Targeting hand-touch surfaces in hospitals that are likely to be contaminated by meticillin-resistant Staphylococcus aureus (MRSA), rather than a focus on removing visible dirt, is a feasible short-term strategy for tackling the transmission of MRSA, according to a Review in The Lancet Infectious Diseases to be published Online, Wednesday, October 31, 2007. Further, this additional cleaning would be easier to implement than improvements in hand-hygiene compliance.
The public associate visibly dirty wards with increasing rates of MRSA, but there is little evidence for the effectiveness of basic cleaning on reducing the risk of acquiring MRSA in health-care institutions. Furthermore, hospital hygiene is usually assessed visually, but this does not necessarily correlate with microbiological risk and fails to recognise that microorganisms, including human pathogens such as MRSA, are invisible to the naked eye*. However, the current standards for assessing hospital hygiene use visible cleanliness as a performance criterion.
Dr Stephanie Dancer (South General Hospital, Glasgow, UK) presents a robust case for targeted hospital cleaning as a strategy for controlling MRSA by reviewing the evidence for the potential impact of cleaning on each stage of the staphylococcal transmission cycle between patients, staff, and their environment. The author notes that cleaning is already accepted as an important factor in the control of other hardy environmental pathogens, such as Clostridium difficile, vancomycin-resistant enterococci, norovirus, and Acinetobacter spp, but argues that the role of near-patient hand-touch sites—such as door handles, bed rails, infusion pumps, and switches— in the transmission of MRSA and other pathogens, has not been given the priority it deserves.
According Dr Dancer, in the UK, ward cleaners work to a set specification that gives emphasis to the cleaning of floors and toilets, and yet the evidence for MRSA contamination of a huge variety of hospital items, and particularly hand-touch sites is overwhelming. Indeed, the author notes that these hand-touch sites, which might harbour and transmit microbial pathogens, are poorly cleaned.
The author concludes: “There can be no doubt that prioritising hand hygiene is the single most beneficial intervention in the control of MRSA…[but] even if everyone does wash their hands properly, the effects of exemplary hand hygiene are eroded if the environment is heavily contaminated by MRSA”. She goes on: “The increasing prevalence of MRSA and other multi-drug-resistant bacteria in UK hospitals support prioritisation of cleaning and other control measures before definitive validation”.
Journal
The Lancet Infectious Diseases