1
|
de Witt Huberts J, Greenland K, Schmidt WP, Curtis V. Exploring the potential of antimicrobial hand hygiene products in reducing the infectious burden in low-income countries: An integrative review. Am J Infect Control 2016; 44:764-71. [PMID: 27061254 DOI: 10.1016/j.ajic.2016.01.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/25/2016] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The purpose of this review was to understand whether adding antimicrobial agents to hand hygiene products could increase the health benefits of handwashing with plain soap (HWWS) in low-income settings. METHODS A review of experimental studies comparing the effects of HWWS with antimicrobial soap and waterless hand sanitizer on health and hand contamination in naturalistic conditions was conducted. In addition, an analysis was completed of the evidence from laboratory studies examining the factors that may affect the impact of antimicrobial soap, taking into account the conditions in low-income settings. RESULTS The review found no evidence for a superior effect of antimicrobial products compared with HWWS on disease incidence and limited evidence for an effect on hand contamination under naturalistic conditions. An analysis of the effectiveness of antimicrobial soap in laboratory settings suggested that it was only more effective than HWWS when handwashing frequency, duration, and product concentrations were above levels that could be expected in low-income settings. CONCLUSIONS The limited available evidence suggests that under naturalistic conditions, antimicrobial products are no more effective than HWWS in removing pathogens from hands. Without significant improvement in efficacy, antimicrobial products are unlikely to produce greater health gains than HWWS in low-income settings.
Collapse
|
2
|
|
3
|
Duggan JM, Hensley S, Khuder S, Papadimos TJ, Jacobs L. Inverse Correlation Between Level of Professional Education and Rate of Handwashing Compliance in a Teaching Hospital. Infect Control Hosp Epidemiol 2015; 29:534-8. [DOI: 10.1086/588164] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.To evaluate educational level as a contributing factor in handwashing compliance.Design.Observation of hand washing opportunities was performed for approximately 12 weeks before an announced Joint Commission on Accreditation of Healthcare Organizations (JCAHO) visit and for approximately 10 weeks after the visit. Trained observers recorded the date, time, and location of the observation; the type of healthcare worker or hospital employee observed; and the type of hand hygiene opportunity observed.Setting.University of Toledo Medical Center, a 319-bed teaching hospital.Results.A total of 2,373 observations were performed. The rate of hand washing compliance among nurses was 91.3% overall. Medical attending physicians had the lowest observed rate of compliance (72.4%; P < .001). Nurses showed statistically significant improvement in their rate of hand hygiene compliance after the JCAHO visit (P = .001), but no improvement was seen for attending physicians (P = .117). The compliance rate in the surgical intensive care unit was more than 90%, greater than that in other hospital units (P = .001). Statistically, the compliance rate was better during the first part of the week (Monday, Tuesday, and Wednesday) than during the latter part of the week (Thursday and Friday) (P = .002), and the compliance rate was better during the 3 PM-1 1 PM shift, compared with the 7 AM-3 PM shift (P < .001). When evaluated by logistic regression analysis, non-physician healthcare worker status and observation after the JCAHO accreditation visit were associated with an increased rate of hand hygiene compliance.Conclusion.An inverse correlation existed between the level of professional educational and the rate of compliance. Future research initiatives may need to address the different motivating factors for hand hygiene among nurses and physicians to increase compliance.
Collapse
|
4
|
Macias JH, Arreguin V, Munoz JM, Alvarez JA, Mosqueda JL, Macias AE. Chlorhexidine is a better antiseptic than povidone iodine and sodium hypochlorite because of its substantive effect. Am J Infect Control 2013; 41:634-7. [PMID: 23380379 DOI: 10.1016/j.ajic.2012.10.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 10/02/2012] [Accepted: 10/02/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The present study compared both the antiseptic efficacy of sodium hypochlorite against that of chlorhexidine gluconate in isopropyl alcohol and the substantive effect of chlorhexidine, povidone iodine, and sodium hypochlorite. METHODS This was a 2-step study that included volunteers. In step 1, 4 skin areas were tested for bacteria in colony-forming units (CFU): 2 were controls to determine baseline bacteria or the effect of scrubbing, and 2 were treated with 10% hypochlorite or 2% chlorhexidine in isopropyl alcohol. Every subject was tested 4 times. The second step tested the substantive effect of 10% povidone-iodine and the aforementioned antiseptics. RESULTS For the first step, 30 volunteers were studied, resulting in 120 determinations for each control and antiseptic. No differences between chlorhexidine gluconate (median 115 CFU/cm(2)) and sodium hypochlorite (median 115 CFU/cm(2)) were found. Both antiseptics were significantly different from rubbing control (317 CFU/cm(2)) and basal control (606 CFU/cm(2)). Only chlorhexidine showed a substantive effect. CONCLUSION We consider that chlorhexidine gluconate in isopropyl alcohol, sodium hypochlorite, and povidone-iodine is equally effective for procedures that do not require a long action. However, chlorhexidine is desirable for procedures such as catheter insertion, skin preparation for surgery, or handwashing prior to surgery.
Collapse
Affiliation(s)
- Juan H Macias
- University of Guanajuato, Leon Guanajuato, Mexico City, Mexico.
| | | | | | | | | | | |
Collapse
|
5
|
Fang JL, Stingley RL, Beland FA, Harrouk W, Lumpkins DL, Howard P. Occurrence, efficacy, metabolism, and toxicity of triclosan. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART C, ENVIRONMENTAL CARCINOGENESIS & ECOTOXICOLOGY REVIEWS 2010; 28:147-71. [PMID: 20859822 DOI: 10.1080/10590501.2010.504978] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Triclosan has broad-spectrum anti-microbial activity against most gram-negative and gram-positive bacteria. It is widely used in personal care products, household items, medical devices, and clinical settings. Due to its extensive use, there is potential for humans in all age groups to receive life-time exposures to triclosan, and, indeed, triclosan has been detected in human tissues and the environment. Data gaps exist regarding the chronic dermal toxicity and carcinogenicity of triclosan, which is needed for the risk assessment of triclosan. The US Food and Drug Administration (FDA) nominated triclosan to the National Toxicology Program (NTP) for toxicological evaluations. Currently, the NTP is conducting several dermal toxicological studies to determine the carcinogenic potential of triclosan, evaluate its endocrine and developmental-reproductive effects, and investigate the potential UV-induced dermal formation of chlorinated phenols and dioxins of triclosan. This paper reviews data on the human exposure, environmental fate, efficacy of anti-microbial activity, absorption, distribution, metabolism and elimination, endocrine disrupting effects, and toxicity of triclosan.
Collapse
Affiliation(s)
- Jia-Long Fang
- National Center for Toxicological Research, Food and Drug Administration, Jefferson, AR 72079, USA.
| | | | | | | | | | | |
Collapse
|
6
|
Aiello AE, Larson EL, Levy SB. Consumer antibacterial soaps: effective or just risky? Clin Infect Dis 2007; 45 Suppl 2:S137-47. [PMID: 17683018 DOI: 10.1086/519255] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Much has been written recently about the potential hazards versus benefits of antibacterial (biocide)-containing soaps. The purpose of this systematic literature review was to assess the studies that have examined the efficacy of products containing triclosan, compared with that of plain soap, in the community setting, as well as to evaluate findings that address potential hazards of this use--namely, the emergence of antibiotic-resistant bacteria. METHODS The PubMed database was searched for English-language articles, using relevant keyword combinations for articles published between 1980 and 2006. Twenty-seven studies were eventually identified as being relevant to the review. RESULTS Soaps containing triclosan within the range of concentrations commonly used in the community setting (0.1%-0.45% wt/vol) were no more effective than plain soap at preventing infectious illness symptoms and reducing bacterial levels on the hands. Several laboratory studies demonstrated evidence of triclosan-adapted cross-resistance to antibiotics among different species of bacteria. CONCLUSIONS The lack of an additional health benefit associated with the use of triclosan-containing consumer soaps over regular soap, coupled with laboratory data demonstrating a potential risk of selecting for drug resistance, warrants further evaluation by governmental regulators regarding antibacterial product claims and advertising. Further studies of this issue are encouraged.
Collapse
Affiliation(s)
- Allison E Aiello
- Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor, Ann Arbor, MI 48104-2548, USA.
| | | | | |
Collapse
|
7
|
Kaiser NE, Newman JL. Formulation technology as a key component in improving hand hygiene practices. Am J Infect Control 2006. [DOI: 10.1016/j.ajic.2006.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
8
|
Nicolay CR. Hand hygiene: an evidence-based review for surgeons. Int J Surg 2005; 4:53-65. [PMID: 17462314 DOI: 10.1016/j.ijsu.2005.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2005] [Accepted: 06/03/2005] [Indexed: 11/16/2022]
Abstract
This review of the literature discusses the scientific evidence behind using different hand hygiene agents on the surgical ward, and in theatre for preoperative disinfection. It considers the mechanism of action of the agents and their effectiveness against different pathogens, as well as possible future agents, and how they are tested. It addresses problems such as the poor compliance with hand hygiene guidelines by healthcare workers (especially doctors) and investigates what can be done to improve compliance. Finally, it demonstrates the reduction in hospital acquired infection (HAI) rate that can be achieved by improving hand hygiene compliance, and shows that the savings associated with this easily outweigh the cost.
Collapse
Affiliation(s)
- C R Nicolay
- Academic Surgical Unit, 10th Floor QEQM Wing, St Mary's Hospital, Praed St, London W2 1NY, UK.
| |
Collapse
|
9
|
Antiseptic antimicrobial hand washes. J Am Dent Assoc 2003; 134:906-7. [PMID: 12892449 DOI: 10.14219/jada.archive.2003.0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
10
|
Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Am J Infect Control 2002; 30:S1-46. [PMID: 12461507 DOI: 10.1067/mic.2002.130391] [Citation(s) in RCA: 374] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.
Collapse
|
11
|
Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol 2002; 23:S3-40. [PMID: 12515399 DOI: 10.1086/503164] [Citation(s) in RCA: 628] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.
Collapse
Affiliation(s)
- John M Boyce
- Hospital of Saint Raphael, New Haven, Connecticut, USA
| | | |
Collapse
|
12
|
Montville R, Chen Y, Schaffner DW. Risk assessment of hand washing efficacy using literature and experimental data. Int J Food Microbiol 2002; 73:305-13. [PMID: 11934038 DOI: 10.1016/s0168-1605(01)00666-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study simulated factors that influence the levels of bacteria on foodservice workers' hands. Relevant data were collected from the scientific literature and from laboratory experiments. Literature information collected included: initial bacterial counts on hands and water faucet spigots, bacterial population changes during hand washing as effected by soap type, sanitizing agent, drying method, and the presence of rings. Experimental data were also collected using Enterobacter aerogenes as a surrogate for transient bacteria. Both literature and experimental data were translated into appropriate discrete or probability distribution functions. The appropriate statistical distribution for each phase of the hand washing process was determined. These distributions were: initial count on hands, beta (2.82, 2.32, 7.5); washing reduction using regular soap, beta (3.01, 1.91, -3.00, 0.60); washing reduction using antimicrobial soap, beta (4.19, 2.99, -4.50, 1.50); washing reduction using chlorhexidine gluconate (CHG), triangular (-4.75, -1.00, 0); reductions from hot air drying, beta (3.52, 1.92, -0.20, 1.00); reduction from paper towel drying, triangular (-2.25, -0.75, 0); reduction due to alcohol sanitizer, gamma (-1.23, 4.42) -5.8; reduction due to alcohol-free sanitizer, gamma (2.22, 5.38) -5.00; and the effect of rings, beta (8.55, 23.35, 0.10, 0.45). Experimental data were fit to normal distributions (expressed as log percentage transfer rate): hand-to-spigot transfer, normal (-0.80, 1.09); spigot to hand, normal (0.36, 0.90). Soap with an antimicrobial agent (in particular, CHG) was observed to be more effective than regular soap. Hot air drying had the capacity to increase the amount of bacterial contamination on hands, while paper towel drying caused a slight decrease in contamination. There was little difference in the efficacy of alcohol and alcohol-free sanitizers. Ring wearing caused a slight decrease in the efficacy of hand washing. The experimental data validated the simulated combined effect of certain hand washing procedures based on distributions derived from reported studies. The conventional hand washing system caused a small increase in contamination on hands vs. the touch-free system. Sensitivity analysis revealed that the primary factors influencing final bacteria counts on the hand were sanitizer, soap, and drying method. This research represents an initial framework from which sound policy can be promulgated to control bacterial transmission via hand contacts.
Collapse
Affiliation(s)
- Rebecca Montville
- Food Risk Analysis Initiative, Department of Food Science, Rutgers--the State University of New Jersey, New Brunswick 08901-8520, USA
| | | | | |
Collapse
|
13
|
Factors to Consider When Selecting Skin Cleansing Products. J Wound Ostomy Continence Nurs 2000. [DOI: 10.1097/00152192-200009000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
|
15
|
|
16
|
Affiliation(s)
- E L Larson
- School of Nursing, Georgetown University, Washington, D.C., USA
| |
Collapse
|
17
|
Pereira LJ, Lee GM, Wade KJ. The effect of surgical handwashing routines on the microbial counts of operating room nurses. Am J Infect Control 1990; 18:354-64. [PMID: 2285173 DOI: 10.1016/0196-6553(90)90249-r] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Many factors may affect the efficiency of handwashing techniques. This study examined two interdependent factors: the time taken to wash the hands and the type of antiseptic solution used. A 3-minute initial scrub and 30-second consecutive scrub regimen was compared with a current standard regimen of a 5-minute initial scrub and a 3-minute consecutive scrub. Chlorhexidine gluconate 4% and povidone-iodine 7.5% were the antiseptics used in the two regimens. The sample (n = 34) was drawn from nurses employed in the operating room suite of a 950-bed hospital. Chlorhexidine gluconate was found to be responsible for lower numbers of colony-forming units of bacteria than povidone-iodine. The duration of the scrub had no significant effect on the numbers of bacteria when povidone-iodine was used. The optimal regimen was found to be the 5-minute initial and 3-minute consecutive scrubs with chlorhexidine gluconate.
Collapse
Affiliation(s)
- L J Pereira
- Department of Biological Sciences, Cumberland College of Health Sciences, Camperdown, Sydney, Australia
| | | | | |
Collapse
|