Alcohol gels reduce hospital infections

SAN DIEGO, Sept. 28 (UPI) -- Researchers said Saturday that having dispensers of alcohol-based hand rubs in every hospital room significantly reduces the transmission of multi-drug resistant killer microbes that cause potentially fatal infections.

At one hospital in Washington, D.C., new hospital-acquired cases of potentially lethal methicillin resistant Staphylococcus aureus infection dipped 23 percent, and cases of vancomycin-resistant enterococci decreased by 40 percent following installation of 500 dispensers of alcohol-based hand foam.

MRSA are particularly vicious organisms that are resistant to almost every antibiotic available, except vancomycin and a handful of new drugs. VRE are resistant to even vancomycin, and are particularly fearsome in elderly and immunocompromised patients.

"We placed the dispensers in every in-patient room, and in every outpatient room and in surgical and other rooms," said Maureen Schultz, an infection control program specialist at the Veterans Affairs Medical Center in Washington. "The product costs us about $200 a month; the company placed the dispensers for free. So over the course of our study we spent about $2,400. Just preventing one infection could cover that cost."

An education program encouraged frequent use of the foam following contact with patients and objects in a patient's room.

In presentations at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy, sponsored by the American Society for Microbiology, Schultz explained in-hospital infections caused by drug resistant bacteria affects lengths of stay, hospital costs and possibly patient mortality.

"Hand hygiene is a cornerstone of the effort to limit the spread of these organisms," she said.

Elaine Larson, associate dean for research at Columbia University School of Nursing, New York, said hand washing in hospitals no longer suffices to prevent spread of infection. Soap and water is inconvenient and incomplete in getting rid of common microbes.

She said new protocols from the Centers for Disease Control and Prevention in Atlanta will mandate hospitals move to alcohol-based hand rubs.

Schultz said prior to the year 2000, when the new dispensers were put into place, the study hospital averaged about 78 new cases of MRSA a year. Since the dispensers have been available, that number has fallen to 60 cases a year. For VRE, the hospital used to see about 40 cases a year, yet after the new program was initiated that dropped to 24 cases a year.

"During that time frame, the number of patients in the hospital was about the same. No new infection control programs were initiated," she said. "The only change was the installation of the alcohol-based hand rub system."

Schultz said any over-the-counter product that has at least 60 percent alcohol would be sufficient to control the microbe spread. She said the hospital tried several different product brands before settling on a foam substance. Various emollients are added to the gels or foams to protect hands.

There are areas in the hospital, however, where success in reducing the risk of infection may be limited, researchers said.

Dr. Peter Kim, an infectious diseases fellow at the University of Maryland Health System in Baltimore, said observations of hand hygiene procedures -- either by washing with soap and water or using the alcohol-based system -- failed to make much on an impact in intensive care settings.

Kim said overall, healthcare personnel in those wards improved their hand hygiene by about 4 percent following the inclusion of alcohol-based hand rubs in the units. He suggested greater educational information regarding the need for continual hand hygiene might improve the situation in those settings.

Larson said alcohol-based hand rub systems have been in place in European hospitals for more than 20 years.

"We are way behind Europe," she said. "We have been very, very slow to pick up on this."

She estimated a very small minority of hospitals in the United States have moved to the alcohol-based system, but most hospital administrators are aware that "a revolutionary change" in hand hygiene is on the near horizon.