Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection
Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection
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DOI：
10.5694/j.1326-5377.2005.tb07151.x
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发表时间：
2005-11-21
影响因子：
11.4
通讯作者：
Grayson, ML
中科院分区：
文献类型：
--
作者：
Johnson, PDR;Martin, R;Grayson, ML
目的：为了评估多方面的手卫生文化改变计划对医护人员行为的影响，并减少医院内耐甲氧西林金黄色葡萄球菌（MRSA）感染的负担。设计和设置：按时间表介绍发言（酒精/洗必泰手部卫生溶液[ACHRS]，改善共用病房设备的清洁，有针对性的患者去殖民化，主要结果测量：医护人员手部卫生依从性; ACHIRS使用量;患者和医护人员MRSA定植率;环境MRSA污染;临床MRSA感染率;产ESBL大肠埃希菌和克雷伯菌实验室检出率。结果：在研究病房中，卫生保健工作者的手部卫生依从性比干预前平均21%有所改善干预后12个月，（95% CI，20.3%-22.9%）至42%（95% CI，40.2%-43.8%）（P < 0.001）。ACHRS的使用从5.7升/1000床日增加到28.6升/1000床日。未观察到患者MRSA定植或环境定植/污染发生变化，并且，除重症监护室外，医护人员的定植没有变化。干预后36个月，全医院临床MRSA分离株总数（减少40%; P < 0.001）、MRSA菌血症患者发作（减少57%; P=0.01）和产ESBL大肠杆菌临床分离株的发生率显著降低。结论：尽管MRSA具有高度的地方性，但ACHRS的引入和详细的培养更换计划在提高手部卫生依从性和减少院内MRSA感染方面是有效的。
Objective: 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.Design and setting: 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.Main outcome measures: Health care worker hand hygiene compliance; volume of ACHIRS 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.Results: 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/contarnination, 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).Conclusions: 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.