Lai Kwan Kew, Fontecchio Sally, Melvin Zita, Baker Stephen P
University of Massachusetts Medical School, Worcester, MA, USA.
Infect Control Hosp Epidemiol. 2006 Oct;27(10):1018-24. doi: 10.1086/507916. Epub 2006 Aug 31.
Colonized and infected inpatients are major reservoirs for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), and transient carriage of these pathogens on the hands of healthcare workers remains the most common mechanism of patient-to-patient transmission. We hypothesized that use of alcohol-based, waterless hand antiseptic would lower the incidence of colonization and/or infection with MRSA and VRE.
On June 19, 2001, alcohol hand antiseptic was introduced at the University campus and not the nearby Memorial campus of the University of Massachusetts Medical School (Worcester, MA), allowing us to evaluate the impact of this antiseptic on the incidence of MRSA and VRE colonization and infection. From January 1 through December 31, 2001, the incidence of MRSA colonization or infection was compared between the 2 campuses before and after the hand antiseptic was introduced. Its effect on VRE colonization and infection was only studied in the medical intensive care unit at the University campus.
At the University campus, the incidence of MRSA colonization or infection decreased from 1.26 cases/1,000 patient-days before the intervention to 0.75 cases/1,000 patient-days after the intervention, for a 1.46-fold decrease (95% confidence interval, 1.04-2.58; P = .037). At the Memorial campus, the incidence of MRSA colonization or infection remained virtually unchanged, from 0.34 cases/1,000 patient-days to 0.49 cases/1,000 patient-days during the same period. However, a separate analysis of the University campus data that controlled for proximity to prevalent cases did not show a significant improvement in the rates of infection or colonization. The incidence of nosocomial VRE colonization or infection before and after the hand antiseptic decreased from 12.0 cases/1,000 patient-days to 3.0 cases/1,000 patient-days, a 2.25-fold decrease (P = .018). Compliance with rectal surveillance for detection of VRE was 86% before and 84% after implementation of the hand antiseptic intervention. The prevalences of VRE cases during these 2 periods were 25% and 29%, respectively (P = .017).
Alcohol hand antiseptic appears to be effective in controlling the transmission of VRE. However, after controlling for proximity to prevalent cases (ie, for clustering), it does not appear to be more effective than standard methods for controlling MRSA. Further controlled studies are needed to evaluate its effectiveness.
定植和感染的住院患者是耐甲氧西林金黄色葡萄球菌（MRSA）和耐万古霉素肠球菌（VRE）的主要储存宿主，医护人员手上这些病原体的短暂携带仍然是患者之间传播的最常见机制。我们假设使用含酒精的无水手部消毒剂会降低MRSA和VRE定植和/或感染的发生率。
2001年6月19日，在马萨诸塞大学医学院（伍斯特市）的大学校区而非附近的纪念校区引入了酒精手部消毒剂，这使我们能够评估这种消毒剂对MRSA和VRE定植及感染发生率的影响。在2001年1月1日至12月31日期间，比较了引入手部消毒剂前后两个校区MRSA定植或感染的发生率。其对VRE定植和感染的影响仅在大学校区的医学重症监护病房进行了研究。
在大学校区，MRSA定植或感染的发生率从干预前的每1000个患者日1.26例降至干预后的每1000个患者日0.75例，下降了1.46倍（95%置信区间，1.04 - 2.58；P = 0.037）。在纪念校区，同期MRSA定植或感染的发生率几乎没有变化，从每1000个患者日0.34例升至0.49例。然而，对大学校区数据进行的一项控制了与流行病例接近程度的单独分析并未显示感染或定植率有显著改善。手部消毒剂使用前后，医院获得性VRE定植或感染的发生率从每1000个患者日12.0例降至3.0例，下降了2.25倍（P = 0.018）。实施手部消毒剂干预前和后，用于检测VRE的直肠监测的依从率分别为86%和84%。这两个时期VRE病例的患病率分别为25%和29%（P = 0.017）。
酒精手部消毒剂似乎在控制VRE传播方面有效。然而，在控制了与流行病例的接近程度（即聚集情况）后，它在控制MRSA方面似乎并不比标准方法更有效。需要进一步的对照研究来评估其有效性。
