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

To the Editor: Johnson et al detailed an intensive hand hygiene program planned to reduce the burden of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infections.1 The results were based on observations before and after the program. Hand hygiene compliance rates reached only 42% despite the program, and there was no effect on patient MRSA colonisation or environmental colonisation or contamination. Outside the intensive care unit, there was no effect on health care worker colonisation. Despite this evidence of ineffectiveness, the program was held responsible for a reduction in hospital-wide rates of clinically important MRSA infections.

The literature on hand hygiene is inadequate. The recent edition of Clinical evidence contains no randomised controlled trials of hand hygiene.2 In fact, the only published randomised trial is the Mortimer study,3 which is now more than 40 years old.

Huynh and Commens made the point that hand hygiene procedures involving application of chemical agents or scrubbing are hazardous for staff and suggested using mechanical barriers (ie, gloves) on clean unscrubbed hands.4

The hand hygiene bandwagon rolls on despite the absence of evidence of benefit for patients and its hazardous nature for staff. Mechanical barriers together with reduced contamination opportunities (hand-shaking, touching telephone handsets and computer key boards) may be better options. We need properly conducted studies to find an effective means of protecting patients from nosocomial infections by MRSA and other agents.