Online Program

Which hand hygiene protocols are effective for the removal of staphylococcus aureus on healthcare staff's hands?

Monday, November 4, 2013

Angela Chow, MBBS, MPH, MS, Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
Healthcare-associated infections (HAI) threaten the health of millions of patients around the world annually. HAIs are preventable through good hand hygiene. There is limited evidence on the effectiveness of different protocols on the removal of specific pathogenic organisms including methicillin-resistant Staphylococcus aureus (MRSA). We conducted a randomized controlled trial in the general wards of a 1,300-bed tertiary-care hospital, to compare the effectiveness of removal of hand carriage of MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) using 3 hand hygiene protocols: (1) alcohol handrubbing covering all hand surfaces, (2) alcohol handrubbing using standard 7-steps, and (3) chlorhexidine handwashing. Hand samples were obtained from 60 medical and 60 nursing staff, before and after hand hygiene. Blinded bacterial evaluations were performed. Post-patient contact but pre-hand hygiene, 4.2% of nurses and 2.5% of doctors carried MRSA on their hands, whilst 3.3% of nurses and 3.3% of doctors carried MSSA. After adjusting for hand hygiene protocol and staff category, MRSA- and MSSA-carriage were reduced by 88.4% (Adj OR 0.116, 95%CI 0.014-0.947, p=0.0444) and 88.2% (Adj OR 0.118, 95%CI 0.014-0.955, p=0.0452) respectively. The two alcohol handrubbing protocols were not different from chlorhexidine handwashing in the removal of MRSA (Alcohol 1: Adj OR 1.536, 95% CI 0.244-9.666; Alcohol 2: Adj OR 2.098, 95%CI 0.364-12.083) and MSSA (Alcohol 1: Adj OR 1.000, 95% CI 0.192-5.214; Alcohol 2: Adj OR 1.000, 95% CI 0.192-5.214). Alcohol handrubbing and chlorhexidine handwashing are effective for the removal of MRSA and MSSA on healthcare staff's hands during routine patient care in busy general wards.

Learning Areas:

Clinical medicine applied in public health
Implementation of health education strategies, interventions and programs
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public

Learning Objectives:
Describe the prevalence of hand carriage of Staphylococcus aureus including MRSA among healthcare staff Explain the conduct of a randomized controlled trial on hand hygiene protocols in a hospital setting Assess and compare the effectiveness of three hand hygiene protocols during routine inpatient care on the removal of hand carriage of Staphylococcus aureus in healthcare staff

Keyword(s): Health Care Quality, Infectious Diseases

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal investigator of this study and was involved with the conception and design of the study, the analysis and interpretation of data, as well as the drafting and final approval of the submitted abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.