Reduction in nosocomial transmission of drug-resistant bacteria after introduction of an alcohol-based handrub.
OBJECTIVE
To assess quantitatively the clinical impact of using an alcohol-based handrub (ABHR) in the hospital environment, measuring impact as the incidence of new, nosocomial isolates of drug-resistant organisms.


METHODS
An observational survey from 1998 to 2003 comparing the first 3 years of no ABHR use with the 3 years following, when an ABHR was provided for hand hygiene.


METHODS
An inner-city, tertiary-care medical center.


METHODS
At baseline, an antimicrobial soap with 0.3% triclosan was provided for staff hand hygiene. The intervention was placement in all inpatient and all outpatient clinic rooms of wall-mounted dispensers of an ABHR with 62.5% ethyl alcohol. Data were collected on change in the incidence of three drug-resistant bacteria.


RESULTS
During the 6 years of the survey, all new, nosocomially acquired isolates of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Clostridium difficile-associated diarrhea were recorded. On comparison of the first 3 years with the final 3 years, there was a 21% decrease in new, nosocomially acquired MRSA (90 to 71 isolates per year; P = .01) and a 41% decrease in VRE (41 to 24 isolates per year; P < .001). The incidence of new isolates of C. difficile was essentially unchanged.


CONCLUSIONS
In the 3 years following implementation of an ABHR, this hospital experienced the value of reductions in the incidence of nosocomially acquired drug-resistant bacteria. These reductions provide clinical validation of the recent CDC recommendation that ABHRs be the primary choice for hand decontamination.
Gordin
Fred M
FM
Veterans Affairs Medical Center, Washington, DC 20422, USA. Fred.Gordin@med.va.gov
Schultz
Maureen E
ME
Huber
Ruth A
RA
Gill
Janet A
JA
D000438:Alcohols / Q000008:administration & dosage*; D016360:Clostridioides difficile; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D018562:Disease Transmission, Infectious / Q000517:prevention & control / Q000706:statistics & numerical data; D004202:Disinfectants / Q000008:administration & dosage*; D004219:District of Columbia / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D004403:Dysentery / Q000453:epidemiology / Q000517:prevention & control; D006235:Hand Disinfection / Q000379:methods*; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000295:instrumentation* / Q000379:methods; D016106:Methicillin Resistance; D010043:Outcome and Process Assessment, Health Care; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000187:drug effects
D000438:Alcohols; D004202:Disinfectants