negative screens that incurred an additional €25,488 in laboratory costs.…”

“…3,4 Universal MRSA screening strategies were more effective but also more cost-intensive than targeted screening. 4,6,7 In a retrospective review of a 3-year MRSA screening program that was implemented from 2006 to 2009 in the United Kingdom, only 7 extra MRSA cases were detected using universal screening compared with targeted screening, and in 1 month, universal screening generated 4,200 negative screens that incurred an additional €25,488 in laboratory costs. 5 Similarly, a prospective study by Creamer et al 8 found that extending screening to patients without risk factors (ie, universal screening) increased the number of screenings and the costs but did not result in the detection of a significant number of additional cases.…”

“…The product used in the current study is based on 70% (vol/vol) ethanol and meets both the EN 1500 efficacy requirements within 30 seconds and the US Food and Drug Administration Healthcare Personnel Handwash requirements at a 2 mL application. 4 Therefore incomplete MRSA eradication cannot be attributed to a lack of efficacy of the handrub product. Second, we acknowledge that a larger volume of product may have been more effective because handrub efficacy is highly dependent on application volume.…”

“…6 In a second cost-effectiveness analysis, targeted screening strategies were found to be more cost-effective than universal screening, with incremental cost-effectiveness ratios of €3,227 to €28,507, depending on the prevalence rate and testing used, compared with €103,169 to €183,269 per additional infection averted for universal screening. 4 Finally, a US prospective study comparing the clinical effectiveness and cost benefit of universal versus targeted screening reported a benefit-to-cost ratio of 0.50, indicating that for every additional euro spent on universal versus targeted screening, only €0.40 could be recovered in avoided costs due to a reduction in MRSA healthcareassociated infection. 7 The control of MRSA is a multidisciplinary task involving surveillance, patient screening, decolonization, isolation and/ or the cohorting of patients, environmental decontamination, antimicrobial stewardship, maintenance of adequate staffing levels, and hand hygiene.…”

Letter to the Editor Regarding “Efficacy of Alcohol Gel for Removal of Methicillin-Resistant Staphylococcus Aureus from Hands of Colonized Patients”

“…3 Several studies showed that training in hand hygiene significantly improves antimicrobial effectiveness. 4 By any means, this study is important and might explain why many studies failed to decrease the spread of methicillin-resistant Staphylococcus aureus despite high compliance with hand hygiene. …”