Hand rub consumption and hand hygiene compliance are not indicators of pathogen transmission in intensive care units

Eckmanns, Tim; Schwab, Frank J.; Bessert, Jan; Wettstein, Richard; Behnke, Michael; Grundmann, Hajo; Rüden, H.; Gastmeier, Petra

doi:10.1016/j.jhin.2006.03.015

Cited by 51 publications

(29 citation statements)

References 14 publications

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“…However, both methods are time-consuming and many have therefore searched for a substitute marker to indirectly measure compliance with hygiene guidelines, e.g., the usage of hand hygiene products (Haas & Larson 2007). Eckmanns et al (2006) showed a positive correlation between hand hygiene compliance and hand rub consumption. The efficacy of hand hygiene monitoring technology, i.e., systems that count alcohol-based hand rub or soap dispensing events or in other ways estimate compliance and/or provide hand hygiene reminders, has recently been reviewed.…”

Section: Monitoring Compliance With Hygiene Guidelinesmentioning

confidence: 99%

Infection control of Staphylococcus aureus : spa typing to elucidate transmission

Mernelius¹

2015

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Staphylococcus aureus is a commensal of the human flora, primarily colonizing the anterior nares and throat, but it may also cause infections ranging from mild skin and soft tissue infections to severe diseases such as endocarditis and septicemia. S. aureus is also a major nosocomial problem increasing with the worldwide dissemination of methicillin-resistant S. aureus (MRSA).The main vector for bacterial cross-transmission in healthcare settings is the hands of healthcare workers (HCWs). No S. aureus was detected in the air in this thesis demonstrating that transmission through air is not important. Despite the fact that good compliance with hand hygiene is essential to prevent cross-transmission the compliance is generally less than 50 %.Gold standard to track bacterial transmission in healthcare settings has for long been pulsedfield gel electrophoresis (PFGE), a method that is labor-intensive, lacks consensus protocol and relies on semi-subjective analysis. Molecular typing by sequencing of the hypervariable part of the S. aureus protein A gene (spa typing) has overcome these problems and has shown promising results in epidemiological investigations.The aims of this thesis were to study bacterial transmission with S. aureus colonization of newborn infants as a model and to evaluate spa typing as a molecular tool. Additionally, the influence of compliance with hygiene guidelines on S. aureus transmission was assessed.Analysis of 280 MRSA isolates by spa typing revealed excellent typeability and epidemiological concordance and satisfactory discriminatory power. Additionally, spa typing was considered superior to PFGE thanks to its accessibility, ease of use and rapidity. Also, spa typing results are registered in a global database, facilitating inter-laboratory comparison.The prevalence of S. aureus ranged from 41 % to 66 % in the populations studied and males had the highest colonization rate. Throat was the premier colonization site for adults and transmission from individuals colonized in the throat only was documented, suggesting that throat cultures should be included in S. aureus screening programs. The umbilicus was the premier colonization site for newborn infants. Incubating the swabs in enrichment broth prior to plating increased the prevalence of S. aureus positive samples by 46 %, resulting in prevalence viii ranging from 51 % to 70 % in the populations studied. Thus enrichment prior to plating is necessary to determine more truthful S. aureus colonization rates. There were no indications of an institutional flora, as the colonization rates, spa type distribution and antibiotic resistance prevalence were similar among parents and HCWs.Direct observations and self-reporting by HCWs were both validated as tools for monitoring compliance with hygiene guidelines. The compliance with hygiene guidelines was significantly higher following a 10-point hygiene intervention as compared to baseline. The compliance was also higher three years after the intervention in three of four participating departm...

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Section: Monitoring Compliance With Hygiene Guidelinesmentioning

confidence: 99%

Infection control of Staphylococcus aureus : spa typing to elucidate transmission

Mernelius¹

2015

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“…In a recent study, Eckmanns et al [6] found no or poor correlation between incidence rates of nosocomial infections, compliance with hand hygiene procedures and hand rub consumption, and transmission episodes of nosocomial pathogens as the "gold standard" for infection control. The results of our study question the use of transmission events identified by the typing of isolates as the gold standard for the quality of hospital hygiene and offer an alternative explanation for the poor correlation.…”

Section: Resultsmentioning

confidence: 99%

Can Escherichia coli be used as an indicator organism for transmission events in hospitals?

Broek

Bernards

Reijden

et al. 2008

Eur J Clin Microbiol Infect Dis

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Can Escherichia coli be used as an indicator organism for transmission events in hospitals? Perineal and pharyngeal swabs were obtained from patients admitted to a medical or surgical intensive care unit within 24 h of admission and then twice per week. Escherichia coli isolates were typed by random amplification of polymorphic DNA (RAPD) and amplified fragment length polymorphism (AFLP) typing. Based on the typing results, transmission rates for RAPD and AFLP typing were 8.5 and 6.6 per 100 patient-days. Requiring in addition to similarity in genotype parity in time and place for a transmission event, the incidence dropped to 3.8 (RAPD) and 1.7 (AFLP) per 100 patient-days. The two typing methods not only differed with respect to numbers of transmissions identified, but also to individuals involved in transmissions. This study identified a number of problems regarding the use of Escherichia coli as indicator organism for transmission events. The use of Escherichia coli for this purpose cannot be recommended at the moment.

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“…The literature reports a wide range of adherence to hand hygiene protocols, often very low. 16,28,29 Perhaps for this reason, hand hygiene alone does not appear to be sufficient to prevent nosocomial infection, and in one case report, 16 an ICU outbreak of MDR P. aeruginosa was only contained after the center instituted pasteurization of water taps. If infection control is to be successfully used to limit the emergence of antibiotic resistance, the combination of resources and education toward hand hygiene, personal protective equipment, environmental sterilization, and patient cohorting are likely to all be essential.…”

Section: The Antibiotic Shortage and Strategies For The Near Futurementioning

confidence: 99%

Overcoming drug resistance in multi-drug resistant cancers and microorganisms

2012

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Hand rub consumption and hand hygiene compliance are not indicators of pathogen transmission in intensive care units

Cited by 51 publications

References 14 publications

Infection control of Staphylococcus aureus : spa typing to elucidate transmission

Infection control of Staphylococcus aureus : spa typing to elucidate transmission

Can Escherichia coli be used as an indicator organism for transmission events in hospitals?

Overcoming drug resistance in multi-drug resistant cancers and microorganisms

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