Increased procurement of soap and alcoholbased hand cleansers was associated with decreased rates of MRSA and C．difficile infections.
Infection with methicillin－resistant Staphylococcus aureus（MRSA）or Clostridium difficile can be acquired in the community or in healthcare settings．To prevent the spread of infectious agents by healthcare workers，thorough hand－cleaning has been emphasized．Adherence to this recommendation varies and is hard to measure.
In a recent study，researchers drew on monthly procurement data for alcohol hand rub and liquid soap to circumvent the difficulties in monitoring hand－washing．Using information from 187 National Health Service hospital trusts in England and Wales，they compared figures for 2005 through 2008 with those from late 2004 － before the start of the national Clean yourhands campaign.
Soap procurement was associated independently with C．difficile infection throughout the study： A 10－mL increase in soap procurement per patient bed－day was correlated with a 7.1％ decrease in the C．difficile infection rate．The relation between alcohol－rub procurement and MRSA bacteremia changed over time and was significant only during the final year of the study．For every 10－mL increase in cleanser procurement per patient bed－day，MRSA bacteremia rates fell by 9.6％.Alcoholrub procurement was not associated with C．difficile infection．Paradoxically，increased soap procurement was significantly associated with an increase in the rate of bacteremia caused by methicillinsensitive S.aureus.
COMMENT
This clever study would be possible only in a closed system of infection and procurement reporting．Although numerous confounding events and actions could have occurred simultaneously with the collection of these data，the association of C．difficile infection with the procurement of soap and not with that of alcohol－based cleansers（to which this organism is resistant）gives considerable validity to the findings.
－ Stephen G.Baum，MD，Journal Watch Infectious Diseases
Stone SP et al．Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene： Four year，prospective，ecological，interrupted time series study.BMJ 2012 May 3；344：e3005.（http://dx.doi.org/10.1136/bmj.e3005）
