Understanding antibiotic resistance
Understanding antibiotic resistance

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Understanding antibiotic resistance

3 Case study: reducing antibiotic resistance by improving hand washing

There have been many campaigns to improve hand washing, particularly in healthcare settings. In the next activity, you will look at how effective these campaigns have been in reducing the transmission of antibiotic-resistant bacteria and, in particular, bacteria that are resistant to cephalosporins.

Activity 4 Improving hygiene to reduce antibiotic-resistance – Part 1

Allow about 15 minutes

Reducing HCAIs

Described image
Figure 8 A poster from the ‘Clean Your Hands’ campaign.

Read the following short article about the ‘Clean Your Hands’ campaign (Figure 8) and then answer the questions below.

Article 1: Hand Hygiene campaign ‘cut superbug infections’. [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)]

  1. How was hand washing measured in the campaign?
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Answer

Hand washing was measured by looking at the amount of soap and alcohol-based hand gel being purchased by hospitals.

  1. Was hand washing altered during the campaign?
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Answer

Yes, the amount of alcohol gel and soap purchased by hospitals during the campaign trebled from 22 ml to 60 ml per patient per day.

  1. What happened to infection rates during the campaign?
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Answer

Rates of MRSA infection more than halved while rates of C. difficile infection decreased by more than 40%.

  1. Is there a correlation between hand washing and infection rates? A correlation simply means that there is a relationship between the two sets of data. For example, there is a positive correlation between antibiotic use and antibiotic resistance: as antibiotic use increases, antibiotic resistance also increases.
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Answer

Yes, there is a negative correlation between hand washing and the rate of antibiotic-resistant infections: as hand washing increased, rates of infection decreased.

Activity 4 Improving hygiene to reduce antibiotic-resistance – Part 2

Allow about 15 minutes

Reducing the spread of cephalosporin-resistant infections

You might remember from Weeks 3 and 4 that ESBL-producing bacteria are resistant to cephalosporins. In the second part of this activity, you will look at how hand hygiene in intensive care units (ICUs, also known as intensive therapy units (ITUs)) can affect the rate of cephalosporin-resistant infections.

Hospital ICUs must work to reduce the emergence and spread of antibiotic-resistant infections because patients are frequently treated with broad-spectrum antibiotics. They are also at high risk of infection from the use of invasive medical devices such as respiration tubes and catheters.

In 2006, a study aimed to assess the effect of a hand hygiene intervention on the number of ESBL-producing Klebsiella pneumoniae infections in ICUs (Prospero et al., 2010). The intervention consisted of a training course and the introduction of alcohol-based hand gels.

Two ICUs took part in the study. ICUb continued its normal hand hygiene practices. ICUa introduced the use of alcohol-based hand gel in addition to its previous hand-washing measures.

The number of cases of ESBL-producing K. pneumoniae infection was recorded before and after the intervention was introduced. Table 2 shows the findings of the study. The infection rate is recorded as the number of cases of infection per 1000 days of patient hospitalisation.

Table 2 Cases of infection in two ICUs before and after the introduction of a hand hygiene intervention.

ICUa (with intervention) ICUb (no intervention)
Pre-intervention cases (no. per 1000 days hospitalisation) 4.50 4.02
Post-intervention cases (no. per 1000 days hospitalisation) 1.68 8.31

Now use the data in the table to answer the following questions.

  1. What happened to the number of infection cases in the ICU where the intervention was introduced (ICUa)?
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Answer

The number of infection cases decreased during the intervention period from 4.50 cases per 1000 days hospitalisation to 1.68 cases per 1000 days hospitalisation.

  1. What happened to the number of infection cases in the ICU without the intervention (ICUb)?
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Answer

The number of infection cases increased during the intervention period from 4.02 cases per 1000 days hospitalisation to 8.31 cases per 1000 days hospitalisation.

  1. Was the hand-washing intervention successful?
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Answer

Yes, the number of infection cases decreased in the ICU with the intervention but increased in the ICU without the intervention. This suggests that using the alcohol-based hand gel was effective at reducing infections.

  1. What effect would you expect the campaigns in this activity to have on the demand for antibiotics?
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Answer

Improving hand washing and decreasing the transmission of antibiotic-resistant infections should decrease the demand for antibiotics by lowering the number of infections requiring treatment.

In Sections 2 and 3 you saw how improving hygiene can act as a barrier to pathogen transmission, reducing the unnecessary use of, and lowering the demand for, antibiotics. Next, you will look at another way to reduce antibiotic use – using rapid diagnostics to reduce the unnecessary prescribing of broad-spectrum antibiotics.

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