The effect of improved hand hygiene on nosocomial MRSA control.

Kalisvar Marimuthu,Didier Pittet,Stephan Harbarth

doi:10.1186/2047-2994-3-34

Abstract

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.

Highlights

It has been more than a century since Ignaz Semmelweis’s discovery that healthcare workers’ hands could potentially transmit infections to patients
Semmelweis’s uncelebrated death in an asylum was vindicated by a slew of evidence that emerged later, and continues to emerge until now, showing clear association between hand hygiene and healthcare associated infections (HAI), especially those related to methicillin-resistant Staphylococcus aureus (MRSA) (Table 1)
This review focuses on summarising existing evidence on the role of hand hygiene on MRSA control

Summary

Introduction

It has been more than a century since Ignaz Semmelweis’s discovery that healthcare workers’ hands could potentially transmit infections to patients. In a recent multicentre controlled trial in Europe comparing enhanced hand hygiene with universal MRSA screening, contact precautions and targeted decolonization, hand hygiene promotion on surgical wards outside of the operating theatre did not effectively reduce MRSA rates on its own [17]. Cooper and colleagues demonstrated that while a large reduction in ward-level prevalence and colonized patient-days of S. aureus is observed when the hand hygiene compliance increases from zero to 20%, minimal additional difference is noticed when the compliance increases above 40% [18] Another modelling study of transmission of MRSA in ICUs did find that hand hygiene enhancement was the most effective way of reducing MRSA transmission [19]. The hypothesis of whether adequate hand hygiene compliance alone without contact precautions is sufficient to control MRSA transmissions, needs to be tested in large clinical trials in which standard precautions and hand hygiene are tested alone, not as a part of a multimodal intervention as is often the case [15]

Conclusions

Findings

Harbarth S