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.
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    ABSTRACT: Every year, millions of people around the world suffer from different infectious diseases, considerable part of which are hospital-acquired infections. WHO considers hand hygiene as a priority measure aimed to reduce the level of infection. We evaluated various aspects related to the situational behavior and prioritization regarding hand hygiene measures among the healthcare workers of Ukraine. Identification of system mistakes in hand hygiene was carried out first of all by direct and indirect observation of the activities of medical and pharmaceutical personnel in their everyday practice as well as during their participation in trainings on routine hand hygiene. Questionnaires also were used to estimate the level of hand hygiene compliance of participants of the study. During this period 112 training courses, 315 master-classes and presentations on proper hand hygiene were realized. The target audience included health care workers of medical centers, clinics, maternity hospitals, health care organizations and staff of pharmacies and pharmaceutical manufacturing enterprises in all regions of Ukraine. 638 respondents took part in anonymous survey on hand hygiene practice. The most common mistakes were to regard hand washing and hand disinfection equally, to wash hands before doing a hand disinfection, to neglect the five moments for hand hygiene and to ignore hand hygiene before and after wearing protective gloves. Practitioners, medical attendants, pharmacy and pharmaceutical industry workers highlighted the need for practical and understandable instructions of various hand hygiene procedures, including the clarification of the possible technical mistakes. This became a ground for us to create individual master classes on hand hygiene for each cluster of healthcare workers. Changing hand hygiene behavior and attitude is possible by beginning to observe clinical practice and by involving healthcare workers in teaching and training.
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    Biomedical and Pharmacology Journal 12/2011; 4(2):365-371. DOI:10.13005/bpj/312


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