Epidemiologic Background of Hand Hygiene and Evaluation of the Most Important Agents for Scrubs and Rubs

Bode Chemie GmbH & Co., Scientific Affairs, Melanchthonstrasse 27, 22525 Hamburg, Germany. .
Clinical Microbiology Reviews (Impact Factor: 17.41). 11/2004; 17(4):863-93, table of contents. DOI: 10.1128/CMR.17.4.863-893.2004
Source: PubMed


The etiology of nosocomial infections, the frequency of contaminated hands with the different nosocomial pathogens, and the role of health care workers' hands during outbreaks suggest that a hand hygiene preparation should at least have activity against bacteria, yeasts, and coated viruses. The importance of efficacy in choosing the right hand hygiene product is reflected in the new Centers for Disease Control and Prevention guideline on hand hygiene (J. M. Boyce and D. Pittet, Morb. Mortal. Wkly. Rep. 51:1-45, 2002). The best antimicrobial efficacy can be achieved with ethanol (60 to 85%), isopropanol (60 to 80%), and n-propanol (60 to 80%). The activity is broad and immediate. Ethanol at high concentrations (e.g., 95%) is the most effective treatment against naked viruses, whereas n-propanol seems to be more effective against the resident bacterial flora. The combination of alcohols may have a synergistic effect. The antimicrobial efficacy of chlorhexidine (2 to 4%) and triclosan (1 to 2%) is both lower and slower. Additionally, both agents have a risk of bacterial resistance, which is higher for chlorhexidine than triclosan. Their activity is often supported by the mechanical removal of pathogens during hand washing. Taking the antimicrobial efficacy and the mechanical removal together, they are still less effective than the alcohols. Plain soap and water has the lowest efficacy of all. In the new Centers for Disease Control and Prevention guideline, promotion of alcohol-based hand rubs containing various emollients instead of irritating soaps and detergents is one strategy to reduce skin damage, dryness, and irritation. Irritant contact dermatitis is highest with preparations containing 4% chlorhexidine gluconate, less frequent with nonantimicrobial soaps and preparations containing lower concentrations of chlorhexidine gluconate, and lowest with well-formulated alcohol-based hand rubs containing emollients and other skin conditioners. Too few published data from comparative trials are available to reliably rank triclosan. Personnel should be reminded that it is neither necessary nor recommended to routinely wash hands after each application of an alcohol-based hand rub. Long-lasting improvement of compliance with hand hygiene protocols can be successful if an effective and accessible alcohol-based hand rub with a proven dermal tolerance and an excellent user acceptability is supplied, accompanied by education of health care workers and promotion of the use of the product.

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    • "The protocol of hygiene measures includes two main actors of the milking process, the cow and the milker. As far as the cows are concerned, mammary gland washing was applied before the milking and teat dipping after each milking with chlorhexidine, that is active against Gram-positive and Gram-negative bacteria and also against fungi and some enveloped viruses (Hugo and Longworth, 1964; Kampf and Kramer, 2004). As for the milkers, they were asked to wash their hands with clean water and with a solution of hypochlorite of sodium before and after milking each cow. "
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    ABSTRACT: Hygiene conditions during milking are essential in dairy cattle to ensure the highest level of milk production. The aim of this work was to assess the efficacy of hygiene measures during the manual milking process with no pre- or post-milking antisepsis measure at the Sahelian experimental station of Toukounous (Niger), on the prevalence of California Mastitis Test (CMT)-positive cows, on the identity of bacterial pathogens recovered from positive milk samples and on the clonality of the Staphylococcus (S.) aureus isolated. The application of mammary gland washing prior to milking, of teat dipping with chlorhexidine after milking and of milkers’ hand washing and disinfection with sodium hypochlorite significantly decreased the number of CMT-positive cows. However, the percentages of bacteriologically positive milk samples and the relative isolation rates of S. aureus and coagulase-negative staphylococci did not significantly differ according to the presence/absence of antisepsis measure. As for the clonality of the S. aureus isolates, the 53 S. aureus isolated in the absence of hygiene measures belonged to 10 Pulsed Field Gel Electrophoresis (PFGE) fingerprints, while, in comparison, only five PFGE fingerprints were identified amongst the 11 S. aureus isolated in the presence of hygiene measures. As a conclusion, the strict application of hygiene and disinfection during hand milking at Toukounous is a major contributor to the decrease of the percentage of CMT-positive cows and, therefore, of mastitis prevalence and incidence. The reasons for the persistence of the remaining S. aureus after application of hygiene measures may be numerous, one of them could be that they belong to more resistant clones.
    African journal of microbiology research 02/2015; 9(6):7. DOI:10.5897/AJMR2014.7253 · 0.54 Impact Factor
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    • "The results show that even a short contact with the device can lead to contamination and consequently to pathogen transfer. Kampf et al. reported that the compliance rate of healthcare workers concerning hand hygiene is around 50% [3]. Usually, patients are not encouraged to perform hand disinfection at all. "
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    ABSTRACT: Background To prove effectiveness of wrapping tablet computers in order to reduce microbiological contamination and to evaluate whether a plastic bag-covered tablet leads to impaired user satisfaction or touchscreen functionality. Materials and Methods Within a period of 11 days 115 patients were provided with a tablet computer while waiting for their magnetic resonance imaging examination. Every day the contamination of the surface of the tablet was determined before the first and after the final use. Before the device was handed over to a patient, it was enclosed in a customized single-use plastic bag, which was analyzed for bacterial contamination after each use. A questionnaire was applied to determine whether the plastic bag impairs the user satisfaction and the functionality of the touchscreen. Results Following the use by patients the outside of the plastic bags was found to be contaminated with various bacteria (657.5 ± 368.5 colony forming units/day); some of them were potentially pathogenic. In contrast, the plastic bag covered surface of the tablet was significantly less contaminated (1.7 ± 1.9 colony forming units/day). Likewise, unused plastic bags did not show any contamination. 11% of the patients reported problems with the functionality of the touchscreen. These patients admitted that they had never used a tablet or a smartphone before. Conclusions Tablets get severely contaminated during usage in a clinical setting. Wrapping with a customized single-use plastic bag significantly reduces microbiological contamination of the device, protects patients from the acquisition of potentially pathogenic bacteria and hardly impairs the user satisfaction and the functionality of the touchscreen.
    PLoS ONE 09/2014; 9(9):e106445. DOI:10.1371/journal.pone.0106445 · 3.23 Impact Factor
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    • "The NI is usually acquired while doing simple tasks by the health care worker, like pulling patient up in bed, touching equipment like bed side rail or over bed tables and other monitors. Most of these infections can be avoided with relatively cheap strategies, such as adhering to recommended infection prevention practices, especially hand washing (Kampf & Kramer, 2004; Lam et al., 2004; Yildirim et al., 2008). "
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    ABSTRACT: Abstract Hand hygiene (HH) is the most significant factor for the improvment of practices and reduction of microorganism transmission to patients, visitors, and health care workers, yet compliance rates remaining low. This study aims to improve the compliance of intensive care unit (ICU) staff in hand disinfection; either by washing or rubbing with alcohol-based solution. We analysised the HH compliance of ICU staff at Al-Istishari hospital in Jordan over a period of four months (December 2008-April 2009). A total of 24 study participants were observed to have a high ratio of HH compliance rate after removing gloves (76%). This prospective, interventional study employed an exploratory mixed qualitative-quantitative method. The study was conducted between December 2008 and April 2009 in the ICU at Al-Istishari Hospital, Amman, Jordan. The Hand Washing Questionnaire (HWQ) and 80 h of observations were used to measure and evaluate the compliance of HH practices among ICU employees. The effective compliance to HH practice was as low as 28% in January, rising to 32% in April; a total improvement of 4%. This was accompanied by a corresponding improvement in the rate of nosocomial infection (NI). The NI rate dropped by 5.6% over a short period; from 16.7% in January 2009 to 11.1% in March 2009.We identified an inverse relationship between HH compliance and NI rates. These findings suggest that the NI rate of ICUs can be reduced by relatively inexpensive strategies. We propose that a national HH program should be implemented in all healthcare sectors in Jordan.
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