title: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Austin Health, Studley Road, Heidelberg, Victoria 3084, Australia. Paul.Johnson@austin.org.au
authors.forename: Paul D R
authors.initials: PD
authors.lastname: Johnson
authors.forename: Rhea
authors.initials: R
authors.lastname: Martin
authors.forename: Laurelle J
authors.initials: LJ
authors.lastname: Burrell
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Grabsch
authors.forename: Susan W
authors.initials: SW
authors.lastname: Kirsa
authors.forename: Jason
authors.initials: J
authors.lastname: O'Keeffe
authors.forename: Barrie C
authors.initials: BC
authors.lastname: Mayall
authors.forename: Deidre
authors.initials: D
authors.lastname: Edmonds
authors.forename: Wendy
authors.initials: W
authors.lastname: Barr
authors.forename: Christopher
authors.initials: C
authors.lastname: Bolger
authors.forename: Humsha
authors.initials: H
authors.lastname: Naidoo
authors.forename: M Lindsay
authors.initials: ML
authors.lastname: Grayson
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D016470:Bacteremia / Q000517:prevention & control; D002710:Chlorhexidine / Q000627:therapeutic use*; D003428:Cross Infection / Q000517:prevention & control*; D004866:Equipment Contamination / Q000517:prevention & control; D004865:Equipment and Supplies, Hospital / Q000382:microbiology; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D000431:Ethanol / Q000627:therapeutic use*; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000379:methods*; D006757:Hospital Units; D006801:Humans; D007362:Intensive Care Units; D007709:Klebsiella / Q000187:drug effects / Q000302:isolation & purification; D016106:Methicillin Resistance; D010564:Personnel, Hospital; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D018440:beta-Lactam Resistance
chemical_list: D000891:Anti-Infective Agents, Local; D000431:Ethanol; D002710:Chlorhexidine