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: 16). 11/2004; 17(4):863-93, table of contents. DOI: 10.1128/CMR.17.4.863-893.2004
Source: PubMed

ABSTRACT 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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    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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    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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    ABSTRACT: A quasi-experimental study using a pretest-posttest design with a control group was used to evaluate the effects of a simplified 5-step multimedia visualization hand hygiene improvement program by schoolchildren with mild intellectual disability (MID). A total of twenty schoolchildren aged 6-12 years old with MID (12 males) were recruited and they were assigned into intervention (n=10) and control (n=10) groups. To evaluate the quality of their hand washing, Glow gel, which contains plastic simulated germs that are visible under an ultra-violet lamp, was applied to participants' hands to assess the quality of hand washing by comparing the amount of visible Glow gel before and after hand washing using a 4-point scale. Four raters used this 4-point scale to assess the quality of hand washing through digital photo images of the participants' hands. A total of eight digital photos per participant were taken. A fifteen-minute hand washing training session was conducted every school day for 4 weeks for the intervention group. Those in the control group received no training. A multimedia visual package on steps of hand washing was presented together with a reward system, whereby a number of stars were earned each week depending on the quality of hand washing. Results showed encouraging findings, as the schoolchildren in the intervention group showed significant improvement in hand washing (p<0.001) and the improvement was stronger than that of the control group (p=0.02). To conclude, a systematic instruction emphasizing multimedia visualization in a hand washing improvement program can be successfully implemented in a special school, and the effect of integrating multimedia visuals in the hand hygiene program could improve hand hygiene among schoolchildren with MID.
    Research in Developmental Disabilities 08/2014; 35(11):3014-3025. DOI:10.1016/j.ridd.2014.07.016 · 3.40 Impact Factor


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