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PubMed1991

Investigations into the efficacy of different procedures for surgical hand disinfection between consecutive operations.

In order to examine whether thorough surgical hand disinfection (handwashing plus hand disinfection) between consecutive operations is necessary, tests were carried out simulating normal clinical conditions. The tests were performed according to the guidelines for the evaluation of disinfection procedures of the German Society for Hygiene and Microbiology. Surgical hand disinfection was as follows: handwashing with soap without antimicrobial additives and subsequent 5-min disinfection with 60% n-propanol. This was followed by simulated operations of 30 or 120 min duration with a 30-min break between operations, during which half of the test group kept on the surgical gloves, while the other half removed them. The second surgical hand disinfection was done without prior handwashing by 50% of the test group. The disinfection time was reduced from 5 to 1 min by 50% of the test group. The results were evaluated by means of explorative data analysis and inductive statistical methods. Removing the surgical gloves during the interoperative break did not result in significantly higher numbers of colony forming units (cfu) compared with retaining the gloves. This was also the case after a subsequent handwashing. At the second surgical hand disinfection, after a simulated operation of 60 min duration (including break), there was no significant difference in the numbers of cfus between the test group who had washed their hands and those who had not. Reducing the disinfection time from 5 min to 1 min was not associated with a significant increase in the number of cfus. However, after a simulated operating time of 150 min (including the break), the second surgical hand disinfection with handwashing resulted in a significantly lower number of microorganisms than disinfection alone. In half the tests, the numbers of cfu were significantly lower when the test group disinfected their hands for 5 min rather than 1 min.

1-Propanol↗
PubMed2001

An in-use evaluation of an alcohol-based pre-surgical hand disinfectant.

OBJECTIVE: To determine whether alcohol hand disinfection is an effective alternative to traditional agents for the pre-surgical scrub. DESIGN: A prospective clinical trial of a 70% isopropanol pre-surgical hand disinfectant. SETTING: The operating room suites at two hospital sites in British Columbia. METHODS: Cases were selected to evaluate both short and longer procedures. The hand disinfectant was compared to agents in current use as surgical scrubs (4% chlorhexidine and 7.5% povidone-iodine). Surgical technique and glove use were not modified. Pre- and postoperative fingertip impression and "glove-juice" cultures were used to determine microbial burden, and hands were evaluated for skin integrity. RESULTS: There was no statistical difference between the microbial hand counts following use of the alcohol-based product or the current agents, for cases less than 2 hours' duration. Comparison of longer surgical cases revealed significantly better pre- and postoperative culture results with the alcohol hand rinse, but analysis of matched pairs showed no significant difference in microbial counts. The alcohol hand rinse was equivalent to the operative scrub in terms of skin integrity and user acceptability. CONCLUSION: An alcohol hand rinse was equivalently effective in reducing microbial hand counts as the traditional pre-surgical scrub, both immediately after hand disinfection and at the end of the surgical procedure.

2-Propanol↗
PubMed1995

Two in-vivo protocols for testing virucidal efficacy of handwashing and hand disinfection.

Whole-hands and fingerpads of seven volunteers were contaminated with poliovirus type 1 Sabin strain in order to evaluate virucidal efficacy of different forms of handwashing and handrub with alcohols and alcohol-based disinfectants. In the whole-hand protocol, handwashing with unmedicated soap for 5 min and handrubbing with 80% ethanol yielded a log reduction factor (RF) of > 2, whereas the log RF by 96.8% ethanol exceeded 3.2. With the fingerpad model ethanol produced a greater log RF than iso- or n-propanol. Comparing five commercial hand disinfectants and a chlorine solution (1.0% chloramine T-solution) for handrub, Desderman and Promanum, both composed of ethanol, yielded log RFs of 2.47 and 2.26 respectively after an application time of 60 s, similar to 1.0% chloramine T-solution (log RF of 2.28). Autosept, Mucasept, and Sterillium, based on n-propanol and/or isopropanol, were found to be significantly less effective (log RFs of 1.16, 1.06 and 1.52 respectively). A comparison of a modified whole-hand and the fingerpad protocol with Promanum showed similar results with the two systems suggesting both models are suitable for testing the in-vivo efficacy of handwashing agents and hand disinfectants which are used without any water.

Adult↗
PubMed2005

Surgical hand disinfection with a propanol-based hand rub: equivalence of shorter application times.

The aim of this study was to determine the efficacy of a propanol-based hand rub at application times shorter than 3 min. The bacterial pre-value was obtained from the finger tips (prEN 12791). Subjects treated their hands with the reference procedure (n-propanol, 60%) for 3 min or the product (crossover design). Sterillium was applied for 3, 2, 1.5 and 1 min. Four other preparations were tested for 1 min. Post-values (immediate effect) were taken from one hand, and the other hand was gloved for 3h. After the gloves were removed, the second post-value was taken (sustained effect). Sterillium was more effective than the reference procedure at 3, 2 and 1.5 min (immediate and sustained effect). The immediate effect after 1 min was significantly lower [mean log(10) reduction factor (RF): 1.91+/-0.90 vs. 2.52+/-0.95; P=0.001], whereas the sustained effect was not (mean RF: 1.81+/-1.06 vs. 2.05+/-1.14; P=0.204). All other preparations failed the efficacy requirement at 1 min for both the immediate and sustained effect. Using 2 x 3 mL Sterillium for a total of 1.5 min for surgical hand disinfection was at least as effective as the 3-min reference disinfection.

1-Propanol↗
PubMed2005

[Hygienic and dermatologic aspects of hand disinfection and prophylactic skin antisepsis].

Hygienic hand disinfection must be carried out after all patient-care activities associated with contamination risks, as well as when moving from contaminated to clean body sites, after contact with environmental surfaces in the immediate vicinity of patients, after glove removal and before aseptic procedures. Preparatory handwashing (for about 10 seconds) to mechanically remove soil and bacterial spores should be performed at least 10 minutes before surgical hand disinfection. This allows time for the normalization of increased skin hydration, a prerequisite for effective hand disinfection. Depending on the manufacturer's instructions, application times of 1.5, 3 or 5 minutes can be observed. The regular use of skin care and skin protection products can help to prevent toxic skin irritation. For skin antisepsis the recommended exposure times are > or =15 seconds before subcutaneous injections, > or =1 minute before puncture of joints and body cavities as well as preoperatively, and > or =10 minutes on skin areas rich in sebaceous glands. For all 3 indications, alcohol-based formulations are the agents of choice.

Anti-Bacterial Agents↗
PubMed2006

One plunge or two?--hand disinfection with alcohol gel.

OBJECTIVE: To compare health care workers' hand surface coverage using two different volumes of alcohol gel for hand disinfection. PARTICIPANTS: and methods. A total of 84 members of staff in our hospital were studied. Subjects were asked to disinfect their hands with alcohol gel containing a clear fluorescent substance. Performance was assessed by using UV light to identify areas which had been missed, and the total surface area missed was calculated. A total of 42 subjects received 3.5 ml of alcohol gel, and 42 age-, sex-, and job-matched subjects received 1.75 ml of alcohol gel. RESULTS: Significantly less area was missed when hand disinfecting with double the volume of alcohol gel; 1.23 versus 6.35% surface area was missed (P < 0.001). CONCLUSION: Doubling the volume of alcohol gel used for hand disinfection significantly improves the efficiency of coverage of the hands with alcohol gel. This may result in lower bacterial count on the hands and may reduce the spread of nosocomial infections including that of methicillin-resistant Staphylococcus aureus.

Adult↗
PubMed2003

Rates of hand disinfection associated with glove use, patient isolation, and changes between exposure to various body sites.

BACKGROUND: Handwashing is the most effective and economic intervention shown to reduce nosocomial infection rates. However, studies have consistently documented low hand disinfection compliance. Literature regarding the roles that concomitant glove use and isolation precautions play in health care worker compliance with hand disinfection is limited. It is unclear whether workers change gloves and disinfect hands adequately between exposures to different body sites/secretions while caring for a patient. METHODS: This was an observational study in which hand disinfection compliance and glove use among workers was evaluated in 2 intensive care units at a tertiary care hospital. RESULTS: Five hundred eighty-nine opportunities for hand disinfection were recorded in 40 hours of observation. Overall compliance was 22.1%. We found a statistically significant, positive association between glove use and subsequent hand disinfection (relative risk [RR], 3.9 [95% CI, 2.5-6.0]; P <.0001). Isolation precautions did not significantly increase disinfection compliance. Only 4.8% (3/63) of workers appropriately complied with disinfection when hands were exposed to multiple body sites/secretions while caring for a patient. CONCLUSIONS: Glove use increases compliance with hand disinfection. Isolation precautions do not increase compliance. Workers do not appropriately comply with disinfection guidelines when attending to multiple body sites/secretions on the same patient. Compliance with hand disinfection remains low.

Attitude of Health Personnel↗
PubMed1991

[Skin and hand disinfection].

In modern medicine, hygiene has become an issue of ever increasing importance. Disinfection of hands is crucial, since hands are the main vector of bacteria. Successful disinfection depends not only on the appropriate choice of an active agent, but equally so on proper techniques and skin care. The spectre and the time profile of activity as well as the skin-protecting properties of the chosen disinfectant must be known. Basic knowledge of disinfection is necessary for a rational interpretation of the information given in the glossy printed material of advertisement.

Disinfectants↗
PubMed1989

Spray dispensing of antiseptics is effective for hand disinfection.

The effectiveness of three hand antiseptics administered using a spray dispenser (Nebucid 840) was studied together with that of conventional hand disinfection. The tests were carried out by a group of 20 dental students. To obtain baseline samples, the subjects washed their hands with unmedicated Sterisol liquid soap under running water for 30s and dried them on sterile-packed paper towels. Microbiologic samples were taken from fingerprints pressed gently onto blood agar plates, which were then incubated aerobically and analyzed. The hand disinfection efficacy of 3 ml Isosept solution rubbed onto the hands for 30 s, followed by air drying for 60 s, was studied as a conventional control method. Dermocol, HD 410, and Hibisol antiseptics were sprayed onto the subjects' hands for 3 s using the automatic dispenser, after which the hands were gently rubbed for 30 s and air-dried for 60 s, before fingerprint contact sampling. All the tests were performed three times, with a minimum of 3 days between the series. The results showed Hibisol applied with the spray dispenser to be significantly more effective in reducing bacterial growth than the other methods. No growth was observed on 51 plates out of 60, while bacterial growth was observed in 29 cases out of 60 in the Isosept series. In most cases the spray-dispensed antiseptics proved to be more efficient than the conventional hand antiseptic. All the antiseptics were significantly more effective than the liquid soap.

Adult↗
PubMed1984

Hygienic hand disinfection.

The purpose of hygienic hand disinfection is to render hands safe after contact with pathogens. Comparing effects of disinfection procedures on infection ratios is too difficult for routine purposes but the degerming efficacy may be determined in laboratory tests with volunteers. In the Vienna test model the efficacy of a specific procedure being tested is compared to that of a standard disinfection (rubbing into hands 3 ml of isopropanol 60% v/v, 30 seconds, twice) tested in parallel with the same volunteers. This ensures standardization, thus comparability of results between laboratories, and provides the investigator with a yardstick for efficacy. The model includes artificial contamination, assessment of the release of test bacteria (E. Coli ATCC 11229) before and after disinfection by the finger tip method, and addition of neutralizers to sampling fluids. Alcohols in appropriate concentrations are highly effective (log reductions: greater than 4.0) whereas procedures employing disinfectant detergents act like soap (log reductions: less than or equal to 3.2) and may cause dissemination of pathogens.

Bacteriological Techniques↗
PubMed2003

Evaluation of the bactericidal effect of five products for surgical hand disinfection according to prEN 12054 and prEN 12791.

Surgical hand disinfection (with an alcohol-based hand rub) and surgical handwash (with an antiseptic-based liquid soap) are accepted measures to reduce the risk for surgical site infections. The new European Standards allow a comparison of their antimicrobial efficacy. The bactericidal activity of surgical hand rubs [Sterillium and Softaman, (active ingredient=alcohols)] and handwashes [Derman plus (triclosan), Hibiscrub (chlorhexidine) and Betadine (PVP-iodine)] was tested according to the prEN 12054 suspension test using Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus hirae, and to prEN 12791 for the effect on resident skin flora in comparison with 1-propanol, 60% (v/v). All five products achieved a reduction of test bacteria within 3 min of >10(5)-fold so fulfilling prEN 12054. However, only Hibiscrub, Sterillium and Softa Man met the requirements of prEN 12791, giving a mean reduction of resident micro-organisms (immediate and sustained effect) which was not significantly lower than the reference alcohol (P>0.1; Wilcoxon matched-pairs signed-rank test). Sterillium was significantly more effective than the reference alcohol (immediate and sustained affect). Products for surgical hand disinfection may have equal antimicrobial activity in suspension tests but show large differences under practical conditions. Healthcare workers should not rely on results from suspension tests when deciding on a product for surgical hand disinfection.

1-Propanol↗
PubMed1998

Limited effectiveness of chlorhexidine based hand disinfectants against methicillin-resistant Staphylococcus aureus (MRSA).

Hand disinfectants containing chlorhexidine are thought to be less bactericidal against methicillin-resistant Staphylococcus aureus (MRSA) than methicillin-susceptible Staphylococcus aureus (MSSA). We report an in vitro comparison between three distinct MRSA strains and three MSSA strains. The bactericidal efficacy of chlorhexidine digluconate, 'Hibiscrub' and 'Hibisol' against Staphylococcus aureus was determined in a quantitative suspension test. Logarithmic reduction factors (RF) were calculated for each of six parallel experiments. Chlorhexidine digluconate and 'Hibisol' showed RF > 5 at most concentrations and reaction times but 'Hibiscrub' did not. MRSA was found to be significantly less susceptible than MSSA to chlorhexidine digluconate, 'Hibiscrub' and 'Hibisol' (P < 0.05; two-tailed t-test for independent samples). 'Hibisol' was significantly more effective against MRSA than 'Hibiscrub' (P < 0.05). Hand disinfectants containing both alcohol and chlorhexidine (e.g., 'Hibisol') are more effective against MRSA than scrubs based only on chlorhexidine ('Hibiscrub') and should be used in clinical practice.

Chlorhexidine↗