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Title: Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection.
Austin Authors: Johnson, Paul D R ;Martin, Rhea D;Burrell, Laurelle J;Grabsch, Elizabeth A ;Kirsa, Susan W;O'Keeffe, Jason;Mayall, Barrie C;Edmonds, Deidre;Barr, Wendy;Bolger, Christopher;Naidoo, Humsha;Grayson, M Lindsay 
Affiliation: Austin Health, Studley Road, Heidelberg, Victoria 3084, Australia
Issue Date: 21-Nov-2005
Publication information: Medical Journal of Australia; 183(10): 509-14
Abstract: To assess the effect of a multifaceted hand hygiene culture-change program on health care worker behaviour, and to reduce the burden of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infections.Timetabled introduction of interventions (alcohol/chlorhexidine hand hygiene solution [ACHRS], improved cleaning of shared ward equipment, targeted patient decolonisation, comprehensive "culture change" package) to five clinical areas of a large university teaching hospital that had high levels of MRSA.Health care worker hand hygiene compliance; volume of ACHRS used; prevalence of patient and health care worker MRSA colonisation; environmental MRSA contamination; rates of clinical MRSA infection; and rates of laboratory detection of ESBL-producing Escherichia coli and Klebsiella spp.In study wards, health care worker hand hygiene compliance improved from a pre-intervention mean of 21% (95% CI, 20.3%-22.9%) to 42% (95% CI, 40.2%-43.8%) 12 months post-intervention (P < 0.001). ACHRS use increased from 5.7 to 28.6 L/1000 bed-days. No change was observed in patient MRSA colonisation or environmental colonisation/contamination, and, except in the intensive care unit, colonisation of health care workers was unchanged. Thirty-six months post-intervention, there had been significant reductions in hospital-wide rates of total clinical MRSA isolates (40% reduction; P < 0.001), patient-episodes of MRSA bacteraemia (57% reduction; P = 0.01), and clinical isolates of ESBL-producing E. coli and Klebsiella spp (90% reduction; P < 0.001).Introduction of ACHRS and a detailed culture-change program was effective in improving hand hygiene compliance and reducing nosocomial MRSA infections, despite high-level MRSA endemicity.
Gov't Doc #: 16296963
Type: Journal Article
Subjects: Anti-Infective Agents, Local.therapeutic use
Bacteremia.prevention & control
Chlorhexidine.therapeutic use
Cross Infection.prevention & control
Equipment Contamination.prevention & control
Equipment and Supplies, Hospital.microbiology
Escherichia coli.drug effects.isolation & purification
Ethanol.therapeutic use
Follow-Up Studies
Guideline Adherence
Hand Disinfection.methods
Hospital Units
Intensive Care Units
Intervention Studies
Klebsiella.drug effects.isolation & purification
Methicillin Resistance
Personnel, Hospital
Staphylococcal Infections.prevention & control
Staphylococcus aureus.drug effects.isolation & purification
beta-Lactam Resistance
Appears in Collections:Journal articles

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