1Department of Microbiology,Queen Mary Hospital,Hong Kong Special Administrative Region,China.
3Infection Control Branch,Centre for Health Protection,Department of Health,Hong Kong Special Administrative Region,China.
Infect Control Hosp Epidemiol. 2018 May;39(5):571-577. doi: 10.1017/ice.2018.21. Epub 2018 Feb 27.
OBJECTIVEMultidrug-resistant organisms (MDROs) are increasingly reported in residential care homes for the elderly (RCHEs). We assessed whether implementation of directly observed hand hygiene (DOHH) by hand hygiene ambassadors can reduce environmental contamination with MDROs.METHODSFrom July to August 2017, a cluster-randomized controlled study was conducted at 10 RCHEs (5 intervention versus 5 nonintervention controls), where DOHH was performed at two-hourly intervals during daytime, before meals and medication rounds by a one trained nurse in each intervention RCHE. Environmental contamination by MRDOs, such as methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter species (CRA), and extended-spectrum β-lactamse (ESBL)-producing Enterobacteriaceae, was evaluated using specimens collected from communal areas at baseline, then twice weekly. The volume of alcohol-based hand rub (ABHR) consumed per resident per week was measured.RESULTSThe overall environmental contamination of communal areas was culture-positive for MRSA in 33 of 100 specimens (33%), CRA in 26 of 100 specimens (26%), and ESBL-producing Enterobacteriaceae in 3 of 100 specimens (3%) in intervention and nonintervention RCHEs at baseline. Serial monitoring of environmental specimens revealed a significant reduction in MRSA (79 of 600 [13.2%] vs 197 of 600 [32.8%]; P<.001) and CRA (56 of 600 [9.3%] vs 94 of 600 [15.7%]; P=.001) contamination in the intervention arm compared with the nonintervention arm during the study period. The volume of ABHR consumed per resident per week was 3 times higher in the intervention arm compared with the baseline (59.3±12.9 mL vs 19.7±12.6 mL; P<.001) and was significantly higher than the nonintervention arm (59.3±12.9 mL vs 23.3±17.2 mL; P=.006).CONCLUSIONSThe direct observation of hand hygiene of residents could reduce environmental contamination by MDROs in RCHEs.Infect Control Hosp Epidemiol 2018;39:571-577.
耐多药菌（MDRO）在养老院中越来越多地被报道。我们评估了由手部卫生大使实施直接观察手部卫生（DOHH）是否可以减少 MDRO 对环境的污染。
2017 年 7 月至 8 月，在 10 家养老院（5 个干预组与 5 个非干预对照组）进行了一项集群随机对照研究，在白天每两小时由一名受过培训的护士对每个干预养老院的居民进行 DOHH，在餐前和发药时进行。使用从基线时公共区域采集的标本评估 MDRO（如耐甲氧西林金黄色葡萄球菌（MRSA）、耐碳青霉烯类不动杆菌种（CRA）和产超广谱β-内酰胺酶（ESBL）的肠杆菌科）的环境污染情况，然后每周进行两次。每周每位居民消耗的酒精基手部消毒剂（ABHR）量进行了测量。
在干预和非干预养老院的基线时，共有 100 个标本中 33 个（33%）检测到 MRSA 阳性，26 个（26%）检测到 CRA 阳性，3 个（3%）检测到产 ESBL 的肠杆菌科阳性。对环境标本的连续监测显示，与非干预组相比，干预组的 MRSA（79 例/600 例[13.2%]比 197 例/600 例[32.8%]；P<.001）和 CRA（56 例/600 例[9.3%]比 94 例/600 例[15.7%]；P=.001）污染显著减少。与基线相比，干预组每周每位居民消耗的 ABHR 量增加了 3 倍（59.3±12.9 毫升比 19.7±12.6 毫升；P<.001），且显著高于非干预组（59.3±12.9 毫升比 23.3±17.2 毫升；P=.006）。
对居民手部卫生的直接观察可减少养老院中 MDRO 对环境的污染。 感染控制与医院流行病学 2018；39：571-577.
