MRSA Infection

Antiseptic resistance genes qacA/B and MRSA in the era of hand hygiene

Prevalence of antiseptic resistance genes qacA/B and specific sequence types of methicillin-resistant Staphylococcus aureus in the era of hand hygiene.

In an attempt to control the spread of methicillin-resistant Staphylococcus aureus (MRSA) and other multiresistant organisms in hospitalized patients, hand hygiene campaigns have promoted the widespread use of alcohol-based hand solutions containing antiseptic agents such as chlorhexidine and quaternary ammonium compounds. The use of these products, however, has led to increased resistance to these antiseptic agents in MRSA strains.1–5 qacA/B are plasmid-borne resistance genes coding for multidrug efflux pumps that confer high-level resistance to chlorhexidine, quaternary ammonium compounds and other antiseptic compounds commonly used in hand hygiene solutions.5 They are associated with higher MICs and tolerance of these antiseptic agents.1,4,5 qacA/B genes have been found in healthcare-associated MRSA (HA-MRSA) isolates from around the world.2–8 In addition, the prevalence of qacA/B genes has been associated with particular sequence types (STs) of HA-MRSA.1,3,4,6 To our knowledge, the prevalence of MRSA strains harbouring these genes has not been researched in Australia. In this study, we characterize the prevalence of qacA/B genes in HA-MRSA isolates in our institution spanning 10 years, from 2000 to 2009. We determined whether the national hand hygiene campaign implemented in 2006 had any impact on the prevalence …

Correlation between glove use practices and compliance with hand hygiene in a multicenter study with elderly patients

Correlation between glove use practices and compliance with hand hygiene in a multicenter study with elderly patients.

In a study conducted in 11 health care settings for elderly patients, we demonstrated a significant negative correlation between the proportion of glove use outside any risk of exposure to body fluids and compliance with hand hygiene (P < .02). This result underscores a major limitation of strategies for controlling the spread of multidrug-resistant bacteria that recommend systematic glove use for each contact with carriers or their environment.

The relationship of antimicrobial use and hand hygiene promotion with the incidence of healthcare-associated infections

Access : Time-series analysis of the relationship of antimicrobial use and hand hygiene promotion with the incidence of healthcare-associated infections : The Journal of Antibiotics.

We analyzed the effect of antimicrobial use and implementation of a hand hygiene program on the incidence of healthcare-associated infections (HAIs) and healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) infections at the Chung Shan Medical University Hospital (Taichung, Taiwan). Monthly data were retrospectively reviewed from January 2004 to December 2010. Use of antimicrobials and alcohol-based hand cleaner were separately regressed against the incidences of HAIs and HA-MRSA infections. Infection incidence was expressed as persons per 1000 patient days (PDs), monthly use of i.v. antibiotics was expressed as defined daily doses per 1000 PDs and monthly alcohol-based hand cleaner use was expressed as bottle per 1000 PDs. Multivariate analysis indicated that use of hand cleaner was associated with reduced incidence of HAIs (P=0.0001) and HA-MRSA infections (P<0.0001). Time-series analysis indicated that increased use of hand cleaner was significantly associated with significant decreases in the incidences of HAIs and HA-MRSA infections. Total antibiotic use had no significant effect on HAIs, but was associated with more HA-MRSA infections. In addition, the use of J01CR01 antibiotics (combinations of penicillins, including β-lactamase inhibitors) in particular was correlated with significantly increased incidence of HA-MRSA infections. Our forecasting model demonstrates the efficacy of a hand hygiene program and the need to limit the use of certain restricted antimicrobials in order to reduce the incidence of HAIs and HA-MRSA infections.

Apple's iPad Touch Technology to Be Used to Aid Hand Hygiene

Apple's iPad Touch Technology to Be Used to Save 50,000 Lives - MarketWatch.

The convenient means one uses to input and access information on the iPhone or iPad (capacitive touch technology) has now been incorporated into a system for monitoring hand hygiene compliance. Re-purposing this familiar iPad touch technology has resulted in a one-of-its-kind U.S. patent No. 7,893,842 being issued to Dr. Richard Deutsch of Annapolis, MD, for a hand hygiene monitoring and surveillance system that assures virtual 100% caregiver compliance with federally recommended HAI prevention and hand hygiene protocol. Use of this technology should significantly reduce the scourge of HAIs via its application as a novel means of electronic surveillance, which is capable of determining the exact moment of actual physical contact between the healthcare worker (not unlike the iPhone user's finger) and the patient or patient's related medical devices such as their bed, intravenous catheter, urinary catheter, or ventilator (not unlike the iPhone screen itself), and then determining the healthcare worker's hygiene status by correlating the detected patient contact with the healthcare worker's previous activation of a system associated fixed or portable hand sanitizer. Detection of contact generates several animated color coded graphics reflecting the healthcare worker's hand hygiene status on an iPad like display screen. Failure to comply with required hand sanitizing creates a forensic visual recording of the hand hygiene violation with the subsequent identification and possible re-education of the non-compliant healthcare worker.

Hand hygiene campaign 'cut superbug infections'

BBC News - Hand hygiene campaign 'cut superbug infections'.

Hospital superbugs were once a real fear for many patients. In response the Clean Your Hands campaign, funded by the Department of Health, was introduced in all hospitals by June 2005.

Alcohol gels were put by bedsides, posters reminded staff to wash their hands and there were regular checks to ensure hands were kept clean.

By 2008, the total amount of soap and alcohol gel being purchased by hospitals trebled, going from 22ml per patient per day to 60ml per patient per day.

Rates of MRSA more than halved in the same time period and C. diff infections fell by more than 40%.

New hope for beating MRSA superbugs... good old soap

New hope for beating MRSA superbugs... good old soap - Mirror Online.

Experts have hit on a simple way to reduce cases of deadly hospital superbugs: order more soap. Handing out more soap to hospital staff and patients has dramatically cut the rate of superbug infections. A national “cleanyourhands” campaign changed the culture toward cleanliness on wards among staff. The more soap hospitals ordered and put by bedsides the more the rates of infection went down, researchers found. An evaluation of the campaign has shown shows for the first time that an effective hand-hygiene campaign, can successfully reduce some healthcare linked infections, according to a study in British Medical Journal.

Hand Sanitizer - Alcohol ones are best

Hand Sanitizer Health Question | WSAV TV.

WSAV face book fan Jamie wanted to know if hand sanitizer do more harm than good? “I've been told that it gets rid of germs that children need to build up immunities too." I checked in with an infection disease specialist at Saint Joseph's/Candler to get answers for Jamie. "Alcohol gel does not alter the makeup of your normal flora. This is a good thing that helps you sustain your health. What it does is it kills the germs that you pick up instantly and then it starts all over again. So it doesn't interfere with your ability to build immunity to other things,” says Infection Preventionist Mary Alice Smiley Mary Alice says you should use hand sanitizer that has at least 60%t alcohol for it to have the best effectiveness.

Finally! An Effective Hand-Hygiene Poster!

Controversies in Hospital Infection Prevention: Finally! An Effective Hand-Hygiene Poster!.

Click the link above to view

Data scrubbing: Hand washing tracked using ultrasound technology

Data scrubbing: Hospital’s surveillance tools help track infections - The Globe and Mail.

Toronto General Hospital will launch a project this month that uses ultrasound technology to paint a detailed picture of staff hand-washing practices, potential “hot spots” for disease transmission and points of contact between staff and patients. “It’s going to provide a level of understanding that we’ve never had before,” said Michael Gardam, director of infection prevention and control at the University Health Network. Dubbed Hospital Watch Live, the new system will rely on more than 1,000 ultrasound devices located throughout the facility.

Hand hygiene in pediatric and neonatal intensive care unit patients

Hand hygiene in pediatric and neonatal intensive care unit patients: Daily opportunities and indication- and profession-specific analyses of compliance.

Results Hand hygiene opportunities were significantly higher for pediatric (321/24 hours) than neonatal (194/24 hours; P = .024) patients. Observed compliance rates were 53% (pediatric) and 61% (neonatal) and found to be significantly higher in nurses (57%; 66%) than in physicians (29%, 52%, respectively; P < .001; P = .017, respectively). For neonates, compliance rates were significantly higher before patient contact and aseptic tasks (78%) than after patient, patient body fluid, or patients’ surrounding contact (57%; P < .001). Calculating disinfectant usage revealed a 3-fold lower compliance rate of 17%. Conclusion This study provides the first data on opportunities for and compliance with hand hygiene in pediatric/neonatal patients encompassing the whole day and night activities and including a comparison of observed and calculated compliance rates. Observation revealed high compliance especially in nurses and in situations of greatest impact. The data provide a detailed characterization of hand hygiene performance in the neonatal/pediatric ICU setting.

Clean hands stopping MRSA in Australian Hospitals

Clean hands stopping hospital superbugs | Herald Sun.

HOSPITALS are beginning to win the war on superbugs after a push to get nurses and doctors cleaning their hands more often. The result follows the introduction of a national program to boost hand hygiene compliance rates in hospitals by encouraging staff to use alcohol-based hand rubs before and after treating patients. A recent audit of 521 hospitals found compliance rates rose to nearly 70 per cent from 43 per cent in the two years since the program began in 2009. At the same time the number of patients being infected with the superbug staphylococcus aureus, also known as MRSA or golden staph, dropped significantly. Director of Hand Hygiene Australia Professor Lindsay Grayson, who helped develop the program, said clean hands were the best protection against superbugs like MRSA, which is resistant to antibiotics and spreads quickly through patient contact.

Hand-hygiene - 16 key moments

Controversies in Hospital Infection Prevention: I'm having a (hand-hygiene) moment.

How can the WHO Guidelines on Hand Hygiene be 270 pages long?!?!?! How can we have directive after directive and keep making it more complicated? Solution: the Iowa City ONE Moment For Hand Hygiene: 

EOR 16 Moments For Hand Hygiene ___entering patient room ___before touching a patient ___before handling medication ___before clean/antiseptic procedure ___before putting on sterile gloves ___after removing gloves ___after exposure to body fluid ___after visibly dirty/soiled ___moving from a contaminated body site to another body site during the care of the same patient (say that one three times while rubbing your belly and head) ___after touching equipment or patient surroundings ___after touching a patient ___exiting a patient room ___before eating ___after using the restroom ___when preparing food ___after delivering food (if worker touches patient, bed linens, or objects in the room)

Practically speaking: Rethinking hand hygiene improvement programs in health care settings

Practically speaking: Rethinking hand hygiene improvement programs in health care settings.

Methods Beginning in 2008, we completely overhauled the approach to hand hygiene at our institution. We created small teams consisting of a representative from Quality Assessment, an Infection Prevention Practitioner, and staff from a particular unit. Teams began by discussing the current barriers to hand hygiene success. They then set their own goals for hand hygiene compliance. Staff learned the World Health Organization (WHO) hand hygiene guidelines, which recently had been adopted as part of hospital infection prevention policy. Using the WHO guidelines, teams diagrammed detailed workflows for several of their most common patient care tasks. Wherever hand hygiene was indicated, the workflow was marked with a number corresponding to one or more of the WHO’s “5 moments for hand hygiene.” At the end of the 12-week period, staff members were trained to observe each other and began officially collecting and submitting data to Infection Prevention. Results Between 2006 and 2008, our average institutional hand hygiene compliance held steady at 60%-70%. After the new program was launched in 2008, compliance reached 97% and has been maintained at this level ever since. In addition to the 19 areas of the hospital that were observed previously, 15 ambulatory facilities and 5 regional sites are now included in the data.

Hand Hygiene More Important Than Anything Else Against MRSA?

Controversies in Hospital Infection Prevention: The “horizontalists”.

Our area has an exceptionally high incidence on CA-MRSA, and the Dept of Public Health has endorsed this approach as well. I think, when you examine any "bundled" approach, hand hygiene is the key factor, tho often it is difficult to break out. I am as concerned about transmission from the patients we don't know are colonized as much as those we know about, so support a "universal" approach.

Individual differences in judgments of hand hygiene risk by health care workers

Individual differences in judgments of hand hygiene risk by health care workers.

Background The hand hygiene practices of health care workers (HCWs) have long been the main vector for nosocomial infection in hospitals. The purpose of this study was to examine influences on risk judgment from the individual differences in knowledge levels and health beliefs among US HCWs. Methods Knowledge levels were assessed by questions taken from published questionnaires. The health locus of control scale was used to characterize internal health beliefs. HCWs assessed the risks of pathogen transfer in situations that varied according to the surface touched and the person doing the touching. Results HCWs reported lower risk assessments for touching surfaces compared with touching skin. Risk assessment was influenced by individual differences, including in knowledge level and internal health locus of control. Conclusion Our data describe the individual differences of HCWs related to hand hygiene in ways that can be used to create targeted interventions and products to improve hand hygiene.

Hand hygiene - from 7% to 89% compliance

Hand hygiene compliance rates steadily increased with new campaign.

A hand hygiene campaign that implemented new signage, a variety of in-services and new automated dispensers placed at the entry of hospital rooms significantly increased hand hygiene compliance rates among health care workers at Lawrence and Memorial Hospital in New London, Conn. During the first month of the campaign, compliance rates increased from 7.7% to 37.4%, and steadily increased to 77% by the end of the year. Rates increased further during the following 3 years, maintaining between 85% and 89% compliance.

Getting Medical Staff to Wash Their Hands - What Works?

CSIRO PUBLISHING - Healthcare Infection.

Objectives: The purpose of this study was to determine the application status of handwashing information given within the context of infection control measures in practice areas; and also to determine the need for inclusion of more in-depth information about handwashing and identifying the predictors for handwashing compliance in relation to knowledge, behaviour, beliefs, and attitude by healthcare professionals. Methods: This study was a cross-sectional survey. The target population was all healthcare professionals, including physicians, nurses and technicians, working in large acute-care hospitals in Amman, Jordan. However, medical and nursing students were excluded. Results: The results showed a predictive model of five predictors which were significantly related to self-reported handwashing: beliefs about outcomes, attitude, referent beliefs, control beliefs and skin assessment. These factors have a comparable power in the prediction of self-reported handwashing. Attitude, control beliefs and skin assessment had relatively higher prediction effects (B = 0.406, P < 0.001), (B = 0.296, P < 0.000), (B = 0.523, P < 0.000), respectively, compared with intention (B = –0.233, P = 0.102) and years of experience (B = –0.078, P = 0.576). Conclusion: The results of this study have important implications for improving healthcare professionals’ compliance with handwashing through continuous education for those providers to reinforce and educate them about the concepts of universal precautions and guidelines of infection control.

Edwina Currie says doctors are 'too posh to wash hands'

Edwina Currie says doctors are 'too posh to wash hands' - Telegraph.

The former Tory health minister, who is now patron of the charity MRSA Action UK, said she had also seen medical staff wearing outdoor clothes and long sleeves on wards, increasing the risk of infections. She also said that trusts should spend money on extra staff to tackle problems of cleanliness, rather than facing fines. Mrs Currie, who caused a scandal in Government when she warned of the dangers of salmonella in British eggs, said: “I’ve come across many instances of bad practice which at the least are folly, at worst criminally negligent. “Sharps being stuck into mattresses ‘so we can find them.’ Commodes rusting and smelly. Floors with stains, pools of congealed blood by toilets, waste bags left in corridors. Intravenous lines being reused repeatedly with inadequate sterilisation. “Doctors ‘too posh to wash’ their hands, or wearing scruffy outdoor apparel with long sleeves. No wonder it’s so hard to eradicate MRSA and other superbugs.”

Hand Hygiene - The definitive video

Hand Hygiene — NEJM.

Health-care associated infections are a threat to patient safety and the most common adverse events resulting from a stay in the hospital.1 Approximately 5 to 10% of hospitalized patients in the developed world acquire such infections, and the burden of disease is even higher in developing countries. Proper use of hand hygiene is a critical to the prevention of these infections, but compliance among health care workers is most often below 40%. . . . .

So go to the link above to find a dowloadable video that is the 'gold standard' for hand hygiene practice

Better Hand-Washing Through Technology Cuts Infection by 89%com

Better Hand-Washing Through Technology - NYTimes.com.

Enter technology. In the last year or two, several new ways to promote hand-washing – all things that beep – have made their debut: HyGreen, BioVigil, Patient Care Technology System’s Amelior 360 and Proventix’s nGage are some of them, but there are others. Some are spinoffs of systems widely used to track hospital equipment (this is how hospitals can find a wheelchair when it is needed). All employ new technology that can detect alcohol — which in hospitals is a component not only of rubbing gel but also soap. They work like this: every health care worker wears an electronic badge. When she washes her hands or uses alcohol rub, a sensor at the sink or dispenser or her own badge smells the alcohol and registers that she has washed her hands. Another sensor near the patient detects when her badge enters a room or the perimeter around a patient that the hospital sets. If that badge shows that her hands were recently washed, it displays a green light or something else the patient can see. If she hasn’t washed, her hands, the badge says so and emits a signal to remind her to do so. The sensor also sends this information to a central data base. Information about the hand-washing practices of a particular unit, shift or individual is instantly available. Do they work? It is early yet — these systems are largely in the pilot phase or in use in only a handful of hospitals. But several different studies have shown that they greatly improve hand-washing compliance. There is some evidence that the systems are associated with a drop in infections. Proventix claims its nGage system saw a 22 percent drop in infection in the units where it was used in a seven-month trial, while elsewhere in the hospital the drop during that time was only 4 percent. Miami Children’s Hospital said that during the time it used the HyGreen system in its oncology unit, the unit had a whopping 89 percent drop in infections. Deise Granado-Villar, chief medical officer, said that the gains have been maintained eight months later.

This is part of a much longer article - well worth the read