Major article
The effect of improved compliance with hygiene guidelines on transmission of Staphylococcus aureus to newborn infants: The Swedish Hygiene Intervention and Transmission of S aureus study

https://doi.org/10.1016/j.ajic.2012.09.014Get rights and content

Background

Newborn infants are often colonized with Staphylococcus aureus originating from health care workers (HCWs). We therefore use colonization with S aureus of newborn infants to determine the effect of an improved compliance with hygiene guidelines on bacterial transmission.

Methods

Compliance with hygiene guidelines was monitored prior to (baseline) and after (follow-up) a multimodal hygiene intervention in 4 departments of obstetrics and gynecology. spa typing was used to elucidate transmission routes of S aureus collected from newborn infants, mothers, fathers, staff members, and environment.

Results

The compliance with hygiene guidelines increased significantly from baseline to follow-up. The transmission of S aureus from HCWs to infants was however not affected. Fathers had the highest colonization rates. Persistent carriage was indicated in 18% of the HCWs. The most commonly isolated spa type was t084, which was not detected in a previous study from the same geographic area.

Conclusion

It is possible to substantially improve the compliance with hygiene guidelines, by using multimodal hygiene intervention. The improved compliance did not decrease the transmission of S aureus from sources outside the own family to newborn infants. Furthermore, we show the establishment of a new spa type (t084), which now is very common in our region.

Section snippets

Study design

The study was performed in 2 counties in the southeast of Sweden, including 4 departments of obstetrics and gynecology in 4 hospitals (1 university hospital, department A; 1 district hospital, department B; and 2 general hospitals, departments C and D). Characteristics of the departments and participants are shown in Table 1. In all 4 departments, newborn infants were roomed with their mothers in rooms with 2 or 4 beds, where they shared diaper changing table and toilet. During the study period

Results

S aureus was recovered from 808 out of 3,243 samples at baseline and from 827 out of 3,287 samples at follow-up.

Discussion

We use colonization with S aureus of newborn infants to determine the effect of changes in compliance with hygiene guidelines on bacterial transmission. To our knowledge, bacterial transmission as the outcome in studies on improved compliance with hygiene guidelines has been scarcely studied. This study shows that it is possible to improve the compliance with hygiene guidelines by the use of a multimodal hygiene intervention. The intervention was performed on the regular budget of the infection

Acknowledgment

The authors would like to extend their sincerest gratitude to all of the participating families and thank all of the staff at the departments of obstetrics and gynecology who helped with obtaining the samples. The authors also thank Susanne Asklöv, Jeanette Letalick, Ingegerd Nyström, Herdis Rydh, Rose-Marie Sigfridsson, Gudrun Svensson, Agneta Svärd, and Lotta Tydén for coordinating the monitoring of compliance and sampling at the departments; Ewa Davidsson, Gunhild Rensfeldt, and Per-Olof

References (30)

  • D. Pittet

    Improving adherence to hand hygiene practice: a multidisciplinary approach

    Emerg Infect Dis

    (2001)
  • P.M. Dubbert et al.

    Increasing ICU staff handwashing: effects of education and group feedback

    Infect Control Hosp Epidemiol

    (1990)
  • Y.C. Chen et al.

    Effectiveness and limitations of hand hygiene promotion on decreasing healthcare-associated infections

    PloS One

    (2011)
  • M.E. Rupp et al.

    Prospective, controlled, cross-over trial of alcohol-based hand gel in critical care units

    Infect Control Hosp Epidemiol

    (2008)
  • PPM VRI. Available from: www.skl.se (Swedish). Accessed May...

    • Cited by (5)

    Supported in part by Futurum, the Academy of Healthcare, County Council, Jönköping, and the Medical Research Council of Southeast Sweden.

    Conflicts of interest: None to report.

    View full text
    Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.