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

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.