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Infection-free surgery: how to improve hand-hygiene compliance and eradicate methicillin-resistant Staphylococcus
1Southmead Hospital, Bristol, UK. chrisdavis959@hotmail.com
Introduction:
Healthcare-associated infections cost the UK National Health Service 1 billion UK pounds per annum. Poor hand hygiene is the main route of transmission for methicillin-resistant Staphylococcus aureus (MRSA), leading to increased mortality and morbidity for infected patients. This study aims to quantify MRSA infection rates and compliance of alcohol gel application at the entrance to a surgical ward and assess how a simple intervention affects compliance.
Subjects And Methods:
Compliance was assessed via a discretely positioned close-surveillance camera at the ward entrance. Footage was reviewed to monitor compliance of all persons entering the ward over a 12-month period.
Results:
For the initial 6 months, mean alcohol gel compliance was 24% for all persons entering the ward. After this period, a conspicuous strip of bright red tape was positioned along the corridor approaching the ward entrance. The red line continued up the wall to an arrow head pointing to the two alcohol gel dispensers on the wall. Mean compliance over the subsequent 6 months significantly improved to 62% (P < 0.0001). Compliance improved for all persons entering the ward as follows (before - after, significance): doctors (0% - 54%, P < 0.01); nurses (24% - 75%, P < 0.05); porters (21% - 67%, P < 0.05); visitors (35% - 68%, P < 0.01); patients (23% - 44%, P > 0.05). There were two cases of MRSA bacteraemia in the initial 6 months and no cases in the following 6 months with the red line in situ.
Conclusions:
This study demonstrates how a simple intervention significantly improves hand-hygiene compliance with associated eradication of MRSA.
Insights
A simple red tape intervention significantly boosted surgical ward hand hygiene compliance from 24% to 62%. This improvement in alcohol gel use was linked to the eradication of methicillin-resistant Staphylococcus aureus (MRSA) infections.
Area of Science:
- Healthcare-associated infections
- Infection control
- Public health
Background:
- Healthcare-associated infections (HAIs) pose a significant burden, costing the UK National Health Service (NHS) 1 billion pounds annually.
- Methicillin-resistant Staphylococcus aureus (MRSA) transmission is primarily driven by poor hand hygiene, leading to increased patient morbidity and mortality.
- Effective infection control strategies are crucial for reducing HAI rates and improving patient outcomes.
Purpose of the Study:
- To quantify methicillin-resistant Staphylococcus aureus (MRSA) infection rates.
- To assess alcohol gel application compliance at a surgical ward entrance.
- To evaluate the impact of a simple visual intervention on hand hygiene compliance.
Main Methods:
- Surveillance cameras discreetly monitored hand hygiene compliance over 12 months.
- Compliance data was collected for all individuals entering the surgical ward.
- A visual intervention (red tape and arrow) was introduced to guide users to alcohol gel dispensers.
Main Results:
- Initial alcohol gel compliance was low at 24%, increasing to 62% after the red tape intervention (P < 0.0001).
- Significant compliance improvements were observed across all user groups, including doctors, nurses, porters, and visitors.
- MRSA bacteraemia cases decreased from two in the initial 6 months to zero in the subsequent 6 months with the intervention.
Conclusions:
- A simple, low-cost visual cue can dramatically improve hand hygiene compliance.
- Effective hand hygiene is critical for controlling the spread of MRSA in healthcare settings.
- Implementing such interventions can lead to the eradication of specific HAIs, reducing patient risk and healthcare costs.
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