Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection

Paul D R Johnson, Rhea Martin, Laurelle J Burrell, Elizabeth A Grabsch, Susan W Kirsa, Jason O’Keeffe, Barrie C Mayall, Deidre Edmonds, Wendy Barr, Christopher Bolger, Humsha Naidoo and M Lindsay Grayson
Med J Aust 2005; 183 (10): 509-514.


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 ACHRS 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/contamination, 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.

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  • Paul D R Johnson1
  • Rhea Martin2
  • Laurelle J Burrell3
  • Elizabeth A Grabsch4
  • Susan W Kirsa5
  • Jason O’Keeffe6
  • Barrie C Mayall7
  • Deidre Edmonds8
  • Wendy Barr9
  • Christopher Bolger10
  • Humsha Naidoo11
  • M Lindsay Grayson12

  • Austin Health, Heidelberg, VIC.



We thank Sara Elkerton from pharmacy for assistance with product useage data and Courtney Thornely, Natalie Plumbley and Shirley Xie from Microbiology for assistance with MRSA screening.

Competing interests:

DeBug™ (a trademark for the hand hygiene product referred to in this article) was developed by the authors (employees of Austin Health) with funding in part from the Victorian Department of Human Services. The intellectual property for this development is held by Austin Health, which handles all patent, trademark and licensing issues. Austin Health, but no individual author, receives a small income stream from the sale of DeBug™.

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