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.

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