A performance improvement task force of Rhode Island infection control professionals was created to develop an epidemiologic model of statewide consistent infection control practices that could reduce the spread of methicillin-resistant Staphylococcus aureus (MRSA).

This model encompasses screening protocols, isolation techniques, methods of cohorting positive patients, decolonization issues, postexposure follow-up, microbiology procedures, and standardized surveillance methodologies. These “best practice guidelines” include three categories of recommendations that define priority levels based on the availability of scientific data.

From 1995 through 2000, several Rhode Island hospitals experienced a fivefold increase in nosocomial acquisition of MRSA.

Rhode Island infection control professionals are a highly interactive group in the unique position of sharing patients and ultimately experiencing similar trends and problems.

The task force collaborated on developing the best hospital infection control practices to prevent and control the spread of MRSA in Rhode Island.

The task force met with local infectious disease physicians and representatives from the Rhode Island Department of Health, the Hospital Association of Rhode Island, and Rhode Island Quality Improvement Partners. Discussions identified numerous and diverse MRSA control practices, issues of consensus, and approaches to resolving controversial methods of reducing the spread of MRSA The guidelines regarding the best hospital practices for controlling MRSA were finalized 8 months later.

These guidelines were distributed to all chief executive officers of Rhode Island hospitals by the Rhode Island Department of Health in December 2001. They were issued separate and apart from any regulations, with the intent that hospitals will adopt them as best hospital practices in an attempt to control MRSA.

To compare the frequency of skin irritation and dryness associated with using an alcoholic–hand-gel regimen for hand antisepsis versus using soap and water for hand washing.

Prospective randomized trial with crossover design. Irritation and dryness of nurses' hands were evaluated by self-assessment and by visual assessment by a study nurse. Epidermal water content of the dorsal surface of nurses' hands was estimated by measuring electrical capacitance of the skin.

Miriam Hospital, a 200-bed university-affiliated teaching hospital.

Thirty-two nurses working on three hospital wards participated in the trial, which lasted 6 weeks.

Self-assessment scores of skin irritation and dryness decreased slightly during the 2 weeks when nurses used the alcoholic–hand-gel regimen (mean baseline score, 2.72; mean final score, 2.0; P=.08) but increased substantially during the 2 weeks when nurses used soap and water (mean baseline score, 2.0; mean final score, 4.8; P<.0001). Visual assessment scores by the study nurse of skin irritation and dryness did not change significantly when the alcoholic–hand-gel regimen was used (mean baseline and final scores were both 0.55), but scores increased substantially when nurses used soap and water (baseline score, 0.59; mean final score, 1.21; P=.05). Epidermal water content of the dorsal surface of nurses' hands changed little when the alcoholic–hand-gel regimen was used (mean ± standard deviation baseline electrical capacitance reading, 24.8±6.8; mean final reading, 25.7±7.3), but decreased significantly (skin became dryer) with soap-and-water hand washing (mean baseline, 25.9±7.5; mean final reading, 20.5±5.4; P=.0003).

Hand antisepsis with an alcoholic–hand-gel regimen was well tolerated and did not result in skin irritation and dryness of nurses' hands. In contrast, skin irritation and dryness increased significantly when nurses washed their hands with the unmedicated soap product available in the hospital. Newer alcoholic hand gels that are tolerated better than soap may be more acceptable to staff and may lead to improved hand-hygiene practices.