title: Reduction in hospitalwide incidence of infection or colonization with methicillin-resistant Staphylococcus aureus with use of antimicrobial hand-hygiene gel and statistical process control charts.
abstract: OBJECTIVE
  To evaluate the impact of serial interventions on the incidence of methicillin-resistant Staphylococcus aureus (MRSA).
  
  
  METHODS
  Longitudinal observational study before and after interventions.
  
  
  METHODS
  The Alfred Hospital is a 350-bed tertiary referral hospital with a 35-bed intensive care unit (ICU).
  
  
  METHODS
  A series of interventions including the introduction of an antimicrobial hand-hygiene gel to the intensive care unit and a hospitalwide MRSA surveillance feedback program that used statistical process control charts but not active surveillance cultures.
  
  
  METHODS
  Serial interventions were introduced between January 2003 and May 2006. The incidence and rates of new patients colonized or infected with MRSA and episodes of MRSA bacteremia in the intensive care unit and hospitalwide were compared between the preintervention and intervention periods. Segmented regression analysis was used to calculate the percentage reduction in new patients with MRSA and in episodes of MRSA bacteremia hospitalwide in the intervention period.
  
  
  RESULTS
  The rate of new patients with MRSA in the ICU was 6.7 cases per 100 patient admissions in the intervention period, compared with 9.3 cases per 100 patient admissions in the preintervention period (P=.047). The hospitalwide rate of new patients with MRSA was 1.7 cases per 100 patient admissions in the intervention period, compared with 3.0 cases per 100 patient admissions in the preintervention period (P<.001). By use of segmented regression analysis, the maximum and conservative estimates for percentage reduction in the rate of new patients with MRSA were 79.5% and 42.0%, respectively, and the maximum and conservative estimates for percentage reduction in the rate of episodes of MRSA bacteremia were 87.4% and 39.0%, respectively.
  
  
  CONCLUSIONS
  A sustained reduction in the number of new patients with MRSA colonization or infection has been demonstrated using minimal resources and a limited number of interventions.
authors.affiliation: Infection Control and Hospital Epidemiology Unit, Alfred Hospital, Melbourne, Victoria, Australia. I.Control@alfred.org.au
authors.forename: Glenys
authors.initials: G
authors.lastname: Harrington
authors.forename: Kerrie
authors.initials: K
authors.lastname: Watson
authors.forename: Michael
authors.initials: M
authors.lastname: Bailey
authors.forename: Gillian
authors.initials: G
authors.lastname: Land
authors.forename: Susan
authors.initials: S
authors.lastname: Borrell
authors.forename: Leanne
authors.initials: L
authors.lastname: Houston
authors.forename: Rosaleen
authors.initials: R
authors.lastname: Kehoe
authors.forename: Pauline
authors.initials: P
authors.lastname: Bass
authors.forename: Emma
authors.initials: E
authors.lastname: Cockroft
authors.forename: Caroline
authors.initials: C
authors.lastname: Marshall
authors.forename: Anne
authors.initials: A
authors.lastname: Mijch
authors.forename: Denis
authors.initials: D
authors.lastname: Spelman
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000382:microbiology / Q000517:prevention & control; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D005782:Gels; D006235:Hand Disinfection / Q000379:methods*; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000191:economics / Q000379:methods*; D007362:Intensive Care Units; D008137:Longitudinal Studies; D016106:Methicillin Resistance; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000302:isolation & purification*
chemical_list: D000890:Anti-Infective Agents; D005782:Gels; C010882:chlorhexidine gluconate; D002710:Chlorhexidine