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Mastracci JC, Bonvillain KW, Gaston RG. Surgical Hand Antisepsis: Environmental and Cost Impact in Hand Surgery. J Hand Surg Am 2024; 49:923-926. [PMID: 38795103 DOI: 10.1016/j.jhsa.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/31/2024] [Accepted: 04/13/2024] [Indexed: 05/27/2024]
Abstract
Health care systems, including operating rooms, are a considerable contributor to environmental waste. Given ongoing concerns regarding water scarcity in the United States and worldwide, action to reduce water utilization should be taken. Traditional water-based hand scrubbing wastes an estimated 11 L of water per scrub. Waterless hand rubbing with an alcohol-based solution has been shown to be as effective as traditional water-based hand scrubbing in surgical hand antisepsis and in preventing surgical site infections. Furthermore, alcohol-based rubbing results in less waste and reduced costs when compared with water-based hand scrubbing. The hand surgery operating room, including minor procedure rooms, serves as an opportunity to decrease water use and reduce the environmental impact of our field. Waterless alcohol-based hand rubbing for antisepsis may also be an opportunity to save money and provide value-based care to our patients.
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Affiliation(s)
- Julia C Mastracci
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC
| | - Kirby W Bonvillain
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC
| | - R Glenn Gaston
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC; OrthoCarolina Hand Center, Charlotte, NC.
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Fofanah BD, Kamara IF, Kallon C, Kamara R, Nuwagira I, Musoke R, Tengbe SM, Lakoh S, Korjie MM, Sheriff B, Maruta A, Katawera V, Kamara A, Hailu BG, Kanu JS, Makamure T, Njuguna C, Kabego L. Evaluating the tolerability and acceptability of a locally produced alcohol-based handrub and hand hygiene behaviour among health workers in Sierra Leone: a longitudinal hospital-based intervention study. BMC Health Serv Res 2024; 24:940. [PMID: 39152407 PMCID: PMC11329988 DOI: 10.1186/s12913-024-11368-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/29/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Alcohol-based handrub (ABHR) is the gold standard for hand hygiene (HH) and is a cornerstone of infection prevention and control (IPC) strategies. However, several factors influence the efficient use of ABHR by health workers. This study evaluated the tolerability and acceptability of a locally produced ABHR product and HH behaviour among health workers. METHODS A longitudinal hospital-based intervention study was conducted in accordance with the WHO's standardized protocol for evaluating ABHR tolerability and acceptability (Method 1). Sixty health workers across 4 hospitals in Sierra Leone were observed over a 30-day period at three separate visits (days 1, 3-5, and 30) by trained observers. The outcomes of interest included skin tolerability and product acceptabilityevaluated using subjective and objective measures. RESULTS Objective and subjective evaluations demonstrated strong skin tolerability and high acceptability with the product. At all three visits, the skin tolerability score assessed by trained observers was < 2 in ≥ 97% of participants, exceeding the WHO benchmark score (BMS = < 2 in ≥ 75%). Participants' self-evaluations of overall skin integrity were 97% (visit 2) and 98% (visit 3) for scores > 4 (BMS = > 4 in ≥ 75%). The primary acceptability criteria increased up to 95% (colour) and 88% (smell) at visit 3 (BMS = > 4 in ≥ 50%). Despite high acceptability, the product's drying effect remained low at 52% and 58% during visits 2 and 3, respectively (BMS = > 4 in ≥ 75%). There were positive HH behaviours (n = 53, 88%), with more than half (n = 38, 63%) of them exhibiting HH at almost every HH moment. The mean ABHR was notably high (76.1 ml, SD ± 35), especially among nurses (mean = 80.1 ml) and doctors (mean = 74.0 ml). CONCLUSION The WHO-formulated, locally produced ABHR was well tolerated and accepted by health workers. These findings support the continuous utilization of evidence-based, cost-effective hand hygiene interventions in resource-limited settings. High handrub consumption and frequent HH practices were noticeable HH behaviours. Further research is recommended to optimize product formulations for skin dryness and investigate the association between ABHR consumption and hand hygiene compliance.
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Affiliation(s)
| | | | | | | | | | - Robert Musoke
- World Health Organization Country Office, Freetown, Sierra Leone
| | | | - Sulaiman Lakoh
- Ministry of Health, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | - Bockarie Sheriff
- World Health Organization Country Office, Freetown, Sierra Leone
| | - Anna Maruta
- World Health Organization Country Office, Freetown, Sierra Leone
| | | | - Abibatu Kamara
- World Health Organization Country Office, Freetown, Sierra Leone
| | | | - Joseph Sam Kanu
- Ministry of Health, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Tendai Makamure
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Charles Njuguna
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Landry Kabego
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of the Congo
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Kunishima H, Ichiki K, Ohge H, Sakamoto F, Sato Y, Suzuki H, Nakamura A, Fujimura S, Matsumoto K, Mikamo H, Mizutani T, Morinaga Y, Mori M, Yamagishi Y, Yoshizawa S. Japanese Society for infection prevention and control guide to Clostridioides difficile infection prevention and control. J Infect Chemother 2024; 30:673-715. [PMID: 38714273 DOI: 10.1016/j.jiac.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 05/09/2024]
Affiliation(s)
- Hiroyuki Kunishima
- Department of Infectious Diseases. St. Marianna University School of Medicine, Japan.
| | - Kaoru Ichiki
- Department of Infection Control and Prevention, Hyogo Medical University Hospital, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Japan
| | - Fumie Sakamoto
- Quality Improvement and Safety Center, Itabashi Chuo Medical Center, Japan
| | - Yuka Sato
- Department of Infection Control and Nursing, Graduate School of Nursing, Aichi Medical University, Japan
| | - Hiromichi Suzuki
- Department of Infectious Diseases, University of Tsukuba School of Medicine and Health Sciences, Japan
| | - Atsushi Nakamura
- Department of Infection Prevention and Control, Graduate School of Medical Sciences, Nagoya City University, Japan
| | - Shigeru Fujimura
- Division of Clinical Infectious Diseases and Chemotherapy, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, Japan
| | | | - Yoshitomo Morinaga
- Department of Microbiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan
| | - Minako Mori
- Department of Infection Control, Hiroshima University Hospital, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Kochi Medical School, Kochi University, Japan
| | - Sadako Yoshizawa
- Department of Laboratory Medicine/Department of Microbiology and Infectious Diseases, Faculty of Medicine, Toho University, Japan
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Suwanchai C, Udompataikul M, Kamanamool N, Kanokrungsee S. A comparative study on the effect of alcohol-based hand sanitizers in spray and gel formulation on the skin: A prospective, randomised, crossover trial. Contact Dermatitis 2024; 90:394-401. [PMID: 38086328 DOI: 10.1111/cod.14476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 03/13/2024]
Abstract
BACKGROUND Many formulations of Alcohol-based hand rubs (ABHRs), such as liquid, gel, and spray have been developed and used for preventing infections. This study aimed to compare skin irritation from using ABHRs in gel and spray formulations. METHOD This was a prospective, randomised, crossover trial conducted to investigate the effect of skin irritation caused by ABHRs in gel compared to spray formulation after 21 days of using each formulation. Clinical outcomes were assessed using subjective Larson's skin assessment score and Frosch and Kligman observer skin assessment score, as well as bioengineering measures: transepidermal water loss (TEWL) and skin capacitance on days 3, 7, 14, and 21. RESULTS Among 38 participants, both formulations showed no significant change in clinical scores and skin capacitance during the study. However, TEWL increased significantly from baseline on day 3 (p = 0.029) for the spray formulation and on day 21 (p = 0.019) for the gel formulation, with no statistically significant difference between the formulations (p = 0.46). CONCLUSION Our research supports the safety of gel and spray ABHRs for regular use, with the only potential issue being mild skin irritation. For those with sensitive skin, the gel formulation is preferable.
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Affiliation(s)
- Chananya Suwanchai
- Department of Dermatology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Montree Udompataikul
- Department of Dermatology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Nanticha Kamanamool
- Department of Preventive and Social Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Silada Kanokrungsee
- Department of Dermatology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
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Pandey J, Gaire S, Sharma K, Pun D, Gyawali A, Lamichhane G, Budean D, Devkota HP. Exploring the potentials of Ziziphus mauritiana Lam. seed kernel oil as pharmaceutical oil base: Physicochemical characterization and ketoconazole soap formulation. Heliyon 2023; 9:e21034. [PMID: 38106666 PMCID: PMC10722321 DOI: 10.1016/j.heliyon.2023.e21034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 12/19/2023] Open
Abstract
Ziziphus mauritiana Lam. (Rhamnaceae) is a large spiny shrub or small tree, native to the Indian subcontinent that can reach a maximum height of 9-15 m. This plant stands as a renowned tropical fruit variety, commonly recognized as the Indian plum, Desert apple, or Indian Jujube. The objective of this study was to examine the standard physicochemical parameters of Z. mauritiana seed kernel oil and to formulate the ketoconazole soap (2 % w/w), using the obtained oil, as a base. The oil was obtained through hexane extraction from the seed kernels. To formulate pharmaceutical ketoconazole soap, Z. mauritiana seed kernel oil was subjected to a basic saponification reaction using potassium hydroxide. All the examined physicochemical parameters, namely acid value (4.71 mg KOH/g), saponification value (229.18 mg KOH/g), peroxide value (4.15 milliequivalents KOH/g), ester value (224.47 mg KOH/g), iodine value (11.19 mg KOH/g), refractive index (1.448), pH (5.93), viscosity (89 cP), and specific gravity (0.912 g/mL) were within the acceptable range for industrial purposes. The examination of quality control parameters, namely drug content (99.49 %), total fatty matter (71.13 %), foam retention time (17.21 min), foam height (18.56 cm), moisture content (9.14 %), and pH (7.16) indicated that the newly formulated ketoconazole soap complied with the acceptable limits. In summary, our research demonstrated the excellent physicochemical stability of Z. mauritiana seed kernel oil and its suitability as a soap base, supporting its promising prospects for cost-effective production of cosmetics, soaps, and shampoos in the pharmaceutical and cosmeceutical industries, reducing reliance on synthetic bases.
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Affiliation(s)
- Jitendra Pandey
- Department of Pharmacy, Crimson College of Technology, Pokhara University, Devinagar-11, Butwal, 32900, Nepal
- Department of Chemistry, University of Hawai'i at Manoa, 2545 McCarthy Mall, Honolulu, HI, 96822, USA
| | - Sushan Gaire
- Department of Pharmacy, Crimson College of Technology, Pokhara University, Devinagar-11, Butwal, 32900, Nepal
| | - Kamal Sharma
- Department of Pharmacy, Crimson College of Technology, Pokhara University, Devinagar-11, Butwal, 32900, Nepal
| | - Dila Pun
- Department of Pharmacy, Crimson College of Technology, Pokhara University, Devinagar-11, Butwal, 32900, Nepal
| | - Anjali Gyawali
- Department of Pharmacy, Crimson College of Technology, Pokhara University, Devinagar-11, Butwal, 32900, Nepal
| | - Gopal Lamichhane
- Department of Oriental Pharmacy, and Wonkwang-Oriental Medicines Research Institute, Wonkwang University, Iksan, South Korea
| | - David Budean
- Department of Chemistry, University of Hawai'i at Manoa, 2545 McCarthy Mall, Honolulu, HI, 96822, USA
| | - Hari Prasad Devkota
- Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oehonmachi, Chuo-ku, Kumamoto, 862-0973, Japan
- Headquarters for Admissions and Education, Kumamoto University, Kurokami, 2-39-1, Chuo-ku, Kumamoto, 860-8555, Japan
- Pharmacy Program, Gandaki University, Pokhara, 33700, Nepal
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Russotto A, Rolfini E, Paladini G, Gastaldo C, Vicentini C, Zotti CM. Hand Hygiene and Antimicrobial Resistance in the COVID-19 Era: An Observational Study. Antibiotics (Basel) 2023; 12:antibiotics12030583. [PMID: 36978450 PMCID: PMC10045068 DOI: 10.3390/antibiotics12030583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Hand hygiene (HH) is one of the most important infection prevention and control strategies at the hospital level. The aim of this study was to evaluate the potential COVID-19 pandemic impact on HH practices and rate of healthcare-associated infections. Data on alcohol-based handrub consumption (AHC) and antimicrobial resistance across 27 Italian hospitals over the period 2017–2021 were considered. Data on Methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteria (CRE) were extracted from the antimicrobial resistance regional surveillance system. A significant increase was highlighted, with a peak in 2020 and a partial fall in 2021 for AHC (p < 0.001). The decrease in MRSA rates in 2021 compared to 2017–2019 was significant (p = 0.013). A significant Spearman’s correlation between AHC and CRE rates was found (Spearman’s ρ −0.646, p = 0.032). This study supports the importance of AHC monitoring and showed that improving AHC was an attainable goal in the COVID-19 era. However, other strategies are needed to maintain the high levels of AHC attained during the pandemic, in order to avoid a progressive drop that has already begun in 2021. Furthermore, our results support the inverse relationship between AHC and infection rates and antimicrobial-resistant bacteria.
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Sakač N, Madunić-Čačić D, Marković D, Jozanović M. Study of Cationic Surfactants Raw Materials for COVID-19 Disinfecting Formulations by Potentiometric Surfactant Sensor. SENSORS (BASEL, SWITZERLAND) 2023; 23:2126. [PMID: 36850724 PMCID: PMC9964672 DOI: 10.3390/s23042126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/08/2023] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
The behavior of a new 1,3-dioctadecyl-1H-imidazol-3-ium tetraphenylborate (DODI-TPB) surfactant sensor was studied in single and complex mixtures of technical grade QACs-benzalkonium chloride (BAC), N,N-didecyl-N,N-dimethylammonium chloride (DDAC), and N,N-dioctyl-N,N-dimethylammonium chloride (DOAC) usually used in COVID-19 disinfecting agents formulations. The results obtained with the new DODI-TPB sensor were in good agreement with data measured by a 1,3-dihexadecyl-1H-benzo[d]imidazol-3-ium-tetraphenylborate (DMI-TPB) surfactant sensor, as well as two-phase titration used as a reference method. The quantitative titrations of a two-component mixture of the cationic homologs (a) DDAC and DOAC; and (b) BAC and DOAC showed that the new DODI-TPB surfactant sensor can clearly distinguish two separate mixture components in a single potentiometric titration curve with two characteristic inflexion points. The consumption of SDS (used as a titrant) in the end-point 1 (EP 1) corresponded to the content of DDAC (or BAC), whereas the consumption in the end-point 2 (EP 2) corresponded to the total content of both cationic surfactants in the mixture. DOAC content in both mixtures can be calculated from the difference of the titrant used to achieve EP1 and EP2. The addition of nonionic surfactants resulted in the signal change decrease from 333.2 mV (1:0; no nonionic surfactant added) to 243.0 mV (1:10, w/w). The sensor was successfully tested in ten two-component COVID-19 disinfecting formulations.
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Affiliation(s)
- Nikola Sakač
- Faculty of Geotechnical Engineering, University of Zagreb, 42000 Varaždin, Croatia
| | | | - Dean Marković
- Department of Biotechnology, University of Rijeka, 51000 Rijeka, Croatia
| | - Marija Jozanović
- Department of Chemistry, University of Osijek, 31000 Osijek, Croatia
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Chopin-Doroteo M, Krötzsch E. Soap or alcohol-based products? The effect of hand hygiene on skin characteristics during the COVID-19 pandemic. J Cosmet Dermatol 2023; 22:347-353. [PMID: 36409429 DOI: 10.1111/jocd.15523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/05/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Different strategies for hand skin hygiene have been used to prevent the spread of SARS-CoV-2. However, frequent hand sanitization has been associated with skin damage. The present study aimed to evaluate hand hygiene habits during the COVID-19 pandemic and the effect of the repetitive use of soap or alcohol-based products on skin characteristics. METHODS We conducted a survey regards hand hygiene habits acquired during the COVID-19 pandemic. Also, we performed cutometry in a cohort of individuals who cleansed their volar forearms every 30 min, during 4 h, using soap or alcohol-based products. RESULTS We received 138 responses from people with medium-high educational level who reported a 2.5-time increase in the frequency of hand cleansing (p < 0.0001) that resulted in skin damage. An in vivo analysis of skin moisture and elasticity was also performed among 19 health workers and students. In general, skin moisture decreased with every cleansing, mainly after 2 h of washing with soap (p < 0.01), while skin elasticity only reduced after 4 h of treatment (p < 0.05). Alcohol-based solution or alcohol-based gel (70% ethanol, both) did not affect skin moisture or elasticity during testing. CONCLUSION It is known that the excessive use of soap or alcohol-based products causes dermatological issues. The present study demonstrates that non-medicated soap significantly affects skin moisture and elasticity, probably because the soap removes the hydrolipidic protective barrier, favoring transepidermal water loss, where the lack of the appropriate stratum corneum hydration also affects skin elasticity, mainly associated with changes in epidermal structure.
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Affiliation(s)
- Mario Chopin-Doroteo
- Laboratory of Connective Tissue, Centro Nacional de Investigación y Atención de Quemados, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico
| | - Edgar Krötzsch
- Laboratory of Connective Tissue, Centro Nacional de Investigación y Atención de Quemados, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico
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Lopes AER, Menegueti MG, Gaspar GG, Tartari E, da Silva Canini SRM, Pittet D, Bellissimo-Rodrigues F. Comparing surgeons' skin tolerance and acceptability to alcohol-based surgical hand preparation vs traditional surgical scrub: A matched quasi-experimental study. Am J Infect Control 2022; 50:1091-1097. [PMID: 35150804 DOI: 10.1016/j.ajic.2022.01.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND We aimed to compare the tolerance and acceptability of alcohol-based surgical hand preparation versus handscrubbing with antimicrobial soap and water by surgeons. METHODS Matched quasi-experimental trial in an academic quaternary care hospital in Ribeirão Preto, Brazil, from April 1 to October, 31, 2017. Participants were cardiac and orthopedics surgeons from the study facility. In the first study phase, they performed handscrubbing with either 2% chlorhexidine (CHG) or 10% iodopovidone (PVP-I) and, in the second phase, they performed handrubbing with alcohol-based handrub (ABHR). Surgeons' skin tolerance and acceptability were evaluated using WHO-validated tools. Data were analyzed using the MacNemar's test within STATA. RESULTS A total of 33 surgeons participated to the "per protocol" population; the majority were male (94%); mean age of 35 years (SD, 8.5). On product tolerance, there was a minimal variation in redness, scaliness, fissures, and visual evaluation of the skin when handrubbing with ABHR was compared to handscrubbing with either PVP-I or CHX. Regarding acceptability, participants rated better handrubbing with ABHR than handscrubbing with PVP-I when assessing product smell (66.6% vs 0%, p=0.002), color (73.3% vs 0%, p=0.001), product texture (60% vs 0%, p=0.004), skin dryness (60% vs 0%, p=0.004), ease of application (66.6% vs 0%, p=0.002) and overall satisfaction (66.6% vs 6.7% p=0.011). Participants rated similarly handrubbing with ABHR and handscrubbing with CHX, except for product texture, where handrubbing rated better (71,4% vs. 0%, p=0.002). Handrubbing with ABHR was preferred by 73.3%. CONCLUSION Although handrubbing and handscrubbing were equally well tolerated by surgeons, alcohol-based surgical hand preparation fell into the personal preference for most of them. TRIAL REGISTRATION Brazilian Clinical Trials Registry (ReBEC), RBR-8ym9yj.
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Affiliation(s)
- Ana Elisa Ricci Lopes
- Department of Fundamental Nursing, Ribeirão Preto Nursing School, University of São Paulo, Ribeirão Preto, Brazil
| | - Mayra Gonçalves Menegueti
- Department of Fundamental Nursing, Ribeirão Preto Nursing School, University of São Paulo, Ribeirão Preto, Brazil
| | - Gilberto Gambero Gaspar
- Infection Control Service, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ermira Tartari
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | | | - Didier Pittet
- Infection Prevention and Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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Okazaki K, Fujino Y, Morikawa Y. Effects of ultra-pure soft water on the hands of nurses in a neonatal intensive care unit: A randomized crossover study. Contact Dermatitis 2022; 87:521-527. [PMID: 35718935 DOI: 10.1111/cod.14177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Healthcare workers (HCWs) wash their hands with tap water (TW) and soap. However, hard TW causes dermatitis. OBJECTIVES The present study aimed to compare the effects of ultra-pure soft water (UPSW) with those of TW on the hands of HWCs. METHODS The present study was a prospective randomized trial with a crossover design. All the nurses in the neonatal intensive care unit (NICU) at the study centre were divided into Sequence 1 (UPSW to TW) or 2 (TW to UPSW) and washed their hands with TW or UPSW in alternating 4-week periods with a 4-week washout period. Trans-epidermal water loss (TEWL) and stratum corneum hydration (SCH) were evaluated. Skin condition was self-assessed. RESULTS Twenty-one and 22 nurses were assigned to Sequence 1 and Sequence 2, respectively. USPW increased SCH to a significantly greater degree than TW (mean: 26.3 μS ± 12.3 SD; 95% confidence interval: 1.12-51.54; p = 0.041) although it did not affect TEWL. UPSW use significantly improved the subjects' skin condition, as reflected in an overall increase in the assessment scores. CONCLUSIONS UPSW improved SCH and the condition of hand skin. Prolonged USPW use may increase nurses' comfort during work and hand hygiene compliance.
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Affiliation(s)
- Kaoru Okazaki
- Department of Neonatology, Tokyo Metropolitan Children's Medical Center, Fuchu, Japan
| | - Yuta Fujino
- Division of Neonatal Intensive Care Unit, Tokyo Metropolitan Children's Medical Center, Fuchu, Japan
| | - Yoshihiko Morikawa
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Fuchu, Japan
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Escudero-Abarca BI, Goulter RM, Manuel CS, Leslie RA, Green K, Arbogast JW, Jaykus LA. Comparative Assessment of the Efficacy of Commercial Hand Sanitizers Against Human Norovirus Evaluated by an in vivo Fingerpad Method. Front Microbiol 2022; 13:869087. [PMID: 35464915 PMCID: PMC9021954 DOI: 10.3389/fmicb.2022.869087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
Human noroviruses (hNoV) are the leading cause of acute non-bacterial gastroenteritis worldwide and contaminated hands play a significant role in the spread of disease. Some hand sanitizers claim to interrupt hNoV transmission, but their antiviral efficacy on human hands is poorly characterized. The purpose of this work was to characterize the efficacy of representative commercial hand sanitizers against hNoV using an in vivo fingerpad method (ASTM E1838-17). Eight products [seven ethanol-based and one benzalkonium chloride (BAK)-based], and a benchmark 60% ethanol solution, were each evaluated on 10 human volunteers using the epidemic GII.4 hNoV strain. Virus titers before and after treatment were evaluated by RT-qPCR preceded by RNase treatment; product efficacy was characterized by log10 reduction (LR) in hNoV genome equivalent copies after treatment. The benchmark treatment produced a 1.7 ± 0.5 LR, compared with Product A (containing 85% ethanol) which produced a 3.3 ± 0.3 LR and was the most efficacious (p < 0.05). Product B (containing 70% ethanol), while less efficacious than Product A (p < 0.05), performed better than the benchmark with a LR of 2.4 ± 0.4. Five of the other ethanol-based products (labeled ethanol concentration ranges of 62–80%) showed similar efficacy to the 60% ethanol benchmark with LR ranging from 1.3 to 2.0 (p > 0.05). Product H (0.1% BAK) was less effective than the benchmark with a LR of 0.3 ± 0.2 (p < 0.05). None of the products screened were able to completely eliminate hNoV (maximum assay resolution 5.0 LR). Product performance was variable and appears driven by overall formulation. There remains a need for more hand sanitizer formulations having greater activity against hNoV, a virus that is comparatively recalcitrant relative to other pathogens of concern in community, healthcare, and food preparation environments.
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Affiliation(s)
- Blanca I. Escudero-Abarca
- Department of Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Raleigh, NC, United States
| | - Rebecca M. Goulter
- Department of Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Raleigh, NC, United States
- *Correspondence: Rebecca M. Goulter,
| | | | | | | | | | - Lee-Ann Jaykus
- Department of Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Raleigh, NC, United States
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Rivers JK, Arlette JP, DeKoven J, Guenther LC, Muhn C, Richer V, Rosen N, Tremblay JF, Wiseman MC, Zip C, Zloty D. Skin care and hygiene among healthcare professionals during and after the SARS-CoV-2 pandemic. SAGE Open Med 2021; 9:20503121211062795. [PMID: 34917384 PMCID: PMC8669117 DOI: 10.1177/20503121211062795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/08/2021] [Indexed: 12/23/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 pandemic has necessitated enhanced protection against viral transmission among healthcare professionals, particularly relating to handwashing and personal protective equipment. Some of these requirements may persist for years to come. They bring associated concerns around skin hygiene and general care, with damage to the face and hands now a well-documented consequence among healthcare professionals. This review assesses optimal skin care during the severe acute respiratory syndrome coronavirus 2 pandemic and in the "new normal" that will follow, identifies current knowledge gaps, and provides practical advice for the clinical setting. Regular, systematic hand cleaning with soap and water or an alcohol-based hand rub (containing 60%-90% ethanol or isopropyl alcohol) remains essential, although the optimal quantity and duration is unclear. Gloves are a useful additional barrier; further studies are needed on preferred materials. Moisturization is typically helpful and has proven benefits in mitigating damage from frequent handwashing. It may be best practiced using an alcohol-based hand rub with added moisturizer and could be particularly important among individuals with pre-existing hand dermatoses, such as psoriasis and eczema. Face moisturization immediately prior to donning a mask, and the use of dressings under the mask to reduce friction, can be helpful dermatologically, but more work is required to prove that these actions do not affect seal integrity. Nonetheless, such measures could play a role in institutional plans for mitigating the dermatologic impact of transmission control measures as we exit the pandemic.
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Affiliation(s)
- Jason K Rivers
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
- Pacific Derm, Vancouver, BC, Canada
| | - John P Arlette
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joel DeKoven
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lyn C Guenther
- Division of Dermatology, Western University, London, ON, Canada
- Guenther Research Inc., London, ON, Canada
| | - Channy Muhn
- Division of Dermatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Dermetics, Burlington, ON, Canada
| | - Vincent Richer
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
- Pacific Derm, Vancouver, BC, Canada
| | | | | | - Marni C Wiseman
- Section of Dermatology, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Skinwise Dermatology, Winnipeg, MB, Canada
| | | | - David Zloty
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
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Crosse KR. Pre-surgical hand preparation in veterinary practice. N Z Vet J 2021; 70:69-78. [PMID: 34586948 DOI: 10.1080/00480169.2021.1987348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The objective of this paper is to review the evidence for different methods of surgical hand preparation applicable to veterinary practice. Surgical hand preparation is an essential step in performing surgery as a veterinarian. Recommended protocols and products for surgical hand preparation have varied since its inception in the late 1800s. Many factors must be considered when assessing the efficacy, safety, and users' compliance with any available product. Traditional scrub methods employing chlorhexidine gluconate or povidone-iodine have been compared to alcohol-based rub protocols with respect to immediate and prolonged efficacy, safety, compliance, requirements for theatre furniture, cost and water usage. Although much of the comparative data has been generated in human medical facilities, extrapolation of the data to veterinary surgery is appropriate. Considerations for veterinary practice are specifically discussed. Overall, the benefits of alcohol-based rubs indicate that this should be the preferred method of pre-surgical hand preparation for veterinarians in all types of practice.
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Affiliation(s)
- K R Crosse
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
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14
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Daverey A, Dutta K. COVID-19: Eco-friendly hand hygiene for human and environmental safety. JOURNAL OF ENVIRONMENTAL CHEMICAL ENGINEERING 2021; 9:104754. [PMID: 33200069 PMCID: PMC7657077 DOI: 10.1016/j.jece.2020.104754] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/07/2020] [Accepted: 11/06/2020] [Indexed: 05/05/2023]
Abstract
The Coronavirus disease-2019 (COVID-19) outbreak is caused by a highly pathogenic novel coronavirus (SARS-CoV-2). To date, there is no prescribed medicine for COVID-19. Frequent handwashing with soap and the use of alcohol-based hand sanitizers is recommended by WHO for hand hygiene and to prevent the spread of COVID-19. However, there are safety concerns associated with the use of soaps and alcohol-based hand sanitizers. Therefore, the review aims to highlight the health and environmental concerns associated with the frequent use of soaps/detergents and alcohol-based hand sanitizers amid COVID-19. The potential of some of the natural detergents and sanitizing agents as eco-friendly alternatives to petrochemical-based soaps and alcohol-based hand rubs for hand hygiene are discussed. The market of soaps and hand sanitizers is expected to grow in the coming years and therefore, future research should be directed to develop eco-friendly soaps and hand sanitizers for human and environmental safety.
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Affiliation(s)
- Achlesh Daverey
- School of Environment and Natural Resources, Doon University, Dehradun, Uttarakhand 248012, India
| | - Kasturi Dutta
- Department of Biotechnology and Medical Engineering, National Institute of Technology, Rourkela, Odisha 769008, India
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15
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Kumar S, Das A. Hand sanitizers: Science and rationale. Indian J Dermatol Venereol Leprol 2021; 87:309-314. [PMID: 33769729 DOI: 10.25259/ijdvl_598_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/01/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Satarupa Kumar
- Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
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Menegueti MG, Bellissimo-Rodrigues F, Ciol MA, Auxiliadora-Martins M, Basile-Filho A, da Silva Canini SRM, Gir E, Laus AM. Impact of replacing powdered gloves with powder-free gloves on hand-hygiene compliance among healthcare workers of an intensive care unit: a quasi-experimental study. Antimicrob Resist Infect Control 2021; 10:6. [PMID: 33407882 PMCID: PMC7789181 DOI: 10.1186/s13756-020-00877-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/OBJECTIVE After wearing powdered gloves, healthcare workers (HCW) are supposed to wash their hands instead of using alcohol-based hand-rub (ABHR). Washing hands takes longer than using ABHR, and the use of powdered gloves may be an obstacle to hand-hygiene compliance. This study aimed to evaluate the impact of replacing powdered gloves with powder-free gloves on hand-hygiene compliance among HCW of an intensive care unit (ICU). METHODS A quasi-experimental study was conducted in a general ICU of a tertiary care university hospital in Brazil. From June 1st to July 15th, 2017, all HCW were provided with powdered latex gloves only for all clinical procedures. From July 15th to August 31st, 2017, HCW were provided with nitrile powder-free gloves only. Hand-hygiene compliance was assessed through direct observation, and evaluated according to the World Health Organization Hand Hygiene guidelines. We calculated that a sample size of 544 hand hygiene opportunities needed to be observed per period. Data analysis were performed using the STATA SE® version 14, and we compared the individual's percentage of compliance using the t test for paired data before and after the intervention. RESULTS Overall, 40 HCW were assessed before and after the introduction of nitrile powder-free gloves, with 1114 and 1139 observations of hand hygiene opportunities, respectively. The proportion of compliance with hand hygiene was 55% (95% confidence interval [CI] 51-59%) using powdered latex gloves and 60% (95% CI 57-63%) using powder-free gloves. The difference in proportions between the two types of gloves was 5.1% (95% CI 2.5-7.6%, p < 0.001). CONCLUSION Our data indicate that replacing powdered gloves with powder-free gloves positively influenced hand-hygiene compliance by HCW in an ICU setting.
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Affiliation(s)
- Mayra Gonçalves Menegueti
- Ribeirão Preto Nursing School, University of São Paulo, Campus Universitário, s/n Monte Alegre, Ribeirão Prêto, São Paulo 14048-900 Brazil
| | | | - Marcia A. Ciol
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, USA
| | - Maria Auxiliadora-Martins
- Intensive Care Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Prêto, Brazil
| | - Anibal Basile-Filho
- Intensive Care Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Prêto, Brazil
| | - Silvia Rita Marin da Silva Canini
- Ribeirão Preto Nursing School, University of São Paulo, Campus Universitário, s/n Monte Alegre, Ribeirão Prêto, São Paulo 14048-900 Brazil
| | - Elucir Gir
- Ribeirão Preto Nursing School, University of São Paulo, Campus Universitário, s/n Monte Alegre, Ribeirão Prêto, São Paulo 14048-900 Brazil
| | - Ana Maria Laus
- Ribeirão Preto Nursing School, University of São Paulo, Campus Universitário, s/n Monte Alegre, Ribeirão Prêto, São Paulo 14048-900 Brazil
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Tasar R, Wiegand C, Elsner P. How irritant are n-propanol and isopropanol? - A systematic review. Contact Dermatitis 2020; 84:1-14. [PMID: 33063847 PMCID: PMC7675697 DOI: 10.1111/cod.13722] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/05/2020] [Accepted: 10/10/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND The use of alcoholic-based hand rubs (ABHRs) is an important tool for hand hygiene, especially in times of the COVID-19 pandemic. Possible irritant effects of ABHR may prevent their use by persons at risk of infection. METHODS This systematic review is based on a PubMed search of articles published between January 2000 and September 2019 in English and German, and a manual search, related to the irritation potential of alcohol-based disinfectants restricted to n-propanol (1-propanol) and its structural isomer isopropanol (isopropyl alcohol, 2-propanol). RESULTS The majority of the included studies show a low irritation potential of n-propanol alone. However, recent studies provide evidence for significant barrier damage effects of repeated exposure to 60% n-propanol in healthy, as well as atopic skin in vivo. The synergistic response of combined irritants, (ie, a combination of n-propanol or isopropanol with detergents such as sodium lauryl sulfate) is greater, compared with a quantitatively identical application of the same irritant alone. CONCLUSION While recent studies indicate a higher risk of skin irritation for n-propanol and isopropanol than reported in the past, this risk still seems to be lower than that for frequent handwashing with detergents, as recommended by some to prevent COVID-19 infections.
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Affiliation(s)
- Ramona Tasar
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - Cornelia Wiegand
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - Peter Elsner
- Department of Dermatology, University Hospital Jena, Jena, Germany
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18
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Agrawal S, Jaiswal S, Mishra DB, Rathi S. Dermatological Manifestation due to Preventive Measures Used During COVID-19 Pandemic. Indian Dermatol Online J 2020; 11:838-841. [PMID: 33235862 PMCID: PMC7678531 DOI: 10.4103/idoj.idoj_343_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/22/2020] [Accepted: 08/04/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sandip Agrawal
- Department of Dermatology, IGGMC, Nagpur, Maharashtra, India
| | - Saurabh Jaiswal
- Department of Dermatology, IGGMC, Nagpur, Maharashtra, India
| | | | - Sushil Rathi
- Department of Dermatology, IGGMC, Nagpur, Maharashtra, India
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19
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Amiraslani S, Darbemamieh G, Karimian F, Tabatabai Ghomsheh F. Design, Fabrication, and Testing of a Novel Surgical Handwashing Machine. Surg Innov 2020; 28:323-328. [PMID: 32921227 DOI: 10.1177/1553350620958241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Surgical hand scrub is strongly recommended as an essential measure to reduce surgical site infections (SSIs). SSI results in morbidity and additional cost. Micropunctures may occur on surgical gloves during operation, thus hand scrub cannot be omitted in any condition. Generally speaking, the adequacy of hand scrub is decided by the surgeon. Only occasionally, surveillance of hygienic status of hands is performed after scrub. Therefore, the potential exists that suboptimal handwash leads to SSIs. There are standards for preoperative handwash, but all of them are operator dependent, and continuous surveillance is actually impossible. One solution is to omit the role of surgeon in handwashing. This can be achieved by designing a standard procedure, performed mechanically by a machine, considering the detailed requirements of hygienic surgical hand scrub. The goal of this study was to develop a procedure that works on the design, fabrication, and trial of a new handwashing machine, for surgical hand scrub. Methods. A machine with a reciprocal spraying mechanism was designed that covers from the fingertips up to the elbow. Various combinations of staged irrigations with antiseptic solutions and water were to be programmed and implemented. Clinical experiments were performed several times with different handwashing programs, and swabs were taken from the skin surface and creases. Results. There was no microbial growth after 72 hours with any handwashing program. Conclusion. The preliminary experiments with this new handwashing machine show promising results for its application in surgical hand scrub.
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Affiliation(s)
- Shahryar Amiraslani
- Department of Biomedical Engineering, Central Tehran Branch, 201585Islamic Azad University, Tehran, Iran
| | - Goldis Darbemamieh
- Department of Biomedical Engineering, Central Tehran Branch, 201585Islamic Azad University, Tehran, Iran
- Hard Tissue Engineering Research Center, Tissue Engineering and Regenerative Medicine Institute, Central Tehran Branch, 201585Islamic Azad University, Tehran, Iran
| | - Faramarz Karimian
- Department of Surgery, IK Teaching Hospital, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Tabatabai Ghomsheh
- Pediatric Neurorehabilitation Research Center, 48533University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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20
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Altunisik Toplu S, Altunisik N, Turkmen D, Ersoy Y. Relationship between hand hygiene and cutaneous findings during COVID-19 pandemic. J Cosmet Dermatol 2020; 19:2468-2473. [PMID: 32757376 PMCID: PMC7436475 DOI: 10.1111/jocd.13656] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the current situation of the COVID-19 pandemic, healthcare workers (HCWs) have to comply with hygiene conditions and use gloves more frequently and for a longer period of time than they would previously to avoid infection and prevent transmission. AIMS We aimed to characterize the adverse skin reactions occurring after hand hygiene and glove use in HCWs in a tertiary university hospital to determine the possible causative factors and whether the use of these measures is affected. METHODS Between April 15 and May 1, 2020, a cross-sectional survey was conducted, using online questionnaire, answered by HCWs in a tertiary university hospital. RESULTS The increase in general hand-skin problems during the pandemic period was statistically significant (P = .004). The most common symptom was dryness. During the pandemic period, 67 (24.3%) HCWs thought that the conditions were caused by glove use, and 197 (71.4%) thought that they were due to alcohol-based hand antiseptics. The incidence of other hand-skin conditions except for vesicles was statistically higher in women than in men (P < .001). CONCLUSIONS Increased number of hand-skin conditions during the pandemic should not be ignored, since hand hygiene and glove use are expected to increase.
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Affiliation(s)
- Sibel Altunisik Toplu
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Inonu University, Malatya, Turkey
| | - Nihal Altunisik
- Department of Dermatology, Medical Faculty, Inonu University, Malatya, Turkey
| | - Dursun Turkmen
- Department of Dermatology, Medical Faculty, Inonu University, Malatya, Turkey
| | - Yasemin Ersoy
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Inonu University, Malatya, Turkey
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21
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Hand Hygiene Among Health Care Workers During COVID-19 Pandemic: Challenges and Recommendations. Dermatitis 2020; 31:233-237. [DOI: 10.1097/der.0000000000000639] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Jing JLJ, Pei Yi T, Bose RJC, McCarthy JR, Tharmalingam N, Madheswaran T. Hand Sanitizers: A Review on Formulation Aspects, Adverse Effects, and Regulations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3326. [PMID: 32403261 PMCID: PMC7246736 DOI: 10.3390/ijerph17093326] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 12/14/2022]
Abstract
Hand hygiene is of utmost importance as it may be contaminated easily from direct contact with airborne microorganism droplets from coughs and sneezes. Particularly in situations like pandemic outbreak, it is crucial to interrupt the transmission chain of the virus by the practice of proper hand sanitization. It can be achieved with contact isolation and strict infection control tool like maintaining good hand hygiene in hospital settings and in public. The success of the hand sanitization solely depends on the use of effective hand disinfecting agents formulated in various types and forms such as antimicrobial soaps, water-based or alcohol-based hand sanitizer, with the latter being widely used in hospital settings. To date, most of the effective hand sanitizer products are alcohol-based formulations containing 62%-95% of alcohol as it can denature the proteins of microbes and the ability to inactivate viruses. This systematic review correlated with the data available in Pubmed, and it will investigate the range of available hand sanitizers and their effectiveness as well as the formulation aspects, adverse effects, and recommendations to enhance the formulation efficiency and safety. Further, this article highlights the efficacy of alcohol-based hand sanitizer against the coronavirus.
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Affiliation(s)
- Jane Lee Jia Jing
- School of Pharmacy, International Medical University, No. 126 Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur 57000, Malaysia; (J.L.J.J.); (T.P.Y.)
| | - Thong Pei Yi
- School of Pharmacy, International Medical University, No. 126 Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur 57000, Malaysia; (J.L.J.J.); (T.P.Y.)
| | - Rajendran J. C. Bose
- Masonic Medical Research Institute, 2150 Bleecker St, Utica, NY 13501, USA; (R.J.C.B.); (J.R.M.)
| | - Jason R. McCarthy
- Masonic Medical Research Institute, 2150 Bleecker St, Utica, NY 13501, USA; (R.J.C.B.); (J.R.M.)
| | - Nagendran Tharmalingam
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI 02903, USA;
| | - Thiagarajan Madheswaran
- Department of Pharmaceutical Technology, International Medical University, No. 126 Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur 57000, Malaysia
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Munn Z, Tufanaru C, Lockwood C, Stern C, McAneney H, Barker TH. Rinse-free hand wash for reducing absenteeism among preschool and school children. Cochrane Database Syst Rev 2020; 4:CD012566. [PMID: 32270476 PMCID: PMC7141998 DOI: 10.1002/14651858.cd012566.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Illness-related absenteeism is an important problem among preschool and school children for low-, middle- and high- income countries. Appropriate hand hygiene is one commonly investigated and implemented strategy to reduce the spread of illness and subsequently the number of days spent absent. Most hand hygiene strategies involve washing hands with soap and water, however this is associated with a number of factors that act as a barrier to its use, such as requiring running water, and the need to dry hands after cleaning. An alternative method involves washing hands using rinse-free hand wash. This technique has a number of benefits over traditional hand hygiene strategies and may prove to be beneficial in reducing illness-related absenteeism in preschool and school children. OBJECTIVES 1. To assess the effectiveness of rinse-free hand washing for reducing absenteeism due to illness in preschool and school children compared to no hand washing, conventional hand washing with soap and water or other hand hygiene strategies. 2. To determine which rinse-free hand washing products are the most effective (if head-to-head comparisons exist), and what effect additional strategies in combination with rinse-free hand washing have on the outcomes of interest. SEARCH METHODS In February 2020 we searched CENTRAL, MEDLINE, Embase, CINAHL, 12 other databases and three clinical trial registries. We also reviewed the reference lists of included studies and made direct contact with lead authors of studies to collect additional information as required. No date or language restrictions were applied. SELECTION CRITERIA Randomized controlled trials (RCTs), irrespective of publication status, comparing rinse-free hand wash in any form (hand rub, hand sanitizer, gel, foam etc.) with conventional hand washing using soap and water, other hand hygiene programs (such as education alone), or no intervention. The population of interest was children aged between two and 18 years attending preschool (childcare, day care, kindergarten, etc.) or school (primary, secondary, elementary, etc.). Primary outcomes included child or student absenteeism for any reason, absenteeism due to any illness and adverse skin reactions. DATA COLLECTION AND ANALYSIS Following standard Cochrane methods, two review authors (out of ZM, CT, CL, CS, TB), independently selected studies for inclusion, assessed risk of bias and extracted relevant data. Absences were extracted as the number of student days absent out of total days. This was sometimes reported with the raw numbers and other times as an incidence rate ratio (IRR), which we also extracted. For adverse event data, we calculated effect sizes as risk ratios (RRs) and present these with 95% confidence intervals (CIs). We used standard methodological procedures expected by Cochrane for data analysis and followed the GRADE approach to establish certainty in the findings. MAIN RESULTS This review includes 19 studies with 30,747 participants. Most studies were conducted in the USA (eight studies), two were conducted in Spain, and one each in China, Colombia, Finland, France, Kenya, Bangladesh, New Zealand, Sweden, and Thailand. Six studies were conducted in preschools or day-care centres (children aged from birth to < five years), with the remaining 13 conducted in elementary or primary schools (children aged five to 14 years). The included studies were judged to be at high risk of bias in several domains, most-notably across the domains of performance and detection bias due to the difficulty to blind those delivering the intervention or those assessing the outcome. Additionally, every outcome of interest was graded as low or very low certainty of evidence, primarily due to high risk of bias, as well as imprecision of the effect estimates and inconsistency between pooled data. For the outcome of absenteeism for any reason, the pooled estimate for rinse-free hand washing was an IRR of 0.91 (95% CI 0.82 to 1.01; 2 studies; very low-certainty evidence), which indicates there may be little to no difference between groups. For absenteeism for any illness, the pooled IRR was 0.82 (95% CI 0.69 to 0.97; 6 studies; very low-certainty evidence), which indicates that rinse-free hand washing may reduce absenteeism (13 days absent per 1000) compared to those in the 'no rinse-free' group (16 days absent per 1000). For the outcome of absenteeism for acute respiratory illness, the pooled IRR was 0.79 (95% CI 0.68 to 0.92; 6 studies; very low-certainty evidence), which indicates that rinse-free hand washing may reduce absenteeism (33 days absent per 1000) compared to those in the 'no rinse-free' group (42 days absent per 1000). When evaluating absenteeism for acute gastrointestinal illness, the pooled estimate found an IRR of 0.79 (95% CI 0.73 to 0.85; 4 studies; low-certainty evidence), which indicates rinse-free hand washing may reduce absenteeism (six days absent per 1000) compared to those in the 'no rinse-free' group (eight days absent per 1000). There may be little to no difference between rinse-free hand washing and 'no rinse-free' group regarding adverse skin reactions with a RR of 1.03 (95% CI 0.8 to 1.32; 3 studies, 4365 participants; very low-certainty evidence). Broadly, compliance with the intervention appeared to range from moderate to high compliance (9 studies, 10,749 participants; very-low certainty evidence); narrativley, no authors reported substantial issues with compliance. Overall, most studies that included data on perception reported that teachers and students perceived rinse-free hand wash positively and were willing to continue its use (3 studies, 1229 participants; very-low certainty evidence). AUTHORS' CONCLUSIONS The findings of this review may have identified a small yet potentially beneficial effect of rinse-free hand washing regimes on illness-related absenteeism. However, the certainty of the evidence that contributed to this conclusion was low or very low according to the GRADE approach and is therefore uncertain. Further research is required at all levels of schooling to evaluate rinse-free hand washing regimens in order to provide more conclusive, higher-certainty evidence regarding its impact. When considering the use of a rinse-free hand washing program in a local setting, there needs to be consideration of the current rates of illness-related absenteeism and whether the small beneficial effects seen here will translate into a meaningful reduction across their settings.
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Affiliation(s)
- Zachary Munn
- The University of AdelaideJoanna Briggs Institute, Faculty of Health Sciences55 King William RoadAdelaideSouth AustraliaAustralia5005
| | - Catalin Tufanaru
- Macquarie UniversityAustralian Institute of Health Innovation75 Talavera RdSydneyNew South Wales (NSW)Australia2113
| | - Craig Lockwood
- The University of AdelaideJoanna Briggs Institute, Faculty of Health Sciences55 King William RoadAdelaideSouth AustraliaAustralia5005
| | - Cindy Stern
- The University of AdelaideJoanna Briggs Institute, Faculty of Health Sciences55 King William RoadAdelaideSouth AustraliaAustralia5005
| | - Helen McAneney
- Queen's University BelfastMedicine, Dentistry and Biomedical Sciences97 Lisburn RoadHealth Sciences BuildingBelfastUKBT9 7BL
| | - Timothy H Barker
- The University of AdelaideJoanna Briggs Institute, Faculty of Health Sciences55 King William RoadAdelaideSouth AustraliaAustralia5005
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Tarka P, Gutkowska K, Nitsch-Osuch A. Assessment of tolerability and acceptability of an alcohol-based hand rub according to a WHO protocol and using apparatus tests. Antimicrob Resist Infect Control 2019; 8:191. [PMID: 31788238 PMCID: PMC6880396 DOI: 10.1186/s13756-019-0646-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/06/2019] [Indexed: 11/13/2022] Open
Abstract
Background The effectiveness of alcohol-based hand rubs (ABHRs) depends substantially on their acceptability and tolerability. In this study, we assessed the acceptability and tolerability of a new ABHR (product EU 100.2018.02). Methods Among physicians, nurses, and cosmetologists who used the ABHR for 30 days, we assessed the product's acceptability and tolerability according to a WHO protocol. Additionally, we used instrumental skin tests. Participants assessed the product's color, smell, texture, irritation, drying effect, ease of use, speed of drying, and application, and they gave an overall evaluation. Moreover, they rated the tolerability, i.e. their skin condition, on the following dimensions: intactness, moisture content, sensation, and integrity of the skin. The tolerability was also assessed by an observer as follows: redness, scaliness, fissures, and overall score for the skin condition. Instrumental skin tests included transepidermal water loss, skin hydration, sebum secretion, and percentage of skin affected by discolorations. All assessments were made at baseline (visit 1), and 3-5 days (visit 2) and 30 days (visit 3) later. Results We enrolled 126 participants (110 [87%] women) with a mean age of 34.3 ± 11.65 years. Sixty-five participants (52%) were healthcare professionals (physicians, nurses), and 61 (48%) were cosmetologists. During visit 2 and visit 3, about 90% of participants gave responses complying with the WHO's benchmark for acceptability and tolerability. Similarly, the ABHR met the WHO criteria for observer-assessed tolerability: on all visits, in more than 95% of participants, the observer gave scores complying with the WHO benchmark. Transepidermal water loss decreased from baseline to visit 3 (p < 0.001), whereas skin hydration, sebum secretion, and the percentage of skin affected by discolorations did not change significantly during the study (p ≥ 130). Conclusions The EU 100.2018.02 had both high acceptability and tolerability, meeting the WHO criteria. The WHO protocol proved useful in the analysis of acceptability and tolerability of ABHRs.
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Affiliation(s)
- Patryk Tarka
- Department of Social Medicine and Public Health, Medical University of Warsaw, ul Oczki 3, 02-007 Warsaw, Poland
| | - Katarzyna Gutkowska
- Department of Social Medicine and Public Health, Medical University of Warsaw, ul Oczki 3, 02-007 Warsaw, Poland
| | - Aneta Nitsch-Osuch
- Department of Social Medicine and Public Health, Medical University of Warsaw, ul Oczki 3, 02-007 Warsaw, Poland
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Menegueti MG, Laus AM, Ciol MA, Auxiliadora-Martins M, Basile-Filho A, Gir E, Pires D, Pittet D, Bellissimo-Rodrigues F. Glycerol content within the WHO ethanol-based handrub formulation: balancing tolerability with antimicrobial efficacy. Antimicrob Resist Infect Control 2019; 8:109. [PMID: 31285821 PMCID: PMC6591802 DOI: 10.1186/s13756-019-0553-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background The World Health Organization (WHO) ethanol-based handrub (EBHR) formulation contains 1.45% glycerol as an emollient to protect healthcare workers' (HCWs) skin against dryness and dermatitis. However, glycerol seems to negatively affect the antimicrobial efficacy of alcohols. In addition, the minimal concentration of glycerol required to protect hands remain unknown. We aim to evaluate the tolerance of HCWs to the WHO EBHR formulation using different concentrations of glycerol in a tropical climate healthcare setting. Methods We conducted a cluster-randomized, double-blind, crossover study among 40 HCWs from an intensive care unit of a tertiary-care hospital in Brazil, from June 1st to September 30, 2017. We tested the WHO EBHR original formulation containing 1.45% glycerol against three other concentrations (0, 0.5, and 0.75%). HCWs used one formulation at a time for seven working days during their routine practice and then had their hands evaluated by an external observer using the WHO scale for visual inspection. Participants also used a WHO self-evaluation tool to rate their own skin condition. We used a generalized estimating equations of the logit type to compare differences between the tolerability to different formulations. Results According to the independent observation, participants had 2.4 times (95%CI: 1.12-5.15) more chance of having a skin condition considered good when they used the 0.5% compared to the 1.45% glycerol formulation. For the self-evaluation scale, participants were likely to have a worst evaluation (OR: 0.23, 95%CI: 0.11-0.49) when they used the preparation without glycerol compared to the WHO standard formulation (1.45%), and there were no differences between the other formulations used. Conclusion In a tropical climate setting, the WHO-modified EBHR formulation containing 0.5% glycerol led to better ratings of skin tolerance than the original formulation, and, therefore, may offer the best balance between skin tolerance and antimicrobial efficacy.
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Affiliation(s)
- Mayra Gonçalves Menegueti
- Infection Control Service, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Campus Universitário, s/n, Monte Alegre, 14048-900, Ribeirão Preto, São Paulo, Brazil
| | - Ana Maria Laus
- Ribeirão Preto Nursing School, University of São Paul, Ribeirão Preto, Brazil
| | | | - Maria Auxiliadora-Martins
- Intensive Care Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Anibal Basile-Filho
- Intensive Care Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Elucir Gir
- Ribeirão Preto Nursing School, University of São Paul, Ribeirão Preto, Brazil
| | - Daniela Pires
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Fernando Bellissimo-Rodrigues
- Infection Control Service, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Social Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Alsagher MR, Soudah SA, Khsheba AE, Fadel SM, Dadiesh MA, Houme MA, Eshagroni AS, Alosta FF, Almsalaty SM. Hand Washing Before and After Applying Different Hand Hygiene Techniques in Places of Public Concern in Tripoli-Libya. Open Microbiol J 2018. [DOI: 10.2174/1874285801812010364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:Hand hygiene has being considered as one of the primary measures to improve standards and practice for hospital care and to minimize the transmission of nosocomial pathogens. There is substantial evidence that incidence of hospital acquired infections is reduced by applying hand antisepsis. Regarding hand hygiene and public concern, hand washing has revealed that 85% of the observed adults wash their hands after using public toilets.Objective:To compare the efficacy of hand rubbing with an alcohol based solution versus conventional hand washing with antiseptic and non-antiseptic soaps in reducing bacterial counts using different hand hygiene techniques.Methods:Ninety-three volunteers took part in this study; 57 from Tripoli Medical Center (TMC); 16 from school; 11 from bank; and 9 from office. All volunteers performed six hand hygiene techniques, immediately before and after a volunteer practice activity: hand washing with non-antiseptic soap for 10 and 30 second (s); hand washing with antiseptic soap for 10, 30 or 60 s; and alcohol-based hand rub. A total of 864 specimens were taken: 432 before and 432 after volunteer's hand hygiene. The fingertips of the dominant hand for each volunteer were pressed on to agar for culture before and after each hand hygiene technique. Plates were incubated at 37oC, and colony-forming units were counted after 48 hours and pathogenic bacteria were identified.Results:Results showed that 617 specimens (71.41%) were positive for bacterial growth. 301 (48.78%) were from TMC, 118 (19.12%) were from office; 107 (14.34%) were from school and 91 (14.75%) were from bank.Conclusion:Both antiseptic and non–antiseptic soaps did not work properly in reducing bacterial counts of worker’s hands at all places of study, but significantly improved by an application of alcohol based gel.
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Hamnerius N, Svedman C, Bergendorff O, Björk J, Bruze M, Pontén A. Wet work exposure and hand eczema among healthcare workers: a cross-sectional study. Br J Dermatol 2017; 178:452-461. [DOI: 10.1111/bjd.15813] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2017] [Indexed: 01/20/2023]
Affiliation(s)
- N. Hamnerius
- Department of Occupational and Environmental Dermatology; Lund University; Skåne University Hospital; Malmö Sweden
| | - C. Svedman
- Department of Occupational and Environmental Dermatology; Lund University; Skåne University Hospital; Malmö Sweden
| | - O. Bergendorff
- Department of Occupational and Environmental Dermatology; Lund University; Skåne University Hospital; Malmö Sweden
| | - J. Björk
- Department of Occupational and Environmental Medicine; Lund University; Lund Sweden
- Clinical Studies Sweden; Forum South; Skåne University Hospital; Lund Sweden
| | - M. Bruze
- Department of Occupational and Environmental Dermatology; Lund University; Skåne University Hospital; Malmö Sweden
| | - A. Pontén
- Department of Occupational and Environmental Dermatology; Lund University; Skåne University Hospital; Malmö Sweden
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Abstract
Two of the most important skin care categories with profound dermatologic implications are cleansers and moisturizers. Cleansers are composed of alkaline soaps or the less barrier-damaging synthetic detergents, known as syndets. The lower skin irritation and dryness found with syndets are related to their reduced tendency to cause protein denaturation due to the charge density of protein-bound micelle-like surfactant aggregates. Many cleansing formulations are available for purchase to meet hygiene needs varying by sex, age, ethnicity, occupation, environment, personal preferences, and the presence or absence of skin disease. This discussion covers the science of skin cleansing.
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Shen L, Wang X, An J, An J, Zhou N, Sun L, Chen H, Feng L, Han J, Liu X. Implementation of WHO multimodal strategy for improvement of hand hygiene: a quasi-experimental study in a Traditional Chinese Medicine hospital in Xi'an, China. Antimicrob Resist Infect Control 2017; 6:98. [PMID: 28944053 PMCID: PMC5607599 DOI: 10.1186/s13756-017-0254-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/04/2017] [Indexed: 12/27/2022] Open
Abstract
Background Hand hygiene (HH) is an essential component for preventing and controlling of healthcare-associated infection (HAI), whereas compliance with HH among health care workers (HCWs) is frequently poor. This study aimed to assess compliance and correctness with HH before and after the implementation of a multimodal HH improvement strategy launched by the World Health Organization (WHO). Methods A quasi-experimental study design including questionnaire survey generalizing possible factors affecting HH behaviors of HCWs and direct observation method was used to evaluate the effectiveness of WHO multimodal HH strategy in a hospital of Traditional Chinese Medicine. Multimodal HH improvement strategy was drawn up according to the results of questionnaire survey. Compliance and correctness with HH among HCWs were compared before and after intervention. Also HH practices for different indications based on WHO “My Five Moments for Hand Hygiene” were recorded. Results In total, 553 HCWs participated in the questionnaire survey and multimodal HH improvement strategy was developed based on individual, environment and management levels. A total of 5044 observations in 23 wards were recorded in this investigation. The rate of compliance and correctness with HH improved from 66.27% and 47.75% at baseline to 80.53% and 88.35% after intervention. Doctors seemed to have better compliance with HH after intervention (84.04%) than nurses and other HCWs (81.07% and 69.42%, respectively). When stratified by indication, compliance with HH improved for all indications after intervention (P < 0.05) except for “after body fluid exposure risk” and “after touching patient surroundings”. Conclusion Implementing the WHO multimodal HH strategy can significantly improve HH compliance and correctness among HCWs. Electronic supplementary material The online version of this article (10.1186/s13756-017-0254-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Li Shen
- Department of Infection Control, Xi'an Hospital of Traditional Chinese Medicine, No.69 Feng Cheng 8th Road, Weiyang District, Xi'an, 710021 China
| | - Xiaoqing Wang
- Department of Infection Control, Xi'an Hospital of Traditional Chinese Medicine, No.69 Feng Cheng 8th Road, Weiyang District, Xi'an, 710021 China
| | - Junming An
- Department of Acupuncture and Moxibustion, Xi'an Hospital of Traditional Chinese Medicine, No.69 Feng Cheng 8th Road, Weiyang District, Xi'an, 710021 China
| | - Jialu An
- Department of Information Consultation, Library of Xi'an Jiaotong University, No.76 Yan Ta West Road, Yanta District, Xi'an, 710061 China
| | - Ning Zhou
- Department of Infection Control, Xi'an Hospital of Traditional Chinese Medicine, No.69 Feng Cheng 8th Road, Weiyang District, Xi'an, 710021 China
| | - Lu Sun
- Department of Infection Control, Xi'an Hospital of Traditional Chinese Medicine, No.69 Feng Cheng 8th Road, Weiyang District, Xi'an, 710021 China
| | - Hong Chen
- Department of Infection Control, Xi'an Hospital of Traditional Chinese Medicine, No.69 Feng Cheng 8th Road, Weiyang District, Xi'an, 710021 China
| | - Lin Feng
- Department of Cadre Health Care, Xi'an Hospital of Traditional Chinese Medicine, No.69 Feng Cheng 8th Road, Weiyang District, Xi'an, 710021 China
| | - Jing Han
- Department of Information Consultation, Library of Xi'an Jiaotong University, No.76 Yan Ta West Road, Yanta District, Xi'an, 710061 China
| | - Xiaorong Liu
- Department of Information Consultation, Library of Xi'an Jiaotong University, No.76 Yan Ta West Road, Yanta District, Xi'an, 710061 China
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Forer Y, Block C, Frenkel S. Preoperative Hand Decontamination in Ophthalmic Surgery: A Comparison of the Removal of Bacteria from Surgeons' Hands by Routine Antimicrobial Scrub versus an Alcoholic Hand Rub. Curr Eye Res 2017; 42:1333-1337. [PMID: 28557536 DOI: 10.1080/02713683.2017.1304559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The goal of this experiment was to evaluate and compare the antimicrobial efficacy of routine preoperative hand washing using commercial medicated sponge brushes versus an alcoholic hand rub, by comparing bacterial growth on ophthalmic surgeons' hands after application of each of these methods. METHODS Twenty ophthalmic surgeons were recruited at the Hadassah-Hebrew University Medical Center in Jerusalem, Israel. Samples were collected twice from the hands of each surgeon after hand decontamination using two different protocols during routine surgical practice. The routine preparation consisted of a 3-minute surgical scrub using commercial brush-sponges incorporating either 4% chlorhexidine gluconate (CHG) or 1% povidone-iodine (PVP-I) formulations with detergent, followed by drying the hands with a sterile towel, while the 70% ethanol solution was applied for 60-seconds and allowed to air dry. Half of the group was randomly assigned to provide samples first after the routine method and the alcoholic solution a week later, and the other half of the group was sampled in the reverse order. Viable counts of bacteria were evaluated using a modified glove juice method. Bacterial colonies were enumerated after incubation for 24 hours and expressed as colony forming units (CFU)/mL for each pair of hands. RESULTS Geometric mean counts were 1310 and 39 CFU/mL, in the routine and alcohol rub groups, respectively, representing a mean log10 reduction in 1.53. The difference between the paired bacterial counts for the routine versus the alcohol rub was statistically significant (p < 0.0001). There was no statistically significant difference between log10 reductions for CHG and PVP-I (p = 0.97). CONCLUSIONS This study provides evidence that an alcohol rub protocol is more effective in reducing bacterial counts on hands than routine surgical hand preparation with PVP-I and CHG in a population of practicing ophthalmic surgeons in the operative clinical setting. Thus, it provides a safe alternative as a preoperative hand disinfection method.
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Affiliation(s)
- Yaara Forer
- a Department of Ophthalmology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - Colin Block
- b Clinical Microbiology & Infectious Diseases , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - Shahar Frenkel
- a Department of Ophthalmology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
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Ataee RA, Ataee MH, Mehrabi Tavana A, Salesi M. Bacteriological Aspects of Hand Washing: A Key for Health Promotion and Infections Control. Int J Prev Med 2017; 8:16. [PMID: 28382192 PMCID: PMC5364736 DOI: 10.4103/2008-7802.201923] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 01/02/2017] [Indexed: 12/15/2022] Open
Abstract
The aim of this review is to show the historical aspects of hands washing for healthy life and explains how can reduce the transmission of community-acquired infectious agents by healthcare workers and patients. This review article is prepared based on available database. The key words used were hands washing, risk assessment, hands hygiene, bacterial flora, contamination, infection, nosocomial, tap water, sanitizer, bacterial resistance, hands bacterial flora, washing methods, antiseptics, healthcare workers, healthcare personnel, from PubMed, ScienceDirect, Embase, Scopus, Web of Sciences, and Google Scholar. Data were descriptively analyzed. The insistence on hand washing has a history of 1400 years. The research results indicate that the bacteria released from the female washed hands in wet and dry condition was lower than from the male's hands with a significance level (3 CFU vs. 8 CFU; confidence interval 95%, P ≤ 0.001). The valuable results of the study indicated that released amount of bacterial flora from wet hands is more than 10 times in compared to dry hands. In addition, established monitoring systems for washing hands before and after patient's manipulation as well as after toilet were dominant indices to prevent the transfer of infectious agents to the patients. Increasing awareness and belief of the healthcare workers have shown an important role by about 30% reduction in the transfection. Hand washing could reduce the episodes of transmission of infectious agents in both community and healthcare settings. However, hand washing is an important key factor to prevent transmission of infectious agents to patients. There is no standard method for measuring compliance. Thus, permanent monitoring of hand washing to reduce the transmission of infections is crucial. Finally, the personnel must believe that hand washing is an inevitable approach to infection control.
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Affiliation(s)
- Ramezan Ali Ataee
- Department of Medical Microbiology, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mohammad Hosein Ataee
- Applied Microbial Research Center, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Ali Mehrabi Tavana
- Department of Medical Microbiology and Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mahmud Salesi
- Department of Medical Microbiology and Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran
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Munn Z, Tufanaru C, Lockwood C, Stern CJ. Rinse-free hand wash for reducing absenteeism among school- and preschool-aged children. Hippokratia 2017. [DOI: 10.1002/14651858.cd012566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Zachary Munn
- The University of Adelaide; Joanna Briggs Institute, Faculty of Health Sciences; 55 King William Road Adelaide South Australia Australia 5005
| | - Catalin Tufanaru
- The University of Adelaide; Joanna Briggs Institute, Faculty of Health Sciences; 55 King William Road Adelaide South Australia Australia 5005
| | - Craig Lockwood
- The University of Adelaide; Joanna Briggs Institute, Faculty of Health Sciences; 55 King William Road Adelaide South Australia Australia 5005
| | - Cindy J Stern
- The University of Adelaide; Joanna Briggs Institute, Faculty of Health Sciences; 55 King William Road Adelaide South Australia Australia 5005
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Making change easy: A peer-to-peer guide on transitioning to new hand hygiene products. Am J Infect Control 2017; 45:46-50. [PMID: 27544793 DOI: 10.1016/j.ajic.2016.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 11/24/2022]
Abstract
This report summarizes our experiences planning and implementing the transition to a new commercial line of hand hygiene products and their dispensing systems in a large academic health care facility in Toronto, Canada. Our lessons learned are organized into a practical guide made available in 2 different formats: this article and an illustrated peer-to-peer guide (http://www.baycrest.org/wp-content/uploads/HCE-PROG-HH_HighQuality.pdf).
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Frequency of Use of Alcohol-Based Hand Rubs by Nurses: A Systematic Review. Infect Control Hosp Epidemiol 2016; 38:189-195. [DOI: 10.1017/ice.2016.247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUNDRecently, the US Food and Drug Administration requested that a “maximal use” trial be conducted to ensure the safety of frequent use of alcohol-based hand rubs (ABHRs) by healthcare workers.OBJECTIVETo establish how frequently volunteers should be exposed to ABHR during a maximal use trial.DESIGNRetrospective review of literature and analysis of 2 recent studies that utilized hand hygiene electronic compliance monitoring (ECM) systems.METHODSWe reviewed PubMed for articles published between 1970 and December 31, 2015, containing the terms hand washing, hand hygiene, hand hygiene compliance, and alcohol-based hand rubs. Article titles, abstracts, or text were reviewed to determine whether the frequency of ABHR use by healthcare workers was reported. Two studies using hand hygiene ECM systems were reviewed to determine how frequently nurses used ABHR per shift and per hour.RESULTSOf 3,487 citations reviewed, only 10 reported how frequently individual healthcare workers used ABHR per shift or per hour. Very conservative estimates of the frequency of ABHR use were reported owing to shortcomings of the methods utilized. The greatest frequency of ABHR use was recorded by an ECM system in a medical intensive care unit. In 95% of nursing shifts, individual nurses used ABHR 141 times or less per shift, and 15 times or less per hour.CONCLUSIONSHand hygiene ECM systems established that the frequency of exposure to ABHRs varies substantially among nurses. Our findings should be useful in designing how frequently individuals should be exposed to ABHR during a maximal use trial.Infect Control Hosp Epidemiol 2017;38:189–195
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Hines J, Wilkinson SM, John SM, Diepgen TL, English J, Rustemeyer T, Wassilew S, Kezic S, Maibach HI. The three moments of skin cream application: an evidence-based proposal for use of skin creams in the prevention of irritant contact dermatitis in the workplace. J Eur Acad Dermatol Venereol 2016; 31:53-64. [PMID: 27545662 PMCID: PMC5434821 DOI: 10.1111/jdv.13851] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/08/2016] [Indexed: 11/29/2022]
Abstract
Contact dermatitis is one of the most common occupational diseases, with serious impact on quality of life, lost days at work and a condition that may be chronically relapsing. Regular prophylactic skin cream application is widely acknowledged to be an effective prevention strategy against occupational contact dermatitis; however, compliance rates remain low. To present a simple programme for skin cream application in the workplace with focus on implementation to drive down the rate of occupational irritant contact dermatitis, an expert panel of eight international dermatologists combined personal experience with extensive literature review. The recommendations are based on clinical experience as supported by evidence-based data from interventional studies. The authors identified three moments for skin cream application in the work place: (i) before starting a work period; (ii) after washing hands; and (iii) after work. Affecting behaviour change requires systematic communications, monitoring and reporting, which is proposed through Kotter's principles of organizational change management. Measurement tools are provided in the appendix. Interventional data based on application of this proposal is required to demonstrate its effectiveness.
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Affiliation(s)
- J Hines
- Deb Group Ltd., Research & Development, Denby, Derbyshire, UK
| | | | - S M John
- Department of Dermatology, Environmental Medicine, Health Theory, University of Osnabrueck, Osnabrueck, Germany
| | - T L Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Heidelberg, Germany
| | - J English
- Nottingham NHS Treatment Center, Nottingham, UK
| | - T Rustemeyer
- Department of Dermatology and Allergology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - S Wassilew
- Hautarztzentrum Krefeld, Krefeld, Germany
| | - S Kezic
- Coronel Institute of Occupational Health, Academic Medical Centre, Amsterdam, The Netherlands
| | - H I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
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Lai KK, Fontecchio S, Melvin Z, Baker SP. Impact of Alcohol-Based, Waterless Hand Antiseptic on the Incidence of Infection and Colonization With Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococci. Infect Control Hosp Epidemiol 2016; 27:1018-24. [PMID: 17006807 DOI: 10.1086/507916] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2006] [Indexed: 11/03/2022]
Abstract
Objective:Colonized and infected inpatients are major reservoirs for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), and transient carriage of these pathogens on the hands of healthcare workers remains the most common mechanism of patient-to-patient transmission. We hypothesized that use of alcohol-based, waterless hand antiseptic would lower the incidence of colonization and/or infection with MRSA and VRE.Methods.On June 19, 2001, alcohol hand antiseptic was introduced at the University campus and not the nearby Memorial campus of the University of Massachusetts Medical School (Worcester, MA), allowing us to evaluate the impact of this antiseptic on the incidence of MRSA and VRE colonization and infection. From January 1 through December 31, 2001, the incidence of MRSA colonization or infection was compared between the 2 campuses before and after the hand antiseptic was introduced. Its effect on VRE colonization and infection was only studied in the medical intensive care unit at the University campus.Results.At the University campus, the incidence of MRSA colonization or infection decreased from 1.26 cases/1,000 patient-days before the intervention to 0.75 cases/1,000 patient-days after the intervention, for a 1.46-fold decrease (95% confidence interval, 1.04-2.58; P = .037). At the Memorial campus, the incidence of MRSA colonization or infection remained virtually unchanged, from 0.34 cases/1,000 patient-days to 0.49 cases/1,000 patient-days during the same period. However, a separate analysis of the University campus data that controlled for proximity to prevalent cases did not show a significant improvement in the rates of infection or colonization. The incidence of nosocomial VRE colonization or infection before and after the hand antiseptic decreased from 12.0 cases/1,000 patient-days to 3.0 cases/1,000 patient-days, a 2.25-fold decrease (P = .018). Compliance with rectal surveillance for detection of VRE was 86% before and 84% after implementation of the hand antiseptic intervention. The prevalences of VRE cases during these 2 periods were 25% and 29%, respectively (P = .017).Conclusions.Alcohol hand antiseptic appears to be effective in controlling the transmission of VRE. However, after controlling for proximity to prevalent cases (ie, for clustering), it does not appear to be more effective than standard methods for controlling MRSA. Further controlled studies are needed to evaluate its effectiveness.
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Affiliation(s)
- Kwan Kew Lai
- University of Massachusetts Medical School, Worcester, MA, USA.
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Gordin FM, Schultz ME, Huber RA, Gill JA. Reduction in Nosocomial Transmission of Drug-Resistant Bacteria After Introduction of an Alcohol-Based Handrub. Infect Control Hosp Epidemiol 2016; 26:650-3. [PMID: 16092747 DOI: 10.1086/502596] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To assess quantitatively the clinical impact of using an alcohol-based handrub (ABHR) in the hospital environment, measuring impact as the incidence of new, nosocomial isolates of drug-resistant organisms.Design:An observational survey from 1998 to 2003 comparing the first 3 years of no ABHR use with the 3 years following, when an ABHR was provided for hand hygiene.Setting:An inner-city, tertiary-care medical center.Intervention:At baseline, an antimicrobial soap with 0.3% triclosan was provided for staff hand hygiene. The intervention was placement in all inpatient and all outpatient clinic rooms of wall-mounted dispensers of an ABHR with 62.5% ethyl alcohol. Data were collected on change in the incidence of three drug-resistant bacteria.Results:During the 6 years of the survey, all new, nosocomially acquired isolates of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Clostridium difficile-associated diarrhea were recorded. On comparison of the first 3 years with the final 3 years, there was a 21% decrease in new, nosocomially acquired MRSA (90 to 71 isolates per year; P = .01) and a 41% decrease in VRE (41 to 24 isolates per year; P < .001). The incidence of new isolates of C. difficile was essentially unchanged.Conclusion:In the 3 years following implementation of an ABHR, this hospital experienced the value of reductions in the incidence of nosocomially acquired drug-resistant bacteria. These reductions provide clinical validation of the recent CDC recommendation that ABHRs be the primary choice for hand decontamination. (Infect Control Hosp Epidemiol 2005;26:650-653)
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Affiliation(s)
- Fred M Gordin
- Veterans Affairs Medical Center, Washington, DC 20422, USA.
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Alp E, Haverkate D, Voss A. Hand Hygiene Among Laboratory Workers. Infect Control Hosp Epidemiol 2016; 27:978-80. [PMID: 16941327 DOI: 10.1086/506404] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Accepted: 04/18/2005] [Indexed: 11/03/2022]
Abstract
We performed a study to measure the compliance of laboratory personnel with different components of hand hygiene. The level of compliance at the end of duty was 100%; however, 36.7% of subjects wore a ring, 46.9% wore a watch, and 6.1% wore a bracelet. Pathogenic microorganisms were exclusively found on hands of laboratory personnel who wore jewelry. After interventions, the level of compliance with the no-jewelry policy among laboratory personnel showed sustained improvement. Efforts to improve hand hygiene should be directed not only at healthcare workers but also at laboratory personnel.
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Affiliation(s)
- Emine Alp
- Department of Clinical Microbiology and Infectious Disease, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Liu LQ, Mehigan S. The Effects of Surgical Hand Scrubbing Protocols on Skin Integrity and Surgical Site Infection Rates: A Systematic Review. AORN J 2016; 103:468-82. [PMID: 27129749 DOI: 10.1016/j.aorn.2016.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/28/2015] [Accepted: 03/03/2016] [Indexed: 11/15/2022]
Abstract
This systematic review aimed to critically appraise and synthesize updated evidence regarding the effect of surgical-scrub techniques on skin integrity and the incidence of surgical site infections. Databases searched include the Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Embase, and Cochrane Central. Our review was limited to eight peer-reviewed, randomized controlled trials and two nonrandomized controlled trials published in English from 1990 to 2015. Comparison models included traditional hand scrubbing with chlorhexidine gluconate or povidone-iodine against alcohol-based hand rubbing, scrubbing with a brush versus without a brush, and detergent-based antiseptics alone versus antiseptics incorporating alcohol solutions. Evidence showed that hand rubbing techniques are as effective as traditional scrubbing and seem to be better tolerated. Hand rubbing appears to cause less skin damage than traditional scrub protocols, and scrub personnel tolerated brushless techniques better than scrubbing using a brush.
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Abstract
BACKGROUND Medical professionals routinely carry out surgical hand antisepsis before undertaking invasive procedures to destroy transient micro-organisms and inhibit the growth of resident micro-organisms. Antisepsis may reduce the risk of surgical site infections (SSIs) in patients. OBJECTIVES To assess the effects of surgical hand antisepsis on preventing surgical site infections (SSIs) in patients treated in any setting. The secondary objective is to determine the effects of surgical hand antisepsis on the numbers of colony-forming units (CFUs) of bacteria on the hands of the surgical team. SEARCH METHODS In June 2015 for this update, we searched: The Cochrane Wounds Group Specialized Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations) and EBSCO CINAHL. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA Randomised controlled trials comparing surgical hand antisepsis of varying duration, methods and antiseptic solutions. DATA COLLECTION AND ANALYSIS Three authors independently assessed studies for inclusion and trial quality and extracted data. MAIN RESULTS Fourteen trials were included in the updated review. Four trials reported the primary outcome, rates of SSIs, while 10 trials reported number of CFUs but not SSI rates. In general studies were small, and some did not present data or analyses that could be easily interpreted or related to clinical outcomes. These factors reduced the quality of the evidence. SSIsOne study randomised 3317 participants to basic hand hygiene (soap and water) versus an alcohol rub plus additional hydrogen peroxide. There was no clear evidence of a difference in the risk of SSI (risk ratio (RR) 0.97, 95% CI 0.77 to 1.23, moderate quality evidence downgraded for imprecision).One study (500 participants) compared alcohol-only rub versus an aqueous scrub and found no clear evidence of a difference in the risk of SSI (RR 0.56, 95% CI 0.23 to 1.34, very low quality evidence downgraded for imprecision and risk of bias).One study (4387 participants) compared alcohol rubs with additional active ingredients versus aqueous scrubs and found no clear evidence of a difference in SSI (RR 1.02, 95% CI 0.70 to 1.48, low quality evidence downgraded for imprecision and risk of bias).One study (100 participants) compared an alcohol rub with an additional ingredient versus an aqueous scrub with a brush and found no evidence of a difference in SSI (RR 0.50, 95% CI 0.05 to 5.34, low quality evidence downgraded for imprecision). CFUsThe review presents results for a number of comparisons; key findings include the following.Four studies compared different aqueous scrubs in reducing CFUs on hands.Three studies found chlorhexidine gluconate scrubs resulted in fewer CFUs than povidone iodine scrubs immediately after scrubbing, 2 hours after the initial scrub and 2 hours after subsequent scrubbing. All evidence was low or very low quality, with downgrading typically for imprecision and indirectness of outcome. One trial comparing a chlorhexidine gluconate scrub versus a povidone iodine plus triclosan scrub found no clear evidence of a difference-this was very low quality evidence (downgraded for risk of bias, imprecision and indirectness of outcome).Four studies compared aqueous scrubs versus alcohol rubs containing additional active ingredients and reported CFUs. In three comparisons there was evidence of fewer CFUs after using alcohol rubs with additional active ingredients (moderate or very low quality evidence downgraded for imprecision and indirectness of outcome). Evidence from one study suggested that an aqueous scrub was more effective in reducing CFUs than an alcohol rub containing additional ingredients, but this was very low quality evidence downgraded for imprecision and indirectness of outcome.Evidence for the effectiveness of different scrub durations varied. Four studies compared the effect of different durations of scrubs and rubs on the number of CFUs on hands. There was evidence that a 3 minute scrub reduced the number of CFUs compared with a 2 minute scrub (very low quality evidence downgraded for imprecision and indirectness of outcome). Data on other comparisons were not consistent, and interpretation was difficult. All further evidence was low or very low quality (typically downgraded for imprecision and indirectness).One study compared the effectiveness of using nail brushes and nail picks under running water prior to a chlorhexidine scrub on the number of CFUs on hands. It was unclear whether there was a difference in the effectiveness of these different techniques in terms of the number of CFUs remaining on hands (very low quality evidence downgraded due to imprecision and indirectness). AUTHORS' CONCLUSIONS There is no firm evidence that one type of hand antisepsis is better than another in reducing SSIs. Chlorhexidine gluconate scrubs may reduce the number of CFUs on hands compared with povidone iodine scrubs; however, the clinical relevance of this surrogate outcome is unclear. Alcohol rubs with additional antiseptic ingredients may reduce CFUs compared with aqueous scrubs. With regard to duration of hand antisepsis, a 3 minute initial scrub reduced CFUs on the hand compared with a 2 minute scrub, but this was very low quality evidence, and findings about a longer initial scrub and subsequent scrub durations are not consistent. It is unclear whether nail picks and brushes have a differential impact on the number of CFUs remaining on the hand. Generally, almost all evidence available to inform decisions about hand antisepsis approaches that were explored here were informed by low or very low quality evidence.
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Affiliation(s)
- Judith Tanner
- University of NottinghamSchool of Health SciencesQueens Medical CentreNottinghamUKNG7 2HA
| | - Jo C Dumville
- University of ManchesterSchool of Nursing, Midwifery and Social WorkManchesterUKM13 9PL
| | - Gill Norman
- University of ManchesterSchool of Nursing, Midwifery and Social WorkManchesterUKM13 9PL
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Liu X, German G. The effects of barrier disruption and moisturization on the dynamic drying mechanics of human stratum corneum. J Mech Behav Biomed Mater 2015; 49:80-9. [DOI: 10.1016/j.jmbbm.2015.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/14/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
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Factors influencing field testing of alcohol-based hand rubs. Infect Control Hosp Epidemiol 2015; 36:302-10. [PMID: 25695172 DOI: 10.1017/ice.2014.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND According to the World Health Organization guidelines, field tests, in the context of a bid for the supply of alcohol-based hand rubs, should take into account climatic region, test period, products already in use, and type of use (hygienic or surgical) when assessing tolerance. This laborious method is often contested. OBJECTIVE To conduct a post hoc analysis of the data of a large bid, including 5 factors, to validate the relevance of their inclusion. METHODS For the purposes of the bid, products were compared in terms of the 4 World Health Organization tolerance criteria (appearance, intactness, moisture content, sensation) during product testing and were separated into groups on the basis of the studied factors. The post hoc analysis method included (1) comparison of the mean before-and-after difference based on the self-evaluation of the skin with the 4 World Health Organization tolerance criteria, between climatic regions, periods, products in use, test product, and the type of use; (2) generalized linear models, taking into account all studied factors. RESULTS The analysis included data for 1,925 pairs of professionals. The means of the differences observed were independently and significantly associated with the test period (P<.001), the hygienic or surgical use (P=.010 to .041, not significant for appearance), the product already in use (significant for appearance P=.021), and the test product (P<.001). The association with climatic region was found to be significant only in the nonadjusted analysis. CONCLUSION The type of use, the test period, and the product in use should be taken into account when designing field tests of alcohol-based hand rubs.
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Trick WE, Vernon MO, Welbel SF, Demarais P, Hayden MK, Weinstein RA. Multicenter Intervention Program to Increase Adherence to Hand Hygiene Recommendations and Glove Use and to Reduce the Incidence of Antimicrobial Resistance. Infect Control Hosp Epidemiol 2015; 28:42-9. [PMID: 17230386 DOI: 10.1086/510809] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2006] [Accepted: 05/01/2006] [Indexed: 11/03/2022]
Abstract
Objective.To determine whether a multimodal intervention could improve adherence to hand hygiene and glove use recommendations and decrease the incidence of antimicrobial resistance in different types of healthcare facilities.Design.Prospective, observational study performed from October 1, 1999, through December 31, 2002. We monitored adherence to hand hygiene and glove use recommendations and the incidence of antimicrobial-resistant bacteria among isolates from clinical cultures. We evaluated trends in and predictors for adherence and preferential use of alcohol-based hand rubs, using multivariable analyses.Setting.Three intervention hospitals (a 660-bed acute and long-term care hospital, a 120-bed community hospital, and a 600-bed public teaching hospital) and a control hospital (a 700-bed university teaching hospital).Intervention.At the intervention hospitals, we introduced or increased the availability of alcohol-based hand rub, initiated an interactive education program, and developed a poster campaign; at the control hospital, we only increased the availability of alcohol-based hand rub.Results.We observed 6,948 hand hygiene opportunities. The frequency of hand hygiene performance or glove use significantly increased during the study period at the intervention hospitals but not at the control hospital; the maximum quarterly frequency of hand hygiene performance or glove use at intervention hospitals (74%, 80%, and 77%) was higher than that at the control hospital (59%). By multivariable analysis, preferential use of alcohol-based hand rubs rather than soap and water for hand hygiene was more likely among workers at intervention hospitals compared with nonintervention hospitals (adjusted odds ratio, 4.6 [95% confidence interval, 3.3-6.4]) and more likely among physicians (adjusted odds ratio, 1.4 [95% confidence interval, 1.2-1.8]) than among nurses at intervention hospitals. A significantly reduced incidence of antimicrobial-resistant bacteria among isolates from clinical culture was found at a single intervention hospital, which had the greatest increase in the frequency of hand hygiene performance.Conclusions.During a 3-year period, a multimodal intervention program increased adherence to hand hygiene recommendations, especially to the use of alcohol-based hand rubs. In one hospital, a concomitant reduction was found in the incidence of antimicrobial-resistant bacteria among isolates from clinical cultures.
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Affiliation(s)
- William E Trick
- Collaborative Research Unit, Department of Medicine, Stroger Hospital of Cook County, Chicago, IL 60612, USA.
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Abstract
Background:Although many catheter-related blood-stream infections (CRBSIs) are preventable, measures to reduce these infections are not uniformly implemented.Objective:To update an existing evidenced-based guideline that promotes strategies to prevent CRBSIs.Data Sources:The MEDLINE database, conference proceedings, and bibliographies of review articles and book chapters were searched for relevant articles.Studies Included:Laboratory-based studies, controlled clinical trials, prospective interventional trials, and epidemiologic investigations.Outcome Measures:Reduction in CRBSI, catheter colonization, or catheter-related infection.Synthesis:The recommended preventive strategies with the strongest supportive evidence are education and training of healthcare providers who insert and maintain catheters; maximal sterile barrier precautions during central venous catheter insertion; use of a 2% chlorhexidine preparation for skin antisepsis; no routine replacement of central venous catheters for prevention of infection; and use of antiseptic/antibiotic-impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (ie, education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis).Conclusion:Successful implementation of these evidence-based interventions can reduce the risk for serious catheter-related infection.
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Jeong I, Park S, Jeong JS, Kim DS, Choi YS, Lee YS, Park YM. Comparison of Catheter-associated Urinary Tract Infection Rates by Perineal Care Agents in Intensive Care Units. Asian Nurs Res (Korean Soc Nurs Sci) 2014; 4:142-50. [PMID: 25031095 DOI: 10.1016/s1976-1317(10)60014-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 05/19/2010] [Accepted: 08/30/2010] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study compared the catheter-associated urinary tract infection (CAUTI) rates resulting from the use of four perineal care agents (soap-and-water, skin cleansing foam, 10% povidone-iodine, and normal saline) among patients in intensive care units (ICUs). METHODS This four-group experimental study was done with 97 adult patients who had urinary catheters over 2 days in three ICUs between April and July 2008. The patients received one of the four types of perineal care. Data collected included the incidence of CAUTI at baseline (prior to perineal care) and 1 week, 2 weeks, and 4 weeks after beginning perineal care. Patients were divided into UTI and non-UTI groups based on the Centers for Disease Control and Prevention/National Healthcare Safety Network UTI definition to calculate incidence rates. The hazard ratio (HR) and 95% confidence intervals were calculated by Cox's proportional hazard analysis. RESULTS The cumulative incidence of CAUTIs per 100 urinary catheter days were 3.18 episodes during 1 week with urinary catheter, 3.31 during 2 weeks, and 3.04 during 4 weeks. No statistically significant difference in hazard ratios of CAUTIs for each perineal care agent was evident with reference to soap-and-water at 1 week, 2 weeks, and 4 weeks after beginning perineal care after controlling for age, use of antibiotics, fecal incontinence, consciousness level, fever, and diabetes. CONCLUSIONS The type of perineal care does not influence the incidence of CAUTIs. Further confirmatory studies with a larger patient population should be conducted, as well as determining perineal agent preference.
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Affiliation(s)
- Ihnsook Jeong
- Associate Professor, College of Nursing, Pusan National University, Busan, Korea
| | - Soonmi Park
- Team Manager, Department of Nursing, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jae Sim Jeong
- Associate Professor, Department of Clinical Nursing, University of Ulsan, Seoul, Korea
| | - Duck Sun Kim
- Team Manager, Department of Nursing, Pusan National University Hospital, Busan, Korea
| | - Young Sun Choi
- Unit Manager, Department of Nursing, Pusan National University Hospital, Busan, Korea
| | - Young Soon Lee
- Team Manager, Department of Nursing, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Young Mi Park
- Unit Manager, Department of Nursing, Pusan National University Hospital, Busan, Korea
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Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A, Bak A, Browne J, Prieto J, Wilcox M, UK Department of Health. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2014; 86 Suppl 1:S1-70. [PMID: 24330862 PMCID: PMC7114876 DOI: 10.1016/s0195-6701(13)60012-2] [Citation(s) in RCA: 671] [Impact Index Per Article: 67.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were originally commissioned by the Department of Health and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were first published in January 2001(1) and updated in 2007.(2) A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective for the prevention of HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. The Department of Health commissioned a review of new evidence and we have updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the epic2 guidelines published in 2007 remain robust, relevant and appropriate, but some guideline recommendations required adjustments to enhance clarity and a number of new recommendations were required. These have been clearly identified in the text. In addition, the synopses of evidence underpinning the guideline recommendations have been updated. These guidelines (epic3) provide comprehensive recommendations for preventing HCAI in hospital and other acute care settings based on the best currently available evidence. National evidence-based guidelines are broad principles of best practice that need to be integrated into local practice guidelines and audited to reduce variation in practice and maintain patient safety. Clinically effective infection prevention and control practice is an essential feature of patient protection. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and the risk of patients acquiring an infection during episodes of health care in NHS hospitals in England can be minimised.
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Affiliation(s)
- H P Loveday
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London).
| | - J A Wilson
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - R J Pratt
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - M Golsorkhi
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - A Tingle
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - A Bak
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - J Browne
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - J Prieto
- Faculty of Health Sciences, University of Southampton (Southampton)
| | - M Wilcox
- Microbiology and Infection Control, Leeds Teaching Hospitals and University of Leeds (Leeds)
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German G, Pashkovski E, Dufresne E. Surfactant treatments influence drying mechanics in human stratum corneum. J Biomech 2013; 46:2145-51. [DOI: 10.1016/j.jbiomech.2013.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 06/10/2013] [Accepted: 07/01/2013] [Indexed: 11/29/2022]
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Chen LK, Liu YL, Hu A, Chang KC, Lin NT, Lai MJ, Tseng CC. Potential of bacteriophage ΦAB2 as an environmental biocontrol agent for the control of multidrug-resistant Acinetobacter baumannii. BMC Microbiol 2013; 13:154. [PMID: 23834712 PMCID: PMC3710471 DOI: 10.1186/1471-2180-13-154] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 07/02/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Multidrug-resistant Acinetobacter baumannii (MDRAB) is associated with nosocomial infections worldwide. To date, the use of a phage to prevent infections caused by MDRAB has not been demonstrated. RESULTS The MDRAB-specific phage ϕAB2 was stable at 4°C and pH 7 in 0.5% chloroform solution, and showed a slight decrease in plaque-forming units (PFU)/ml of 0.3-0.9 log after 330 days of storage. The addition of ϕAB2 at a concentration of at least 10⁵ PFU/ml to an A. baumannii M3237 suspension killed >99.9% of A. baumannii M3237 after 5 min, regardless of A. baumannii M3237 concentration (10⁴, 10⁵, or 10⁶ colony-forming units (CFU)/ml). The addition of ϕAB2 at a concentration of 10⁸ PFU/slide (>10⁷ PFU/cm²) to glass slides containing A. baumannii M3237 at 10⁴, 10⁵, or 10⁶ CFU/slide, significantly reduced bacterial numbers by 93%, 97%, and 99%, respectively. Thus, this concentration is recommended for decontamination of glass surfaces. Moreover, infusion of ϕAB2 into 10% glycerol exhibited strong anti-MDRAB activity (99.9% reduction), even after 90 days of storage. Treatment of a 10% paraffin oil-based lotion with ϕAB2 significantly reduced (99%) A. baumannii M3237 after 1 day of storage. However, ϕAB2 had no activity in the lotion after 1 month of storage. CONCLUSIONS Phages may be useful for reducing MDRAB contamination in liquid suspensions or on hard surfaces. Phages may also be inoculated into a solution to produce an antiseptic hand wash. However, the phage concentration and incubation time (the duration of phage contact with bacteria) should be carefully considered to reduce the risk of MDRAB contamination.
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Affiliation(s)
- Li-Kuang Chen
- Institute of Medical Sciences, Department of Laboratory Diagnostics, College of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Laboratory Medicine, Clinical Pathology, Emerging Infectious Pathogen Research Laboratory, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Yu-Lin Liu
- Department and Graduate Institute of Public Health, Tzu Chi University, Hualien, Taiwan
| | - Anren Hu
- Department of Laboratory Medicine and Biotechnology, Tzu Chi University, Hualien, Taiwan
| | - Kai-Chih Chang
- Department of Laboratory Medicine and Biotechnology, Tzu Chi University, Hualien, Taiwan
| | - Nien-Tsung Lin
- Master Program, Microbiology, Immunology, and Biochemistry, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Meng-Jiun Lai
- Department of Laboratory Medicine and Biotechnology, Tzu Chi University, Hualien, Taiwan
| | - Chun-Chieh Tseng
- Department and Graduate Institute of Public Health, Tzu Chi University, Hualien, Taiwan
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Suchomel M, Rotter M, Weinlich M, Kundi M. Glycerol significantly decreases the three hour efficacy of alcohol-based surgical hand rubs. J Hosp Infect 2013; 83:284-7. [PMID: 23433581 DOI: 10.1016/j.jhin.2012.11.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 11/30/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Glycerol in alcohol-based hand rubs has positive effects on skin condition and user acceptability, but, to the authors' knowledge, its effect on the bactericidal effect of alcohol-based pre-operative hand rubs has not been reported. AIM To investigate the impact of glycerol on the reduction of resident hand flora by ethanol 80% (w/w), isopropanol 75% (w/w) and n-propanol 60% (V/V). METHODS In three series of in-vivo laboratory tests on volunteers hands, the efficacy of each of three alcohol-based formulations was tested concurrently with and without added glycerol 1.45% (V/V) according to European Norm EN 12791 for testing pre-operative hand rubs. Formulations were allotted at random to 24 volunteers to rub on to their hands for 3 min. Viable counts from fingertip samples were compared with the respective pretreatment counts immediately after treatment and 3 h later. FINDINGS The 3-h bactericidal effects of the three pure alcoholic formulations were significantly greater than those of formulations containing glycerol (P < 0.01). With ethanol, this was also true for the immediate effect. CONCLUSION Glycerol 1.45% (V/V) inhibits the bactericidal efficacy of alcohol-based surgical hand rubs, especially sustained efficacy.
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Affiliation(s)
- M Suchomel
- Institute of Hygiene and Applied Immunology, Medical University of Vienna, Vienna, Austria.
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