Infection-free surgery: how to improve hand-hygiene compliance and eradicate methicillin-resistant Staphylococcus aureus from surgical wards.
BACKGROUND
Healthcare-associated infections cost the UK National Health Service 1 billion UK pounds per annum. Poor hand hygiene is the main route of transmission for methicillin-resistant Staphylococcus aureus (MRSA), leading to increased mortality and morbidity for infected patients. This study aims to quantify MRSA infection rates and compliance of alcohol gel application at the entrance to a surgical ward and assess how a simple intervention affects compliance.


METHODS
Compliance was assessed via a discretely positioned close-surveillance camera at the ward entrance. Footage was reviewed to monitor compliance of all persons entering the ward over a 12-month period.


RESULTS
For the initial 6 months, mean alcohol gel compliance was 24% for all persons entering the ward. After this period, a conspicuous strip of bright red tape was positioned along the corridor approaching the ward entrance. The red line continued up the wall to an arrow head pointing to the two alcohol gel dispensers on the wall. Mean compliance over the subsequent 6 months significantly improved to 62% (P < 0.0001). Compliance improved for all persons entering the ward as follows (before - after, significance): doctors (0% - 54%, P < 0.01); nurses (24% - 75%, P < 0.05); porters (21% - 67%, P < 0.05); visitors (35% - 68%, P < 0.01); patients (23% - 44%, P > 0.05). There were two cases of MRSA bacteraemia in the initial 6 months and no cases in the following 6 months with the red line in situ.


CONCLUSIONS
This study demonstrates how a simple intervention significantly improves hand-hygiene compliance with associated eradication of MRSA.
Southmead Hospital, Bristol, UK. chrisdavis959@hotmail.com
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Davis
D001296:Audiovisual Aids; D003428:Cross Infection / Q000517:prevention & control* / Q000635:transmission; D004739:England; D000431:Ethanol; D013502:General Surgery; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000379:methods / Q000592:standards*; D006801:Humans; D008505:Medical Staff, Hospital; D055624:Methicillin-Resistant Staphylococcus aureus; D009741:Nursing Staff, Hospital; D010349:Patient Compliance; D010362:Patients' Rooms / Q000592:standards*; D010564:Personnel, Hospital / Q000592:standards; D017410:Practice Guidelines as Topic; D013203:Staphylococcal Infections / Q000517:prevention & control* / Q000635:transmission; D014789:Visitors to Patients
D000431:Ethanol