Dramatic Reduction in Rates of Methicillin-Resistant Staphylococcus Aureus (MRSA) Following Introduction of a Hand Hygiene Initiative

Background: Hand hygiene (HH) compliance is the single most effective intervention to reduce the risk of healthcare associated infections. Barwon Health (BH) is a large healthcare network in Geelong, Victoria, Australia.

Objective: To illustrate the reduction in MRSA rates after the introduction of a HH initiative.

Methods:

Alcohol-based hand rub was introduced at BH in 2004, and between its rollout and November 2007 HH was promoted, but there was no consistent designated staff member assigned this task. A funded hand hygiene initiative commenced in November 2007 as part of a HH program in effect at 84 participating health centers in Victoria. This successful hand hygiene program has incorporated promotion of the use of alcohol hand rub, education of health care workers regarding hand hygiene practices, involvement of institutional leaders and collection of several standardized outcome measures including rates of hand hygiene compliance, and rates of MRSA/MSSA isolates. Benchmarking is possible with countries participating in the World Health Organisation's “Clean Care is Safer Care” initiative. The focus of this HH program are the five moments for hand hygiene. These moments are; before touching a patient, before a procedure, after a procedure or body fluid exposure risk, after touching a patient and after touching a patient's surroundings. Audits of compliance have been performed every 4 months on different wards of both the acute care and long-term care hospitals, and results are communicated to clinical areas, representative medical groups, allied health staff, and hospital administration. Results: When the HH initiative commenced in 2007, average compliance with hand hygiene was between 25 and 50%, after 2 years compliance was 70-80%. At BH, screening for MRSA colonization is undertaken weekly in ICU and on ward admission for patients recently transferred from another center or for patients with a history of MRSA infection or colonization in the preceding 6 months. Over the last decade, our benchmark for new MRSA colonizations and infections was 8 new cases per month. However, new MRSA clinical infections and colonizations have decreased dramatically to 4 new cases per month since the funded HH initiative commenced. The number of patients infected or colonized with MRSA was 74 in 2006, 96 in 2007, 47 in 2008, and 14 for the first 3 quarters of 2009.

Conclusions: The introduction of a HH initiative has dramatically decreased MRSA rates at our institution. HH culture change is feasible for healthcare workers and is vital in preventing disease transmission.