Alcohol handwash is becoming less effective against some strains of antibiotic-resistant bacteria, but it doesn’t mean we stop sanitising our hands, according to Victorian researchers.
For decades, the front-line in the battle against antibiotic-resistant bacteria has been alcohol-based hand sanitisers and cleaning liquids that effectively kill bacteria before they can get close to infecting vulnerable patients.
But now the bacteria are fighting back. New strains have an increased tolerance to the alcohols in sanitisers and are forcing a re-think of how hospitals can protect patients from these deadly super-bugs.
A new study by the Peter Doherty Institute for Infection and Immunity and Austin Health published in Science Translational Medicine has found that strains of Enterococcus faecium, a notorious healthcare-associated bacterial pathogen, have emerged since 2010 that are ten times more tolerant of alcohol-based hand rubs than older strains.
A strict regime of hand washing with alcohol-based sanitisers before and after patient interactions has been in place in hospitals around Australia, and many other countries, since 2002, to curb a rise in deadly MRSA, an antibiotic resistant form of Staphylococcus aureus (golden staph).
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Professor Tim Stinear
Lead author Professor Tim Stinear from the Doherty Institute says that this program has been incredibly successful up until now.
“The Austin Hospital Infectious Diseases team has been at the forefront of rolling out hand hygiene programs around Australia – the use of alcohol-based disinfectants before and after every contact with a patient.”
“Really regimented infection control ensures medical professionals, visitors or patients themselves aren’t spreading bacteria around the hospital.
“That’s been highly effective at getting rid of golden staph. Rates of golden staph infection have been decreasing for the last 15 years.”
But while MRSA infections have dropped considerably, Professor Paul Johnson, Director of Research at Austin Health and co-lead author of the latest research, noticed a rise in infections of Enterococcus faecium.
“Paul said maybe they’re becoming tolerant to all the alcohols we use in our hand hygiene products,” says Professor Stinear, “and we said, that’s ridiculous. What are the chances that something could become tolerant to alcohol?”
“It’s a broad-spectrum disinfectant – it gets into the bacterial membranes and blows them apart. It’s a general annihilator of cells.”
Enterococcal bacteria are a normal part of the human gut bacteria and don’t usually cause health problems, however certain species are becoming more prevalent in our hospitals and these can cause infections that are very difficult to treat.
One particularly problematic group of enterococci are those that develop resistance to the last-line antibiotic, vancomycin. These bacteria are known as vancomycin resistant enterococci (VRE).
“The people that become infected with VRE are in hospital and they’re sick and usually they’ve been given some course of antibiotics that’s taken out their healthy gut bacteria, and that predisposes them to VRE infection,” says Professor Stinear.
“So people that go on antibiotic treatment prior to organ transplant would be at high risk. Renal patients are at risk, as are cancer patients who might be on chemotherapies and given antibiotics to prevent or treat infections.
“When your natural gut bacteria are disturbed you can become prone to VRE, in the context of a health-care institution.”