Becker's Clinical Quality & Infection Control

48 Traditional Hand Hygiene Audits Exaggerate Compliance Gap Between Nurses, Physicians By Heather Punke O vert hand hygiene compliance audits have shown a large gap in compliance between nurses and physicians, with nurses washing their hands more oen than physicians. But a new study in the Journal of Hospital Medicine shows that gap narrows when hand hygiene rates are mea- sured by covert observers. Researchers introduced trained covert observers to a hospital during clinical rotations and compared hand hygiene compliance rates they observed to those gathered by overt auditors. ey found that covert observation produced lower compliance rates than overt observation during the same time period, 50 percent versus 83.67 percent. Additionally, researchers found that physicians' compliance difference between overt and covert observers was 19 percent (73.2 percent versus 54.2 percent), while for nurses it was much higher, at 40.7 percent (85.8 percent versus 45.1 percent). "Our study suggest that traditional HH audits not only overstate HH perfor- mance overall, but can lead to inaccurate inferences about performance by professional groupings due to relative differences in the Hawthorne effect," the authors concluded. n Is Household Decolonization of MRSA Effective? By Heather Punke M ethicillin-resistant Staphylococcus aureus is noto- riously difficult to get rid of because people can carry MRSA without becoming infected and then pass it on to others. One strategy to clear MRSA is decolo- nization of close contacts. A new study in Infection Control & Hospital Epidemiology showed that household decoloni- zation is only effective if patients are compliant. The three-arm randomized trial was conducted at five hospitals in Pennsylvania with members of 223 house- holds. Participants were split into three groups: those who received only education on personal and household hygiene; those who received education with treatment and reminders with daily phone calls and texts; and those who received education with treatment but no reminders. Researchers found no significant difference in time to clear- ance of MRSA colonization in the education-only and the two decolonization groups. However, they found compli- ance with the steps was associated with decreased time to clearance. They then recommended clinicians work with patients to emphasize the importance of compliance with the treat- ment to successfully clearing MRSA. "We believe that our study leads to other crucial questions that deserve attention, such as the role of other parts of the household, including pets and the environment, in MRSA transmission, the importance of compliance with decol- onization protocols and the optimal timing, duration and frequency of decolonization," said Valerie Cluzet, MD, the study's lead author. n Chlorhexidine Bathing Can Reduce MRSA Acquisition in ICUs, Study Finds By Heather Punke D aily chlorhexidine bathing in intensive care units where acquisition rates of methicillin-resistant Staphylococcus au- reus are high can bring those MRSA rates down significantly, according to a study in the Ameri- can Journal of Infection Control. Researchers implemented daily chlorhexidine bathing for 16 months in a medical ICU with MRSA endemicity after a 14-month control period. They used regression analysis to find the effect of the bathing on MRSA acquisition, and they also measured MRSA chlorhexidine suscep- tibility with polymerase chain reaction tests. They found a significant reduction in the inci- dence density of MRSA in the ICU. "Daily chlorhexidine bathing resulted in a sig- nificantly decreasing trend of MRSA acquisition rates irrespective of increased MRSA prevalence rates in the medical ICU," the study concludes. "There was no shift of chlorhexidine-resistant MRSA strains." n

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