Impact of alcohol hand-rub use on meticillin-resistant Staphylococcus aureus: an analysis of the literature.

We aimed to evaluate the impact of alcohol hand disinfection with alcohol hand rub (AHR) as surrogate parameter of compliance or with compliance observations on the meticillin-resistant Staphylococcus aureus (MRSA) situation in hospital settings. Medline was searched for the keywords 'hand hygiene', 'compliance', 'disinfection', 'time series analysis' combined with 'meticillin-resistant Staphylococcus aureus/MRSA'. Data were included only from studies reporting exact numbers of AHR and/or compliance observations of MRSA situations over time. The literature search resulted in 272 hits, of which 12 studies met the inclusion criteria. The amount of AHR ranged between 3 and 78 mL/patient-day (pd) at the beginning and increased to 12 to 103 mL/pd at the end of the intervention studies. Compliance with hand disinfection ranged between 20% and 64% at the beginning and between 42% and 71% at the end. An increase in AHR correlated significantly with an improvement in the MRSA situation (r=0.78), whereas there was no such correlation between compliance and MRSA. An increased consumption of AHR was associated with a significant reduction of MRSA rates. Copyright 2009 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.