Targeting surfaces often touched by hand in hospitals where MRSA is likely to be present, rather than concentrating on removing visible dirt only, could be a better way to stop the spread of the highly resistant bacteria says a UK scientist.
This was the result of a review published today, Wednesday 31st October in the The Lancet Infectious Diseases and written by researcher Dr Stephanie Dancer of South General Hospital, Glasgow, UK.
In the mind of the public, increasing rates of MRSA as reported in the news, is linked to visibly dirty hospital wards. But while this may make “common sense”, there is little published scientific evidence that hospital cleaning reduces MRSA.
Dancer suggests it could be because a clean environment is usually taken for granted, and therefore we should not be surprised there is no evidence that cleanliness could be an important factor in stopping the spread of MRSA. Not so much a case of evidence of absence as absence of evidence.
MRSA stands for meticillin (or methicillin in the US) resistant Staphylococcus aureus, a variation of the commonly occuring Staphylococcus aureus bacteria that has evolved to a strain that is difficult to treat and does not respond to antibiotics such as penicillin and meticillin.
Dancer argues that cleaning surfaces often touched by hand in MRSA infected hospitals would be an easier strategy to enforce than trying to get everyone to comply with hand-hygiene standards.
Part of the problem is the traditional method for assessing hospital cleanliness is done by eye. Yet this does not necessarily guarantee reduced microbial risk since pathogens like MRSA are not visible to the naked eye. So while a surface may pass the clean test by eye, it could be riddled with MRSA.
Dancer reviews the literature for evidence on the impact of cleaning on each stage of the transmission cycle of staphylococcal bacteria among patients, staff, and the environment and makes a strong case for it.
Cleaning is already regarded as an important strategy in the control of other robust pathogens such as Clostridium difficile, vancomycin-resistant enterococci, norovirus, and Acinetobacter spp, wrote Dancer.
However, she wrote that insufficient importance has been given to the part played by often touched surfaces that are near patients such as light switches, door handles, bed rails, infusion pumps, and so on, in the spread of MRSA.
In the UK said Dancer, cleaners work to a standard that emphasizes cleanliness of floors and toilets, which overlooks the overwhelming evidence that other “hand-touch sites” are more likely to harbour MRSA. In fact, the hand touch sites are not cleaned very well at all, said Dancer.
Dancer concedes that hand washing plays an important role in the control of MRSA, and goes so far as to say that:
“There can be no doubt that prioritising hand hygiene is the single most beneficial intervention in the control of MRSA.”
But she points out that:
“Even if everyone does wash their hands properly, the effects of exemplary hand hygiene are eroded if the environment is heavily contaminated by MRSA.”
Dancer concludes that:
“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.”
“Review: Importance of the environment in meticillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning.”
Stephanie J Dancer.
The Lancet Infectious Diseases Early Online Publication, 31 October 2007.
DOI:10.1016/S1473-3099(07)70241-4
Written by: Catharine Paddock