Friday, February 24, 2012

Alcohol Hand-Rub: Concerns about Efficacy?

Don't write off hand hygiene!
Here is a short report in the Journal of Hospital Infection. Investigators performed a retrospective analysis of alcohol hand-rub use and its correlations with hospital acquired MRSA infections and ESBL enterobacteriacea infections.

Between 2005 and 2008, the use of alcohol hand rubs increased significantly by 8 L per 1000 patient-days of hospitalization per year. During the same period, adherence to hand hygiene increased significantly from 55.6% to 70.9% (P < 0.0001). Despite these improvements there was an increase in the incidence of ESBL-producing strains in the past three years and a marginally significant negative correlation (decrease) in MRSA infections. 
Figure 1 in the manuscript nicely summarizes the findings in pictorial fashion, to include it here, however, would be a gross violation of copyright. Sorry.

I would caution the conclusion that alcohol based hand rubs are ineffective for the control of drug resistant pathogens. Hand hygiene is only part of a multi-modal infection prevention effort. Infection prevention best practices include hand hygiene, central line checklists, ventilator associated pneumonia 'bundles', urinary catheter 'bundles', removal of unnecessary invasive devices, chlorhexidine bathing of patients, reducing antibiotic selective pressure (for ESBLs- limiting the use of 3rd generation cephalosporins  and fluoroquinolones), use of gowns and gloves and adherence with isolation precautions.

This was a small study, and failed to account for all of the above with the exception of alcohol hand rub use/hand hygiene.

Hand hygiene remains vitally important.

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