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PubMed2001

Hand disinfection according to the European Standard EN 1500 (hygienic handrub): a study with gram-negative and gram-positive test organisms.

It was the aim of this study to compare the efficacy of alcohol-based hand disinfectants according to European Standard EN 1500 (hygienic handrub), using the routine test organism Escherichia coli and, additionally, Micrococcus luteus as a surrogate for Gram-positive pathogens. One ethanol-based hand disinfectant (product A) and one propanol-based hand disinfectant (product B) were used in all experiments. Product B (propanol-based) was significantly more effective against both test organisms than product A (ethanol-based) in quantitative suspension tests but not in tests simulating practical conditions. In the experiments according to EN 1500 germ reduction rates obtained with the ethanol-containing formulation A were identical for E. coli and M. luteus. Product B was slightly, but not significantly more effective against M. luteus. To conclude, using E. coli as the test organism for evaluating the antibacterial efficacy of alcoholic hand disinfectants under practical conditions even appears to be sufficient to permit the drawing of conclusions for Gram-positive pathogens. However, more alcohol-based hand disinfectants should be tested in further studies to verify the results obtained.

Anti-Infective Agents, Local↗
PubMed1977

[Bacteriological control of surgical hand disinfection by means of selected agents].

Three techniques of surgical hand disinfection (use of Fesia-cito, utilization of a Wofasteril-alcohol-water mixture and a modified Fürbringer-Ahlfeld method) were verified with regard to the reduction in the bacterial count of the non-infected day-hand. The Wofasteril-alcohol-water mixture caused a 99.8% reduction in the bacterial count on the right hand, and a 99.9% reduction on the left hand. The data obtained with Fesia-cito were 80.2% and 66.6% respectively. With the modified Fürbringer-Ahlfeld method the reduction in the bacterial count was 96.9% and 98.6% respectively. The authors emphasize the claim for the principle of non-infection in the field of maxillofacial surgery and recommended to exercise reserve in regard to the routine use of Fesia-cito for surgical hand disinfection.

Alcohols↗
PubMed1994

[Preoperative hand disinfection].

At Telemark Central Hospital we decided to change the procedure for preoperative disinfection of the hands in order to improve antimicrobial efficacy and to minimize skin problems for the personnel. Previously, preoperative disinfection of hands was performed by scrubbing the hand with a detergent containing chlorohexidine (Hibiscrub) which often caused dryness, fissures and dermatitis. In the recent years it has been amply shown that alcoholic solutions have a very good and immediate antibacterial effect on the skin flora, while chlorohexidine has a prolonged effect. In this paper we describe our new procedures for preoperative disinfection of hands and the necessary planning and preparation we undertook to obtain acceptance for these procedures among the personnel.

Alcohols↗
PubMed1993

[Microbiological and economic studies of abbreviated procedures for surgical hand disinfection].

An investigation was performed of whether shortened procedures for surgical hand disinfection (2 and 3 min, respectively) are equally effective as the usual German standard procedure of 5 min duration and, in addition, which saving of working time and costs would be achievable if shorter procedures were employed. The shortened procedures were: 1) 3 min alcoholic disinfectant (1 min prior handwashing) and 2) 1 min chlorhexidine detergent (Hibiscrub), 2 min 0.5% chlorhexidine in 70% isopropanol (Hibisol). The two shortened procedures were equally effective as the standard procedure (test of equivalence, p < 0.05). The savings of working time and costs calculated for 17708 operations were 1) 2360 h or 79768 German marks and 2) 3540 h or 119652 German marks, respectively.

Bacteria↗
PubMed1985

Studies on the use of povidone-iodine with the 'hygienic hand disinfection' test.

The DGHM test for hygienic hand disinfection is based on that of Rotter et al. (1980), and compares the ability of a test agent with 60% isopropanol to reduce Escherichia coli counts on artificially contaminated fingers using 15 volunteers. The test was performed seven times--three with 10% povidone-iodine (PVP-I) scrub, three with 10% PVP-I solution and once with 5% PVP-I solution. Initial tests with PVP-I scrub ('Betadine') gave comparable results with the iso-propanol, but the latter gave an activity below that normally expected, and specified in the Austrian standard (but not in the DGHM test). A repeat test with greater attention to detail gave similar activity with the scrub, but markedly greater activity from the iso-propanol so that the PVP-I scrub failed the test. Subsequent tests with four aqueous PVP-I solutions showed that all passed the tests with activity marginally greater than that of iso-propanol. Interestingly enough, two German formulations of PVP-I solution showed almost identical activity.

1-Propanol↗
PubMed1990

A multi-centre evaluation of two chlorhexidine-containing formulations for surgical hand disinfection.

Many experimental methods have been used to assess the efficacy of products intended for surgical hand disinfection. In this study, a modification of the Peterson glove juice method was used to compare two chlorhexidine-based surgical hand disinfectants, 'Hibiscrub' and an experimental formulation, F.6115. The study was performed by four independent laboratories and data merged for analysis. There was found to be no significant difference between the two formulations. The results illustrate that this modified Peterson glove juice method has the potential to form the basis of a standard method for testing surgical hand disinfectants which is both relevant to the practical situation and reproducible in different laboratories.

Chlorhexidine↗
PubMed1983

Antiviral activity of an alcoholic hand disinfectant. Comparison of the in vitro suspension test with in vivo experiments on hands, and on individual fingertips.

The inactivation of eleven viruses by a commercial alcoholic hand disinfectant ("Desderman') was tested by three different procedures, viz., in vitro in a standardized suspension test, in vivo on the entire surface of both hands, and in vivo on individual fingertips of a single volunteer. The test protocols were chosen such as to make results comparable. The influence of varying disinfectant/virus volume ratios, serum protein loads, and reaction temperatures was evaluated in vitro, and partly demonstrated in vivo. In some experiments, 5% formaldehyde was included as a reference disinfectant. The experiments support the prevailing concept, that enveloped viruses are considerably more susceptible to alcoholic disinfection than naked ones. Additionally, enveloped viruses were shown to be subject to more "spontaneous' decay on skin. The main result of the study appears to be that the in vitro model predicted a greater effectiveness of the disinfectant than was observed in vivo both in the "hand' test and the "finger' test, although some differences were noted between these tests. Reasons for the lesser in vivo inactivation may lie in the evaporation of the disinfectant with ensuing changes in disinfectant/virus volume ratio, effective temperature, and inactivation time, all shown to influence disinfection. Other mechanisms such as a "sheltering' effect of the skin may have also been operating. The results suggest that, at the present stand of knowledge, in vitro screening tests should be complemented by in vivo tests for the evaluation of antiviral hand disinfectants.

Alcohols↗
PubMed1990

Surgical hand disinfection: effect of sequential use of two chlorhexidine preparations.

The antimicrobial efficacy of three 'two-phase' surgical hand disinfection procedures was compared, in a volunteer study, to 60% n-propanol, applied for 5 min, which is the reference hand-disinfection procedure used in Austria and West Germany (FRG). The procedures involved sequential use of unmedicated soap or a disinfectant-detergent containing 4% chlorhexidine gluconate (CHX; 'Hibiscrub') followed by a handrub preparation containing 70% w/w isopropanol plus 0.5% CHX ('Hibisol'). The immediate and sustained effects (3 h) of washing with unmedicated soap (3 min) followed by rubbing on 'Hibisol' (4 min) were significantly smaller (log10 reductions of 1.72 and 1.12) than with each of the other procedures. Use of 'Hibiscrub' (3 min) and 'Hibisol' (4 min) produced log10 reductions of 2.50 and 1.71, equalling those of the reference procedure with n-propanol (2.49 and 1.78). When 'Hibisol' was used for 5 min rather than 4 min, a considerable, though not significant, increase in effect was achieved (log10 reductions of 2.90 and 2.07). Replacement of unmedicated soap by 'Hibiscrub' could significantly improve the effectiveness of the hand disinfection procedure commonly used by surgeons in German-speaking countries; namely to wash hands first with soap and then disinfect them with an alcoholic preparation. It may also be of additional advantage as this adds another 'layer' of CHX when 'Hibisol' rather than alcohol alone is used.

1-Propanol↗
PubMed1981

[Resorption of 2-phenylphenol from washing hand disinfectants (author's transl)].

2-phenylphenol may be applied as active agent in hand disinfectants which have a simultaneous cleaning effect. Such a preparation (Primasept M, Schülke & Mayr GmbH, Norderstedt) which is also suited for the inactivation of Hepatitis B viruses was applied according to prescription and the intake of the active agent by the skin was determined indirectly by the quantity separated in the urine. After 10 minutes successive application of the preparation a mean value of 6.2 mg was observed. Compared with the ADI-value, admitting significantly higher values, no particular risk has to be expected by application of the preparation.

Absorption↗
PubMed1997

[Effectiveness of alcoholic hand disinfectants against methicillin resistant Staphylococcus aureus].

In order to determine the efficacy of hand disinfectants based on alcohol against three MRSA strains and 3 methicillin-susceptible S. aureus strains (MSSA), 1-propanol (60%) as well as Sterillium and Spitaderm were investigated in the quantitative suspension test at various dilutions and reactions times (15, 30 and 60s). All undiluted disinfectants revealed reduction factors > 6 against MRSA and MSSA after 30s. Diluted disinfectants (50%) were significantly less effective against MRSA at short reaction times (15 s) (p < 0.05). Sterillium in a dilution of 50% did not reach 5 reduction factors against either MRSA or MSSA after 30 s. The impact of an appropriate use of hand disinfectants in order to break chains of infections with MRSA is obvious.

1-Propanol↗
PubMed2006

Does a preceding hand wash and drying time after surgical hand disinfection influence the efficacy of a propanol-based hand rub?

BACKGROUND: Recently, a propanol-based hand rub has been described to exceed the efficacy requirements of the European standard EN 12791 in only 1.5 min significantly. But the effect of a 1 min preceding hand wash and the effect of one additional minute for evaporation of the alcohol after its application on the efficacy after a 1.5 min application time has never been studied. METHODS: We have investigated a propanol-based hand rub (Sterillium, based on 45% propan-2-ol, 30% propan-1-ol and 0.2% mecetronium etilsulfate) in three variations: with (A) and without (B) a 1 min hand wash before the disinfection of 1.5 min with immediate sampling after the disinfection; and (C) without a hand wash before the disinfection but with sampling 1 min after the disinfection. The efficacy of the three variations was compared to the reference treatment of EN 12791. All experiments were performed in a Latin-square design with 20 volunteers. Pre- and post-values (immediate and after 3 hr) were obtained according to EN 12791. RESULTS: The 3 min reference disinfection reduced resident hand bacteria on average by 1.8 log10 steps (immediate effect) and 1.4 log10-steps (sustained effect) respectively. Method A was equally effective as the reference (immediate efficacy: 1.5 log10-steps; sustained efficacy: 1.6 log10-steps). Method B seemed to be more effective (immediate efficacy: 2.3 log10-steps; sustained efficacy: 1.7 log10-steps). Method C revealed the best efficacy (immediate efficacy: 2.3 log10-steps; sustained efficacy: 2.0 log10-steps). A comparison of all three treatment variations and the reference treatment revealed a significant difference for the immediate efficacy (p = 0.026; Friedman test), but not for the sustained efficacy (p = 0.430). A post-hoc-test for the immediate efficacy indicated a significant difference between methods A and C (p < 0.05; Wilcoxon-Wilcox test). Hence, none of the treatment variations was significantly less effective than the reference treatment. CONCLUSION: An application of the propanol-based hand rub for 1.5 min after 1 min hand wash fulfills the efficacy requirements of EN 12791. The efficacy can be improved to some extent by omitting the preceding hand wash and by awaiting the evaporation of the alcohol which is clinical practice anyway. The preceding hand wash has the most negative effect on the immediate effect. Based on our data hands should not be routinely washed before the disinfection period unless there is a good reason for it such as visible soiling.

Anti-Infective Agents, Local↗
PubMed2006

In vivo efficacy of an alcohol-based surgical hand disinfectant containing a synergistic combination of ethylhexylglycerin and preservatives.

Alcohol-based surgical hand disinfectants are widely available in healthcare settings. Some currently marketed alcohol-based products use active concentrations of antimicrobials to achieve the required efficacy, raising the risk for exposure to potentially irritating levels of antimicrobials. This study compares the in vitro and in vivo efficacy of an alcohol-based surgical hand preparation containing 70% ethanol and preservative levels of chlorhexidine gluconate (CHG) and benzalkonium chloride (BZK) in synergistic combination with ethylhexylglycerin (Surgicept) with a surgical hand disinfectant containing 61% ethanol and 1% CHG (Avagard). The in vivo efficacy of Surgicept and Avagard was evaluated in volunteers using the Tentative Final Monograph method of the Food and Drug Administration (FDA), and their prolonged effect against transient pathogens was compared using a pig skin model. Surgicept exceeded the FDA requirements for surgical hand antiseptic with mean log(10) reductions of 2.36, 3.3 and 3.54 in resident flora 1 min after initial application, and showed a persistent effect with mean log(10) reductions of 2.23, 2.73 and 3.3, 6h post application on days 1, 2 and 5, respectively. Surgicept showed a superior prolonged effect against transient bacteria compared with Avagard. Surgicept (70% alcohol and preservative levels of CHG and BZK) may provide similar in vivo efficacy as Avagard (61% ethanol and 1% CHG).

Administration, Cutaneous↗
PubMed2001

Better compliance and better tolerance in relation to a well-conducted introduction to rub-in hand disinfection.

The aim of the study was to demonstrate that the introduction of rub-in hand disinfection (RHD) in hospital units, with the implementation of suitable equipment, drafting of specific protocols, and training users, improved compliance of hand disinfection and tolerance of user's hands. In four hospital units not previously using RHD an external investigator conducted two identical studies in order to measure the rate of compliance with, and the quality of, disinfection practices, [rate of adapted (i.e., appropriate) procedures, rate of correct (i.e., properly performed) procedures, rate of adapted and correct procedures carried out] and to assess the state of hands (clinical scores of dryness and irritation, measuring hydration with a corneometer). Between the two studies, the units were equipped with dispensers for RHD products and staff were trained. Compliance improved from 62.2 to 66.5%, quality was improved (rate of adapted procedures from 66.8% to 84.3%, P > or = 10(-6), rate of correct procedures from 11.1% to 28.9%, P > or = 10(-8), rate of adapted and correct procedures from 6.0 to 17.8%, P > or = 10(-8)). The tolerance was improved significantly (P > or = 10(-2)) for clinical dryness and irritation scores, although not significantly for measurements using a corneometer. This study shows the benefit of introducing RHD with a technical and educational accompaniment.

Attitude of Health Personnel↗