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PubMed1993

Preliminary study of test methods to assess the virucidal activity of skin disinfectants using poliovirus and bacteriophages.

Two tests for assessing the virucidal activity of antiseptics are proposed. These involve applying either poliovirus (vaccine strain Sabin 1 an) or Escherichia coli bacteriophage (MS2 or K1-5) to the fingertips. Both test viruses are considered safe although poliovirus may be unacceptably tolerant to antiseptics. The use of bacteriophages as test organisms precludes the need for sophisticated recovery systems and can be undertaken readily by any bacteriology laboratory. The virucidal activity of 70%, 80% and 90% ethanol, 7.5% povidone-iodine, and soap and water was assessed using these tests. Thorough cleansing, followed by disinfection with 90% ethanol, was the most effective treatment. Removal of viruses from the gloved hand was also assessed and this was found to be more easily achieved than cleaning and disinfecting the ungloved hand. Wearing gloves protects the hands from viral contamination but changing them after each patient or contact is expensive.

Administration, Topical↗

PubMed1993

Effects of a protective foam on scrubbing and gloving.

OBJECTIVE: To test the effects of a skin protectant on surgical scrub and glove integrity. DESIGN: Forty-nine healthy adult volunteers were assigned (12 subjects per group) to apply a protective foam (DermaMed; Benchmark Enterprises, Salt Lake City, Utah) in conjunction with surgical scrub in one of the following formulations: 70% isopropyl alcohol, a liquid detergent base containing 4% chlorhexidine gluconate, a liquid detergent base containing 7.5% povidone-iodine, or a nonantimicrobial liquid soap (control). According to a standard protocol, subjects performed a surgical scrub on 3 days (every other day). Foam was applied after surgical scrub on day 1 and before surgical scrub on day 3. No foam was applied on day 2. Subjects were gloved for 2 hours after surgical scrub. SETTING: Laboratory setting. RESULTS: On all test days, there were significant differences in bacterial reduction by products (chlorhexidine gluconate or alcohol > povidone-iodine > control). When controlling for baseline counts and products used, there were no significant differences in colony-forming unit counts on hands with or without foam immediately after scrubbing or at 2 hours after scrub on gloved or ungloved hands, nor were there differences in glove leakage rates when foam was on hands. CONCLUSIONS: Such protectants can be used without detrimental effects to scrub effectiveness or glove integrity.

1-Propanol↗

PubMed1994

Comparative effectiveness of hand-cleansing agents for removing methicillin-resistant Staphylococcus aureus from experimentally contaminated fingertips.

BACKGROUND: Five subjects participated in a study of optimal conditions for removing methicillin-resistant Staphylococcus aureus from contaminated fingertips. METHODS: Fingertips were contaminated experimentally and cleaned by various methods. Bacterial removal was measured as percentage and is given as mean +/- standard error of the mean. RESULTS: Rinsing the fingertips with tap water for 20 seconds and drying them with paper towels removed 95.2% +/- 1.6% of the contamination. Application of hand-cleansing agents to fingertips for 20 seconds, followed by a 20-second tap-water rinse and towel drying, removed bacteria as follows: povidone-iodine detergent, 99.2% +/- 0.4%; chlorhexidine detergent, 97.2% +/- 0.8%; and liquid soap, 96.1% +/- 1.1%. In a modification of the method, 80% ethyl alcohol applied to the fingertips for 20 seconds, followed by air drying for 40 seconds, removed 99.1% +/- 0.8% of the bacteria. Statistical analyses indicated that povidone-iodine and 80% ethyl alcohol were more effective than the other agents. CONCLUSIONS: Rinsing contaminated fingertips with tap water and towel drying them is sufficient to reduce contamination with methicillin-resistant S. aureus by 95%. Washing with povidone-iodine or 80% ethyl alcohol further reduces contamination by an additional 99%.

Adult↗

PubMed1986

Human and rabbit eye responses to chemical insult.

Groups of eight human volunteers and eight albino rabbits, under controlled laboratory conditions, were exposed in one eye without subsequent rinsing to the same concentrations and volumes of four prototype consumer products: fabric softener, shampoo, hand soap, and laundry detergent. Dose volume was 0.10 or 0.01 ml. The dose concentrations were selected to produce moderate effects with recovery within 24 to 48 hr. Two irritation scales were employed with both human and animal subjects: the Draize scale by a technician and a medical scale used with slit lamp examination by an ophthalmologist. Eyes were examined by both graders before and after dosing at specified intervals until recovery. Mean and maximum irritation scores are presented for each grading time, method, and exposure, as are the mean hours to recovery (clearing) for each exposure. Recovery times for human eyes were consistent with those reported previously for accidental human exposures to similar materials. Correlation coefficients for time to clear, comparing human vs rabbit for each dose volume-species combination across the four test products, were 0.72, 0.1 ml-human vs 0.01 ml-rabbit; 0.66, 0.01 ml-human vs 0.01 ml-rabbit; 0.40, 0.01 ml-human vs 0.1 ml-rabbit; 0.35, 0.1 ml-human vs 0.1 ml-rabbit. Thus, recovery time obtained under conditions of the "Low-Volume" test (0.01 ml-rabbit) better correlates with human eye recovery time (either dose volume) than does recovery time under Draize test conditions (0.10 ml-rabbit).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1987

Skin effects of trichothecenes and their amelioration by decontamination.

The ability of trichothecenes, in particular T2 toxin (T2), to cause irritant effects on the skin has been investigated in laboratory rodents and rabbits. Quantitatively, T2 was found to be highly potent in this respect, causing irritant reactions on rat skin at contamination densities of less than 1 microgram.cm-2. The first appearance of skin effects was delayed for approximately 6 h after application, irrespective of the dose applied. Similarly, variation in solvent or injection into or beneath the skin failed to accelerate the onset of the irritant reaction. An aqueous soap solution was largely effective in removing low doses of T2 from the skin, but was ineffective in removing larger doses. However, washing the contaminated skin with polyethylene glycol 300 was very effective at removing even large doses of T2 from the skin. The macrocyclic trichothecene verrucarin A was of comparable irritancy to T2 on rat skin. Diacetoxyscirpenol and nivalenol were less potent.

Animals↗

PubMed2006

The effect of random voice hand hygiene messages delivered by medical, nursing, and infection control staff on hand hygiene compliance in intensive care.

Hand hygiene (HH) compliance in the intensive care unit has been studied extensively, with short-term, nonsustained compliance often because of lack of ongoing reinforcement. HH messages delivered by health care workers responsible for overseeing staff in the intensive care unit provided continuous reinforcement of HH. Compliance measured through product usage and reported as HH/bed-days increased by 60% for soap and sanitizer combined and 25% for sanitizer usage (P < 001).

Administration, Cutaneous↗

PubMedDate not supplied

Reusability of plastic scintillators used in beta emitter activity determination.

The use of plastic scintillation in the measurement of beta emitter activity is a suitable alternative to classical detection techniques in spite of the high cost and potential memory effects. Reuse of the plastic scintillator beads after a cleanup procedure would overcome both drawbacks. In the present paper, we tested several cleaning solutions (water, HCl 0.1M, commercial soap, EDTA 0.01 M pH=3, citric acid 0.1 M pH=3). The recommended procedure consists of the immersion of the beads in three consecutive citric acid baths for 24 h. If this protocol is followed, plastic beads contaminated with 90Sr/90Y, 14C, and 3H recover their initial condition, and can be used in successive determinations.

Beta Particles↗

PubMedDate not supplied

Back to the basics: Handwashing.

Handwashing remains the single most effective means of controlling infection, yet research shows this simple procedure often is not performed by health care providers. This article reviews three studies: one examines the failure of health care personnel to wash their hands between patient contacts, and two deal with alternatives to traditional hand cleansers, such as waterless soaps. Recommendations are included.

Hand Disinfection↗

PubMed2005

Assessment of benefits from use of antimicrobial hand products: reduction in risk from handling ground beef.

Quantitative microbial risk assessment (QMRA) has been used to estimate the benefits resulting from the use of hand cleansing products (e.g., soaps) containing anti-microbial ingredients. This was done by developing a model for the scenario of hand contact with ground beef during food preparation, considering transference of bacteria to the hands, removal and inactivation by handwashing, and subsequent transference from the hands to the mouth. Organisms of interest in this case study were pathogenic Escherichia coli and the particular strain E. coli O157:H7. It was found that QMRA could be applied to this problem, and that the antimicrobials provided some quantifiable benefit (i.e., reduced the risk of infection and illness). Benefits from the use of triclosan-containing products were less than from the use of products in which alcohols or chlorhexidine were active ingredients.

Anti-Infective Agents↗

PubMed2005

Alcohol-based hand disinfection: a more robust hand-hygiene method in an intensive care unit.

This study involved observation of hand-hygiene behaviour and evaluation of the effect of alcohol-based hand disinfection and handwashing with plain liquid soap on microbial flora. The study was performed in a combined medical and surgical intensive care unit. We demonstrated a crude compliance of hand hygiene of 50.4%, which was only performed adequately in 20.8% of cases. Of this group, handwashing and hand-disinfection procedures were performed properly 34.0% and 71.6% of the time, respectively. Hand samples for bacteriological examinations with the glove juice method demonstrated that whilst handwashing was sensitive to the way in which hand hygiene was performed, alcohol-based hand disinfection was less sensitive to such performance. Our study demonstrated that alcohol-based hand disinfection is a robust hand-hygiene method with many advantages in a practical setting. It is very feasible for use in hospital wards.

Adult↗

PubMed2005

Microbiological evaluation of two hand hygiene procedures achieved by healthcare workers during routine patient care: a randomized study.

The aim of this study was to evaluate the comparative microbiological efficacy of hand rubbing and handwashing in healthcare workers from different wards, with particular emphasis on transient flora, and to assess predisposing factors for hand contamination after patient care in everyday practice. Over a six-month period, 50 healthcare workers were randomly assigned, using a crossover design, to perform handwashing with unmedicated soap and hand rubbing with an alcoholic solution following a healthcare procedure. Imprints of palms and fingertips were taken separately before and after each hand hygiene procedure. The number of colonies per plate was counted and transient pathogens were identified. Risk factors for hand contamination were determined. Hand rubbing produced a significantly greater reduction in microbiological load than handwashing (P<0.0001 for palms and P=0.0003 for fingertips). In multivariate analysis, working in a medical ward rather than in an intensive care unit was significantly associated with increased hand contamination (P=0.03 for palms and P=0.02 for fingertips). Transient pathogens were found on 15% of healthcare workers' hands before hand hygiene. The only factor associated with hand contamination by transient pathogens was the absence of gloving during the healthcare procedure (odds ratio 4.8; 95% confidence interval 1.2-19; P=0.03). After hand rubbing, no transient pathogens were recovered, while these were found in two cases after handwashing. Hand rubbing is more efficacious than handwashing for the decontamination of healthcare workers' hands following contact with patients and patients' environments. Gloving may reduce microbiological hand contamination by transient pathogens.

2-Propanol↗

PubMed2005

Can a handwashing intervention make a difference? Results from a randomized controlled trial in Jerusalem preschools.

BACKGROUND: Preschools are often focal points for the spread of illness among young children. The objective of this preschool intervention trial was to determine whether a hygiene program can promote handwashing and thereby reduce illness absenteeism. METHODS: This cluster randomized trial included 40 Jerusalem preschools with 1029 children for 6 baseline days and 66 study days, yielding 73,779 child days. The main outcomes were rates of handwashing and illness absenteeism. The intervention included an educational program and environmental changes. A simultaneous subtrial was run to test a home component. RESULTS: This multi-site intervention program produced sustained behavioral and environmental changes over a 6-month period. An approximately threefold increase in handwashing with soap was observed among preschool children exposed to the intervention. Neither the preschool nor the home intervention program reduced illness absenteeism or overall absenteeism. CONCLUSIONS: This trial illuminates the potential of the preschool as a promising venue for health promotion activities leading to sustained behavioral change, yet suggests the need for enhanced approaches for reducing illness absenteeism.

Absenteeism↗

PubMed1999

Monitoring of mercury pollution in Tanzania: relation between head hair mercury and health.

Through 1996 into 1997, a spot investigation on mercury contamination was conducted three times in Tanzania, especially around the Lake Victoria. A total of 150 goldminers, 103 fishermen and their families, and 19 residents of Mwanza City volunteered for the current study. A high total mercury level of 48.3 ppm (near to 50 ppm, a critical level of Minamata disease) and over in the head hair was observed in six goldminers (highest value, 953 ppm), four fishermen and their families (highest value, 416 ppm), and four Mwanza people (highest value, 474 ppm). With the exception of these 14 subjects, however, each mean total mercury level was well within the normal range (below 10 ppm). Out of the goldminers examined, 14 cases were diagnosed as a mild form of inorganic-mercury poisoning according to their clinical symptoms (such as polyneuropathy mercurialis, neuroasthemia, or tremor mercurialis) and the low ratio of methylmercury to total mercury, whereas neither inorganic-mercury poisoning nor methylmercury poisoning (Minamata disease) was noted in the fishermen and their families or in the Mwanza people. In addition, some subjects who showed a high total mercury level made habitual use of toilet soap containing much mercury. The findings obtained suggest that the mercury pollution in Tanzania is not very serious, however, it should be observed continuously.

Adolescent↗

PubMed1986

Electrocardiography electrode and hand dermatitis from parachlorometaxylenol.

Parachlorometaxylenol is used as a germicide in many topical products. To our knowledge, this is the first case of dermatitis from parachlorometaxylenol in electrocardiograph electrodes used with cardiac monitors. The patient also had hand eczema from a germicidal soap containing parachlorometaxylenol. In addition, our patient had a cross-reaction to dichlorometaxylenol, a reaction not previously reported.

Aged↗

PubMed2001

Arguments for alcoholic hand disinfection.

The non-aqueous use of ethanol or propanols offers various advantages over washing hands with either unmedicated or medicated soap in both hygienic and surgical hand disinfection. Alcohols exert the strongest and fastest activity against a wide spectrum of bacteria and fungi (but not bacterial spores) as well as enveloped (but less so against non-enveloped) viruses, being little influenced by interfering substances. They are of low toxicity and offer acceptable skin tolerability when made up with suitable emollients. The mode of their application is simple and three to four times more economical of time than wash procedures, features which help to increase the compliance with the rules of hand hygiene.

Anti-Infective Agents, Local↗

PubMed2001

Handwashing compliance in a French university hospital: new perspective with the introduction of hand-rubbing with a waterless alcohol-based solution.

The baseline compliance with handwashing in a French university hospital was as low as the compliance rates reported in other countries, i.e., less than 50%. By introducing the use of hand-rubbing with an alcoholic solution, as a substitution method for both handwashing with soap and handwashing with an antiseptic agent, we significantly improved hand-cleansing compliance. Despite these encouraging results, mainly due to the accessibility of these non-aqueous products, three major obstacles remain before a wide acceptance by healthcare workers: distrust in terms of efficacy, distrust in terms of skin tolerance and lack of knowledge on hand-cleansing indications.

Anti-Infective Agents, Local↗

PubMed1996

Triclosan: applications and safety.

Triclosan (2,4,4'-trichloro-2'-hydroxydiphenyl ether) is a nonionic, broad spectrum, antimicrobial agent that, because of its favorable safety profile, has been incorporated into a variety of many personal care products, including deodorant soaps, underarm deodorants, shower gels, and health care personnel handwashes. Triclosan exhibits a moderate degree of substantivity to the skin, and, in many products, it imparts a remnant antimicrobial effect. Although direct contact with the material under exaggerated exposure conditions causes dermal irritation in laboratory animals, it has only rarely been associated with skin irritation or sensitization in human being in formulated products. Acute, subacute/subchronic, and chronic toxicity profiles have been established to determine that triclosan is neither an acute oral toxicant nor that it acts as a carcinogen, mutagen, or teratogen. A new application for triclosan is in oral dentifrices for plaque control. Currently under investigation in the United States, it is approved for oral care application in Canada and many European countries.

Animals↗

PubMed1992

Can patients wash during radiotherapy to the breast or chest wall? A randomized controlled trial.

A total of 99 patients receiving adjuvant radiotherapy to the breast or chest wall were randomized to one of three washing policies: (1) not washing, (2) washing with water alone, and (3) washing with soap and water. Fifty-three of the patients were treated without the use of bolus, and 46 patients were treated using bolus for 10 to 15 of the 20 treatment fractions. Approximately half of the patients randomized to washing were tattooed. Subjective and objective measurements of acute skin reactions were found to be less in the two groups randomized to washing. There was little difference between the two washing groups. These findings were the same whether or not bolus was used. It is concluded that washing of the skin should be encouraged in patients undergoing radiotherapy associated with low skin doses.

Baths↗