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PubMed2001

Evaluation of the contribution of isolation precautions in prevention and control of multi-resistant bacteria in a teaching hospital.

From February 1999 to January 2000, a control programme to prevent the spread multi-resistant bacteria (MRB) was implemented in a French teaching hospital. This programme focused on methicillin-resistant Staphylococcus aureus (MRSA) and Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBL), and was based on the application of barrier precautions (washing hands with antiseptic soaps, wearing disposable gloves and gowns, identifying MRB carriers). No changes in antibiotic policy occurred during the year. Our aim was to conduct an evaluation of this programme by measuring incidence rates. Concurrently, the effect of barrier precautions was estimated in an indirect way, by documenting the availability of barrier precautions in MRB carriers' rooms and by analysing the monthly correlation between the supply of such material and the theoretical cumulated length of MRB carriers' isolation in six randomized wards. All MRB isolated in hospitalized patients were recorded, and differentiated between acquisition in our hospital or from elsewhere. For the analysis of trends, the year was divided in three periods of four months. Over the year, the global MRB incidence was 1.26 per 1000 patient-days (PD) [95% confidence interval (95%CI)=1.16-1.36]. The MRSA incidence was 0.89 per 1000 PD (95%CI=0.81- 0.97) and the ESBL incidence was 0.38 per 1000 PD (95% CI=0.33-0.43). The MRB incidence decreased significantly in all types of specialties except for surgical wards. The incidence decreased by 17.9% for MRSA, 54.9% for ESBL and 34.8% for both MRB. Concurrently, the proportion of strains acquired in our hospital decreased for MRSA (P for trend > or = 0.05) and ESBL (P for trend > or = 0.01), whereas the incidence of imported strains increased slightly. The proportion of multiresistant strains in S. aureus (36.8%) and Enterobacter aerogenes (37.0%) remained similar throughout the year. Thus, the decrease of the incidence concerned both resistant and susceptible strains. The availability of antiseptic soaps increased significantly (P for trend > or = 0.01). The amount of antiseptic soap ordered and the theoretical lengths of isolation were correlated on a monthly basis (Spearman coefficient = 0.72; P > or = 0.02). These results shows the efficacy of such a programme of MRB containment in a large hospital, provided barrier nursing is instigated, together with the availability of such material as antiseptic soap, to allow implementation.

Bacterial Infections↗
PubMed1989

The use of antiseptics for handwashing by medical personnel.

Numerous studies have shown that the major reservoir of nosocomial infection in the hospital is the infected or colonised patient and the major mode of spread of organisms between patients is on the hands of medical personnel. A prolonged preoperative scrub with an antiseptic is one of the most time-honoured rituals of surgical asepsis. Hygienic handwashing in the hospital or clinic, to remove transient contaminants acquired from patients or the environment and prevent cross-infection to vulnerable patients, is similarly regarded as one of the most fundamental infection control measures, yet is done infrequently by personnel in most hospitals. Following a typical brief (7.10 second) handwashing with a nonmedicated soap, the number of organisms that can be transmitted from the person's hands may, paradoxically, actually increase. Use of chlorhexidine for handwashing or application of an evaporative alcohol-based lotion has been found to reduce shedding of bacteria-laden skin squames. Routine use of antiseptic-containing handwashing agents is clearly more effective than nonmedicated soaps for microbial removal, can enhance the value of the handwashings that are done and might further confer protection against contaminants acquired between handwashings. In a sequential comparative trial of three handwashing agents in a surgical intensive care unit--a nonmedicated soap, 10% povidone-iodine solution, and 4% aqueous chlorhexidine, each used exclusively for approximately six weeks--the incidence of nosocomial infection was 50% lower during the use of the antiseptic handwashing products than during the use of nonmedicated soap (P less than .001). Novel approaches are needed to improve the frequency of hygienic handwashing.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Infective Agents, Local↗
PubMed1995

Recovery of vancomycin-resistant enterococci on fingertips and environmental surfaces.

OBJECTIVE: To determine the recovery of vancomycin-resistant enterococci (VRE) on fingertips, gloved fingertips, and environmental surfaces commonly encountered in the healthcare setting, and to examine the importance of handwashing on the removal of these organisms. DESIGN: Two clinical isolates of VRE (Enterococcus faecalis and Enterococcus faecium) were inoculated onto the hands of healthy human volunteers and the following environmental surfaces: countertops, bedrails, telephones, and stethoscopes. Following inoculation, samples were obtained at various time intervals to determine rates of recovery of organisms. To evaluate the effects of handwashing on enterococcal recovery, two different soap preparations were tested. Hands were washed with water alone or with one of the soaps and water. The soap and water studies were performed with a 5-second and a 30-second wash. RESULTS: Both enterococcal strains survived for at least 60 minutes on gloved and ungloved fingertips. The E faecalis was recoverable from countertops for 5 days; the E faecium persisted for 7 days. For bedrails, both enterococcal species survived for 24 hours without significant reduction in colony counts. The bacteria persisted for 60 minutes on the telephone handpiece and for 30 minutes on the diaphragmatic surface of the stethoscope. A 5-second wash with water alone resulted in virtually no change in recovery of enterococci; a 30-second wash with water plus either soap was necessary to eradicate the bacteria from hands completely. CONCLUSION: VRE are capable of prolonged survival on hands, gloves, and environmental surfaces. Hands should be washed thoroughly and gloves removed following contact with patients infected or colonized with these multidrug-resistant bacteria. Finally, environmental surfaces may serve as potential reservoirs for nosocomial transmission of VRE and need to be considered when formulating institutional infection control policies.

Drug Resistance, Microbial↗
PubMed2004

Insecticidal properties of a Chenopodium-based botanical.

The emulsifiable concentrate UDA-245 based on an essential oil extract from Chenopodium ambrosioides variety near ambrosioides, a North American herbaceous plant, was compared with commercially available pesticides for their effectiveness to control green peach aphid, Myzus persicae (Sulzer) (Homoptera: Aphididae), western flower thrips, Frankliniella occidentalis (Pergande) (Thysanoptera: Thripidae), and greenhouse whitefly, Trialeurodes vaporariorium (Westwood) (Homoptera: Aleyrodidae). Side effects on the whitefly parasitoid Encarsia formosa Gahan (Hymenoptera: Aphelinidae) also were determined. With green peach aphid, UDA-245 at 0.5% concentration was significantly more effective than the control (water) treatment in a laboratory bioassay and significantly more effective than neem oil and the control treatment and as effective as insecticidal soap in a greenhouse assay. With the western flower thrips, UDA-245 at 0.5% was significantly more effective than neem oil, insecticidal soap and the control treatment in a laboratory bioassay, whereas in a greenhouse assay, UDA-245 at 1.0% was the only treatment that maintained control of the western flower thrips 2 wk after the last treatment period. UDA-245 at 0.5% (laboratory bioassay) was significantly more effective in managing greenhouse whitefly than neem oil, endosulfan, and the control treatment and as effective as insecticidal soap. Insecticidal soap proved to be toxic to the parasitoid E. formosa (71.9% mortality), whereas UDA-245 at 0.5% was not significantly more toxic than the control (11.2 and 4.6% mortality, respectively). Our results suggest that a greenhouse integrated pest management (IPM) program using a botanical such as UDA-245 could effectively control infestations of major pests present while having a negligible effect on biological control agents.

Animals↗
PubMed1997

The effect of triglyceride positional distribution on fatty acid absorption in rats.

BACKGROUND: Human milk contains palmitic acid predominantly in the triglyceride sn-2 position, and differs from the palmitic acid positional distribution found in most infant formulas (predominantly positions sn-1 and sn-3). Following lipolysis by pancreatic lipase, 2-monoglycerides and free fatty acids are produced. All 2-monoglycerides are well absorbed, including 2-monopalmitin, thus providing one reason for the efficient absorption of palmitic acid in breast-fed infants. If infants are fed fat blends with palmitic acid located in the sn-1 and sn-3 positions, the resulting free fatty acids may form poorly absorbed calcium soaps. Therefore, many infant formulas contain only modest levels of palmitic acid. METHODS: Fat absorption studies were conducted in rats with preparations containing various amounts of palmitic acid in the triglyceride sn-2 position. Determining total fat absorption, specific fatty acid absorption, and the presence of calcium-fatty acid soaps. RESULTS: Betapol, a new triacylglycerol, similar to human milk in its palmitic acid content and positional distribution, demonstrated excellent absorption characteristics compared to fat blends derived from either palm olein or oleo (similar in fatty acid profile to Betapol, but with most palmitic acid in the sn-1 and sn-3 positions). A five-point dose response was used to further evaluate the relationship of positional distribution and fat loss. Palmitic acid excretion and fecal fatty acid soaps were negatively correlated to the presence of palmitic acid in the sn-2 position. CONCLUSION: These studies provide evidence that palmitic acid can be efficiently absorbed, avoiding fatty soap formation of it is present in the sn-2 position.

Animals↗
PubMed1995

Effects of incontinence care cleansing regimens on skin integrity.

Soap and water and a no-rinse cleanser, with and without a moisture barrier, were examined for their effects as cleansing regimens on the perineal skin of 10 older female residents of an extended care facility. Each cleansing regimen was used for 3 weeks, with two weekly measurements obtained for erythema, pH, and transepidermal water loss. Results indicated that soap and water was the least efficacious regimen unless used with a moisture barrier. The no-rinse cleanser was better than soap and water in terms of skin effects and cost savings. The findings suggest that a no-rinse cleanser in conjunction with a moisture barrier is a more skin-preserving and cost-effective incontinence care cleansing regimen than soap and water for older female nursing home residents with incontinence.

Aged↗
PubMed1994

Effects of undegradable protein and supplemental fat on milk yield and composition and physiological responses of cows.

Because some previous studies indicated that addition of dietary fat may delay milk yield response and that effects carry over after withdrawal, an objective of this reversal design with four 28-d periods was to estimate residual effects. Diets were fed 2 wk before period 1 to permit inclusion of pretreatment diet in the mathematical model and changed for each of 33 cows at the start of periods 1 through 3; period 4 treatments continued those for period 3. Diets were 50% corn silage supplemented to be 12% CP with soybean meal and urea; 15% CP with soybean meal, blood and soybean meals, or feather and soybean meals; and 18% CP with soybean meal or blood and soybean meals. Protein treatments were replicated in diets containing 2.0% Ca soaps of fatty acids. No carry-over effects were significant; however, yield increases from Ca soaps were not evident until wk 4. Diet CP had a positive linear effect on milk and SCM yields, BW, and blood urea N. Milk protein percentage was higher from soybean meal diets. Addition of dietary Ca soaps of fatty acids increased milk, protein, fat, and SCM yields. Milk protein percentage was depressed when Ca soaps of fatty acids were fed with blood meal but not with soybean meal. No positive responses were observed from increasing dietary undegradable protein with blood meal or feather meal.

Animals↗
PubMed1984

Effects of dietary saturated or unsaturated fatty acids and calcium levels on performance and mineral metabolism of broiler chicks.

The effects of inclusion of 8% oleic, palmitic, or a 50/50 mixture of oleic and palmitic acids as the major source of fat in the presence of .8, 1.2, or 1.6% calcium in broiler diets was investigated using broiler chicks from day-old to 3 weeks of age. Supplementation of broiler diets with oleic acid reduced feed intake (P less than .05) and improved feed efficiency (P less than .01) compared to other treatments. Chicks fed diets supplemented with oleic acid or a mixture of oleic and palmitic acid gained more weight (P less than .01) over a 3-week period. Significant interactions were observed between type of dietary fatty acid and calcium level on metabolizable energy of diets (P less than .01), magnesium retention (P less than .05), calcium and fat retention (P less than .01), and proportion of excreta fatty acid that was present as soap (P less than .01). Although all fatty acids tested formed soap in the small intestine, soaps of oleic acid were efficiently utilized as opposed to soaps of palmitic acid. There was a significant (P less than .05) reduction in bone ash and bone calcium content of chicks fed diets supplemented with palmitic acid. There was a significant interaction (P less than .05) between type of fatty acid and calcium level on bone magnesium content. Increasing the calcium content of diets aggravated the decrease in calcium retention and bone calcium content associated with addition of fat.

Animals↗
PubMed2002

[Hygiene and methods of decontamination, disinfection and sterilization in dental offices in Yaounde].

Hygiene and asepsis of the dental office depend on medical ethics and legal obligation. The survey done with the participation of 33 practitioners over the 42 practicing in Yaounde allows apprehending the reality of the daily hygiene. The ways of cleaning, decontamination, disinfection or of sterilization of the premises, the dental equipment and instruments, hand-washing, disposable materials and the vaccination protection of the practitioners were analyzed. The cleaning of the floor and door mats is daily (100%); disinfection is done daily in 83% of the departments in all of the centers. The cleaning and disinfection of the dental chair is daily and is done using soap (23%) and/or bleaching-water (56%). Cleaning or disinfection of the suction machine is done with soap (24%) or with bleaching-water (47%). The hand-pieces and the turbines are cleaned and/or disinfected after each usage in (94%) with alcohol (17%) or with bleaching-water (32%) and sterilized with a heat sterilizer (45%), an autoclave(40%) or cold disinfected(15%). The frequency of the treatment of the instruments is well-respected (83%). Nevertheless the products used are very varied and are not always used in the prescribed order. Hand-washing is systematic after each patient; 50% of the practitioners use soap bars or powered soap and 50% use an antiseptic or a disinfectant solutions. With the regard to the vaccination, only 3 practitioners were properly vaccinated against hepatitis B, tetanus, diphtheria, poliomyelitis and tuberculosis. With regard to the protection of the practitioners, 72% do not wear caps, 56% do not wear eyeglasses, 40% do not wear masks, 95% do not use rubber dams, 56% do not disinfect the radiographic films and 37% do not disinfect the impressions; the habitual attire consists of a smock worn over street clothes (78%) and street shoes (90%). The debris is burnt in 35% of the centers. Better knowledge of the different stages (cleaning, decontamination, disinfection or sterilization and the products used, absolute respect of the disposable materials, optimal vaccination protection and the elaboration of the correct procedures written and posted up in the different departments are fundamental points for quality treatment. As a matter of fact, negligence and ignorance of the rules of hygiene and asepsis should not be part and parcel of the therapeutic hazard in the dental department.

Cameroon↗
PubMed2006

Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci.

BACKGROUND: Historically, methods of interrupting pathogen transmission have focused on improving health care workers' adherence to recommended infection control practices. An adjunctive approach may be to use source control (eg, to decontaminate patients' skin). METHODS: We performed a prospective sequential-group single-arm clinical trial in a teaching hospital's medical intensive care unit from October 2002 to December 2003. We bathed or cleansed 1787 patients and assessed them for acquisition of vancomycin-resistant enterococci (VRE). We performed a nested study of 86 patients with VRE colonization and obtained culture specimens from 758 environmental surfaces and 529 health care workers' hands. All patients were cleansed daily with the procedure specific to the study period as follows: period 1, soap and water baths; period 2, cleansing with cloths saturated with 2% chlorhexidine gluconate; and period 3, cloth cleansing without chlorhexidine. We measured colonization of patient skin by VRE, health care worker hand or environmental surface contamination by VRE, and patient acquisition of VRE rectal colonization. RESULTS: Compared with soap and water baths, cleansing patients with chlorhexidine-saturated cloths resulted in 2.5 log(10) less colonies of VRE on patients' skin and less VRE contamination of health care workers' hands (risk ratio [RR], 0.6; 95% confidence interval [CI], 0.4-0.8) and environmental surfaces (RR, 0.3; 95% CI, 0.2-0.5). The incidence of VRE acquisition decreased from 26 colonizations per 1000 patient-days to 9 per 1000 patient-days (RR, 0.4; 95% CI, 0.1-0.9). For all measures, effectiveness of cleansing with nonmedicated cloths was similar to that of soap and water baths. CONCLUSION: Cleansing patients with chlorhexidine-saturated cloths is a simple, effective strategy to reduce VRE contamination of patients' skin, the environment, and health care workers' hands and to decrease patient acquisition of VRE.

Adult↗
PubMedDate not supplied

Sustained improvements in hygiene behaviour amongst village women in Lombok, Indonesia.

Fifty-seven mothers in Indonesia were involved in a face-to-face health education programme which encouraged hand-washing with soap. The intervention spanned 4 months and comprised fortnightly visits by 2 community organizers, who supplied free soap. Two years after the intervention, 79% of mothers were still using hand soap, despite the fact that they now had to buy it themselves. The community seemed to be benefiting from a sustained reduction in diarrhoea episodes due to improved hygiene practices.

Child↗
PubMed1987

A placebo-controlled trial of the effect of two preoperative baths or showers with chlorhexidine detergent on postoperative wound infection rates.

The effect of preoperative whole-body washing with chlorhexidine detergent on the incidence of postoperative wound infection was assessed in a placebo-controlled trial of 1989 patients. Patients bathed or showered with chlorhexidine, placebo, or conventional bar soap, on two occasions in the 24 h before operation. The overall infection rate for patients treated with chlorhexidine was 9%, against 12.8% in the bar soap and 11.7% in the placebo groups; in the 'clean' surgery group infections were 7.2% against 10.2% and 10%, respectively. The Staphylococcus aureus infection rate in the 'clean' group was 3% for chlorhexidine against 6% for bar soap.

Baths↗
PubMed1988

Preoperative whole body disinfection--a controlled clinical study.

Preoperative whole body washing with chlorhexidine scrub was compared with soap for its effect on prevention of wound infection in clean surgery. Two thousand and fifteen patients were studied using chlorhexidine scrub, placebo or plain soap. The overall infection rate in the control and placebo groups was 12.8% (p less than 0.05) and 11.7% as opposed to 9% (p less than 0.05) in the treated group. Three per cent fewer infections were found in treated 'clean surgery' patients, and the incidence of Staphylococcus aureus infections was reduced from 6% (bar soap) to 3% (chlorhexidine). The saving in bed occupancy from prevention of infection is a significant cost-saving.

Baths↗
PubMed1989

Cleansing of hands with emulsion--a solution to skin problems of hospital staff?

In this study of hand cleansing, nursing staff with skin problems used emulsion followed by rinsing with water, while control groups, with or without skin problems, used liquid soap and water. Clinical evaluation of the without skin problems, used liquid soap and water. Clinical evaluation of the skin by a dermatologist, as well as by self-assessment, suggested that when the staff with skin problems used emulsion their skin was in better condition than that of controls with similar skin problems. This favourable effect on skin was later confirmed in extended use of emulsion for hand cleansing in other hospital wards. Objective evaluation of skin condition with biophysical measurements was unsuccessful. Emulsion cleansing of the hands seems to offer a favourable alternative to washing with soap and water, especially for persons with skin problems.

Adult↗
PubMed1991

The evaluation of residual antimicrobial activity on hands and its clinical relevance.

A model for evaluation of the residual activity of agents used for hygienic hand disinfection, which relates closely to the "in-use" setting, is described. We looked for residual activity following hand disinfection by a standard method with soap and water and four skin disinfectants in common use. Two test organisms known to have caused cross-infection and having clinically-significant antibiotic resistance were used: a strain of vancomycin-resistant Enterococcus faecium and one of gentamicin-multiply-resistant Enterobacter cloacae. Both organisms survived well on artificially inoculated hands. Residual activity on previously disinfected hands against both test organisms was most marked for alcoholic chlorhexidine ('Hibisol') which showed a 4 log10 reduction within 1 min of inoculation. Chlorhexidine digluconate skin cleanser ('Hibiscrub') and povidone-iodine surgical scrub ('Betadine') also had marked residual activity, but less than alcoholic chlorhexidine. 60% Isopropanol showed no residual activity and, except for marginal activity against E. cloacae, soap and water showed little residual activity. The residual activity of alcoholic chlorhexidine may be useful to control cross-infection with those multiply-resistant strains which survive well on fingers previously washed with soap and water.

1-Propanol↗
PubMed1991

Handwashing in Finland.

To prevent skin problems we have recommended in Finland that hospital personnel should avoid soap or other detergents for handwashing and instead use alcoholic preparations containing emollients such as 2% glycerol. Alcohol with emollient disinfection is used frequently in hospitals and it causes fewer complaints of skin dryness than washing with soap. However, there are still members of staff who have hand skin problems. Our studies conducted during winter have shown that when these persons used emulsion for hand cleansing, instead of washing with soap, skin deterioration was much less, allowing alcoholic disinfection of the hands whenever necessary, without impairment of the disinfecting effect of alcohol.

Alcohols↗
PubMed1989

Influence of two handwashing frequencies on reduction in colonizing flora with three handwashing products used by health care personnel.

Four handwashing products (containing either 2% chlorhexidine gluconate, 0.6% parachlorometaxylenol, 0.3% triclosan, or a nonantimicrobial control) at two handwashing frequencies (6 or 18 times/day) were compared with regard to their effectiveness in reducing colonizing hand flora. Eighty adult volunteers were assigned by block randomization to one of the four products and one of the two frequency schedules (n = 10/group) and washed their hands under supervision for 5 consecutive days. There were no significant differences between products in mean log10 colony-forming units after the initial wash (p = 0.61), nor were there significant differences in products after 5 days among subjects washing six times per day. For those who washed 18 times per day, however, the effectiveness of all three antimicrobial soaps was significantly better than that of the control soap (p less than 0.05). Chlorhexidine gluconate produced significantly greater reductions than triclosan or parachlorometaxylenol (p less than 0.05), which were not significantly different from each other. On the basis of these findings an antimicrobial soap is recommended when handwashing frequency is high and a long-term reduction in colonizing flora is desirable. When handwashing frequency is low (6 times/day), there seems to be less advantage of one product over another, although the use of chlorhexidine gluconate resulted in greater reductions at both high and low handwashing frequencies.

Adult↗
PubMed1995

Post-defecation handwashing in Bangladesh: practice and efficiency perspectives.

Inadequate handwashing after defecation and anal cleaning practices in the Indian subcontinent is an important source of faeco-oral transmission of enteric diseases. To better understand the process as traditionally practised, 90 women in semi-rural Bangladesh were observed washing hands after defecation. Several components of handwashing practices were identified: the cleaning agent, using left or both hands; frequency of rubbing hands, type and amount of water used to wash, and the drying of hands on the wearer's clothes. A subsequent experiment was conducted to assess the effect of currently practised handwashing and drying according to standardised procedure on faecal coliform count of hands. As a rubbing agent, soil was commonly used (40%); soap was used by 19% and was reported unaffordable by about 81% of the non-users. Good handwashing behaviour was positively associated with better social and economic indicators including education of the women observed. Both hands were unacceptably contaminated after traditional handwashing (the geometric mean count of left was 1,995 and right hand was 1,318 faecal coliform units/hand). After standardising the observed components of handwashing procedures the use of any rubbing agent, i.e. soil, ash or soap, produced similar acceptable cleaning. Use of a rubbing agent (e.g. soil, ash or soap), more rubbing (i.e. six times), rinsing with safer water (e.g. 2 litres of tubewell water) and drying with a clean cloth or in the air produced acceptable bacteriological results. Components of traditional handwashing practices were defined through careful observation, and experiments on handwashing with standardised components showed that efficient and affordable options for handwashing can be developed; this knowledge should be helpful in disease control programmes.

Bangladesh↗