The effect of improved hand hygiene on nosocomial MRSA control.
The purpose of this review is to examine studies that have assessed the association between hand hygiene enhancement and methicillin-resistant Staphylococcus aureus (MRSA) rates and to explore controversies surrounding this association. Many studies have been published confirming the link between improved hand hygiene compliance and reduction in MRSA acquisition and infections, including bacteremia. These studies have also shown the cost-beneficial nature of these programmes. Despite considerable research some issues remain unanswered still, including the temporal relationship between hand hygiene enhancement strategies and decrease in MRSA rates, association between hand hygiene enhancement and MRSA-related surgical site infections, diminishing effect of hand hygiene compliance on MRSA rates after reaching a threshold and the role of instituting contact precautions in the setting of low MRSA rates and sufficient hand hygiene compliance. In conclusion, enhancement of hand hygiene compliance has been shown to reduce MRSA rates; however, some open issues warrant further investigation.
Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore ; Infection Control Program, Geneva University Hospitals and Faculty of Medicine, 1211 Geneva 14, Switzerland.
Kalisvar
K
Marimuthu
Infection Control Program and WHO Collaborating Center on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Didier
D
Pittet
Infection Control Program, Geneva University Hospitals and Faculty of Medicine, 1211 Geneva 14, Switzerland.
Stephan
S
Harbarth
Alcohol-based handrubs; Hand hygiene; Hand washing; MRSA bacteremia; MRSA control; Multimodal strategy; Nosocomial MRSA