Using Automatic HH Dispensers with Feedback Reduces Staph Transmission Substantially

Weterings et al. (2013) aimed to observe the effect of improved hand hygiene compliance (HHC) on nosocomial transmission of S. aureus between patients. The study was conducted between October 2011 and December 2012 in the oncology ward of a Dutch teaching hospital and contained multiple consecutive interventions: Increase the number of alcohol hand sanitizerdispensers; educate on HH; replace standard alcohol hand sanitizers and soap dispensers by new automated dispensers, no feedback was given; and personnel feedback of HHC.

HHC was manually monitored according to the WHO method, twice a week during the whole study period. All patients were cultured weekly to detect nasal carriage of S.aureus. Isolates collected in period 2 and 4 were typed using Amplification Fragment Length Polymorphism (AFLP). The ratio between secondary and primary cases, Transmission Index (TI), was calculated. The HHC improved significantly from 31.5%(92/302;CI 25.3-36.0) in period 2 to 52.9% (139/263;CI 46.6-59.0) in period 4(p<0.001). In period 2, 266 patients were hospitalized on the days of culture; 246 nasal swabs (92.5%) were collected from 151 unique patients. In total 42/151 patients (27.5%) were S.aureus carriers. AFLP revealed six unrelated isolates and 13 clusters (2-14 isolates,median 3). Number of primary cases (PC) was 19. Transmission of S.aureus from a PC to other patients occurred in 10 out of 19 (52.6%) PC, resulting in 22 secondary cases (SC). TI of 1.2(22/19). In period 4, 314 patients were hospitalized on the days of culture; 268 nasal swabs (85.4%) were collected from 134 unique patients. In total 45/134 patients (33.6%) were S.aureus carriers. AFLP revealed 16 unrelated isolates and nine clusters (2-7 isolates,median 3). Number of PC was 25. Transmission of S.aureus from a PC to other patients occurred in 9 of 25(36.0%) PC, resulting in 17 SC. TI of 0.7(17/25). The ratio of unique versus clustered strains was significantly higher in period 4 (p=0.028).
 
The researchers conclude that improvement of HHC using automatic dispensers with personnel feedback reduces the transmission of S.aureus in the hospital substantially.

Reference: Weterings V, Esser JV, Etten RV and Kluytmans J. Oral presentation O040 at the 2nd International Conference on Prevention and Infection Control (ICPIC 2013): The effect of improved hand hygiene compliance on nosocomial transmission of Staphylococcus aureus. Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O40 doi:10.1186/2047-2994-2-S1-O40.