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234 Screening of Healthcare Workers' Hands for Methicillin-resistant Staphylococcus aureus (MRSA)

Friday, March 19, 2010
Grand Hall (Hyatt Regency Atlanta)
Eilish Creamer, MSc , Royal College of Surgeons in Ireland, Dublin, Ireland
Sarah Dorrian, BSc , Royal College of Surgeons in Ireland, Dublin, Ireland
Anthony Dolan, BSc , Royal College of Surgeons in Ireland, Dublin, Ireland
Orla Sherlock, PhD , Royal College of Surgeons in Ireland, Dublin, Ireland
Toney Thomas, MBA , Beaumont Hospital, Dublin, Ireland
John Walsh, BSc , Beaumont Hospital, Dublin, Ireland
Anna Shore, PhD , School of Dental Science and Dublin Dental Hospital, TCD, Dublin, Ireland
Angela S. Rossney, PhD , National MRSA Reference Laboratory, Dublin, Ireland
Robert Cunney, MD , Health Protection Surveillance Centre, Dublin, Ireland
David Coleman, PhD , School of Dental Science and Dublin Dental Hospital, TCD, Dublin, Ireland
Hilary Humphreys, MB, MRCPath , Royal College of Surgeons in Ireland, Dublin, Ireland
Background: Hand hygiene is an essential component of infection control practice to reduce the prevalence of MRSA. Education and audits with feedback are strategies to improve compliance, but little is known of the effectiveness of these in reducing MRSA hand carriage among healthcare workers (HCWs).

Objective: To evaluate MRSA carriage on HCW hands after hand hygiene and other occasions and assess the impact of education on hand hygiene.

Methods: 1273 consenting HCWs on 9 wards of a 700-bed acute hospital participated in three phases; one ward (Phase 1), eight wards 8 months later (Phase 2) and nine wards a further 6 months later (Phase 3). Sampling of fingertips was conducted using MRSA Select Chromogenic Agar. An educational programme and an observational hand hygiene audit were carried out between phases 2 and 3.

Results: MRSA was isolated from 56/1273 (4%) of staff hands; 21/381 (5%) during Phase 1, 21/451 (5%) during Phase 2 and 18/451 (4%) during Phase 3. MRSA was recovered from 36/706 (5%) when no hand hygiene was conducted, 16/371 (4%) after soap and water, 2/56 (4%) after chlorhexidine and 2/102 (2%) after alcohol hand gel. MRSA was isolated after clinical procedures, 12/254 (5%), after patient environmental contacts, 14/202 (7%), and after other contacts (e.g. handling charts, telephone), 25/580 (4%).  An audit just before Phase 3, indicated, 136/227 (60%) compliance; nurses, 61/148 (74%), other HCWs, 35/48 (73%), and medical staff, 13/52 (25%). During Phase 3, MRSA was recovered from HCWs hands, 15/18 (83%), on wards with low, 39/91 (43%), hand hygiene compliance.

Conclusions: Screening revealed higher than anticipated carriage rates of MRSA  associated with poor hand hygiene compliance. MRSA was recovered after environmental and administrative procedures, highlighting the need for increased awareness of hand hygiene after all ward activities. There was little reduction in MRSA hand carriage after education programmes, indicating the need to change the culture. Hand sampling can be used to monitor the effectiveness of hand hygiene.