Targeting Virus but Killing Bacteria: Impact of Alcohol-Based Hand Rub on the Incidence of Multi-resistant Bacteria during Influenza H1N1 Outbreak

Background: The recent H1N1 outbreak imposed a major challenge to infection control experts. As a consequence, hand hygiene with alcohol-based solutions has been reinforced, since this intervention is known to reduce the transmission of several infections, particularly in the health care setting. Even though hand hygiene is the most important factor to reduce cross-transmission of nosocomial infections, adhesion to these practices has been poor worldwide.

Objective: The purpose of this study was to report the impact of increased consumption of alcohol formulations for hand hygiene during an H1N1 outbreak on the incidence of multi-resistant bacteria in a tertiary hospital in Southern Brazil.

Methods: A retrospective audit was performed to correlate the consumption of alcohol formulations from January 2009 to October 2009 with the incidence of multi-resistant bacteria recovered from clinical samples. The study was performed in a single 1,200-bed university hospital. The H1N1 outbreak started in July 2009. The study comprised two distinct periods, before (Period I; January-June) and after (Period II; July-October) the onset of the epidemy. The consumption of alcohol-based formulations was measured in terms of volume per 1,000 patient-days. Only one distinct isolate was considered per patient. Statistical analyses were performed with SPSS software version 14.0. P values were considered statistically significant if <0.05.

Results: During the period of study, 612 multi-resistant bacterial isolates were recovered from clinical samples. Mean number of multi-resistant isolates was 122.5 and 91.7 during Periods I and II, respectively (p=0.23). Alcohol consumption increased from 9.6 ml/1,000 patient-days (Period I) to 22.3 ml/1,000 patient-days (Period II) (p=0.047). There was a negative and significant correlation between alcohol consumption and the prevalence of multi-resistant bacteria during periods I and II (r= –0.79; p=0.007).

Conclusions: The novel H1N1 infection put health care providers at risk for the acquisition of a potentially serious infection. We suspect that this might have influenced adherence to hand disinfection practices, which in turn resulted in a higher consumption of alcohol-based hand rub and a lower incidence of multi-resistant bacteria.