Review
Impact of alcohol hand-rub use on meticillin-resistant Staphylococcus aureus: an analysis of the literature

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Summary

We aimed to evaluate the impact of alcohol hand disinfection with alcohol hand rub (AHR) as surrogate parameter of compliance or with compliance observations on the meticillin-resistant Staphylococcus aureus (MRSA) situation in hospital settings. Medline was searched for the keywords ‘hand hygiene’, ‘compliance’, ‘disinfection’, ‘time series analysis’ combined with ‘meticillin-resistant Staphylococcus aureus/MRSA’. Data were included only from studies reporting exact numbers of AHR and/or compliance observations of MRSA situations over time. The literature search resulted in 272 hits, of which 12 studies met the inclusion criteria. The amount of AHR ranged between 3 and 78 mL/patient-day (pd) at the beginning and increased to 12 to 103 mL/pd at the end of the intervention studies. Compliance with hand disinfection ranged between 20% and 64% at the beginning and between 42% and 71% at the end. An increase in AHR correlated significantly with an improvement in the MRSA situation (r = 0.78), whereas there was no such correlation between compliance and MRSA. An increased consumption of AHR was associated with a significant reduction of MRSA rates.

Introduction

Staphylococcus aureus is one of the leading nosocomial pathogens worldwide and meticillin-resistant Staphylococcus aureus (MRSA) is the most prominent resistant pathogen.

For more than 150 years hand hygiene has been recognised as the key measure to prevent transmission of pathogens and to reduce the incidence of nosocomial infections. Despite the simplicity of this procedure, adherence to hand hygiene is often low, usually below 50%.1, 2, 3 Compliance with hand disinfection is a typical example of a so-called effectiveness gap; the need for this action is well known but compliance is not fully effective or satisfactory in daily routine.4 For example, the isolation of MRSA patients in single rooms is thought to be preventive because medical staff normally fail to show good compliance with hand hygiene.5, 6

In recent years, some studies have shown that an improved compliance with hand hygiene and an increase in the use of hand antiseptics have a positive impact on MRSA.7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32

The aim of our review is to summarise the evidence published so far and to evaluate the impact of alcohol hand disinfection on MRSA in the hospital setting.

Section snippets

Study selection

Medline was searched for the keywords ‘hand hygiene’, ‘compliance’, ‘disinfection’, ‘time series analysis’ combined with ‘met(h)icillin-resistant Staphylococcus aureus’ or ‘MRSA’. All studies reporting data on ‘alcohol(ic) hand rub use’ and/or ‘compliance’ and ‘met(h)icillin-resistant Staphylococcus aureus’ or ‘MRSA’ were considered. No language, study design or time restrictions were applied.

Inclusion and exclusion criteria

Studies were included if they reported exact numbers of changes over time in the amount of alcohol hand

Results

The literature search resulted in 272 hits, of which 12 studies (nine on AHR use and/or six on compliance observations) met the inclusion criteria. Table I shows the studies on AHR and/or hand hygiene compliance observations and MRSA according to the inclusion criteria.

The amount of AHR ranged between 3 and 78 mL/pd at the beginning of the studies and increased to 12–103 mL/pd at the end of the studies (Figure 1). Two studies with a comparatively high consumption did not implement systematic

Discussion

In our study we showed that there was a significant association between the increase in the consumption of AHR and MRSA rates. It was the landmark study of Pittet et al. that rediscovered hand hygiene as a simple but key infection control measure to reduce nosocomial and even MRSA infections.16 In 2000, MRSA was already on the rise in many European countries. Since then, there have been many studies focusing AHR and MRSA; however, they are difficult to compare and analyse together because of

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