Objective: To assess the effect of a multifaceted hand hygiene culture‐change program on health care worker behaviour, and to reduce the burden of nosocomial methicillin‐resistant Staphylococcus aureus (MRSA) infections. Design and setting: Timetabled introduction of interventions (alcohol/chlorhexidine hand hygiene solution [ACHRS], improved cleaning of shared ward equipment, targeted patient decolonisation, comprehensive “culture change” package) to five clinical areas of a large university teaching hospital that had high levels of MRSA. Main outcome measures: Health care worker hand hygiene compliance; volume of ACHRS used; prevalence of patient and health care worker MRSA colonisation; environmental MRSA contamination; rates of clinical MRSA infection; and rates of laboratory detection of ESBL‐producing Escherichia coli and Klebsiella spp. Results: In study wards, health care worker hand hygiene compliance improved from a pre‐intervention mean of 21% (95% CI, 20.3%–22.9%) to 42% (95% CI, 40.2%–43.8%) 12 months post‐intervention (P < 0.001). ACHRS use increased from 5.7 to 28.6 L/1000 bed‐days. No change was observed in patient MRSA colonisation or environmental colonisation/contamination, and, except in the intensive care unit, colonisation of health care workers was unchanged. Thirty‐six months post‐intervention, there had been significant reductions in hospital‐wide rates of total clinical MRSA isolates (40% reduction; P < 0.001), patient‐episodes of MRSA bacteraemia (57% reduction; P = 0.01), and clinical isolates of ESBL‐producing E. coli and Klebsiella spp (90% reduction; P < 0.001). Conclusions: Introduction of ACHRS and a detailed culture‐change program was effective in improving hand hygiene compliance and reducing nosocomial MRSA infections, despite high‐level MRSA endemicity.

Given the nature of the contamination risk posed by fecally continent cVRE patients undergoing outpatient procedures, infection control measures should focus on effective HCW and patient hand hygiene and chair and couch cleaning, to minimize transmission of VRE.

We assessed cutaneous adverse reactions (CARs) to alcohol-based hand rub (ABHR) after the introduction of a hand hygiene culture change program at our institution. CARs were infrequent among exposed health care workers (HCWs) (13/2,750; 0.47%; 1 CAR per 72 years of HCW exposure) and were not influenced by the duration or intensity of ABHR use but were associated with the presence of irritant contact dermatitis.

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