Response to letter, "Inclusion of chlorhexidine gluconate in alcohol-based presurgical hand antiseptics: can a product be considered 'superior' if it does not meet established efficacy requirements?"

Comparative Antimicrobial Efficacy of Two Hand Sanitizers in Intensive Care Units Common Areas: A Randomized, Controlled Trial

OBJECTIVE

Contaminated hands of healthcare workers (HCWs) are an important source of transmission of healthcare-associated infections. Alcohol-based hand sanitizers, while effective, do not provide sustained antimicrobial activity. The objective of this study was to compare the immediate and persistent activity of 2 hand hygiene products (ethanol [61% w/v] plus chlorhexidine gluconate [CHG; 1.0% solution] and ethanol only [70% v/v]) when used in an intensive care unit (ICU).

DESIGN

Prospective, randomized, double-blinded, crossover study

SETTING

Three ICUs at a large teaching hospital

PARTICIPANTS

In total, 51 HCWs involved in direct patient care were enrolled in and completed the study.

METHODS

All HCWs were randomized 1:1 to either product. Hand prints were obtained immediately after the product was applied and again after spending 4–7 minutes in the ICU common areas prior to entering a patient room or leaving the area. The numbers of aerobic colony-forming units (CFU) were compared for the 2 groups after log transformation. Each participant tested the alternative product after a 3-day washout period.

RESULTS

On bare hands, use of ethanol plus CHG was associated with significantly lower recovery of aerobic CFU, both immediately after use (0.27 ± 0.05 and 0.88 ± 0.08 log10 CFU; P = .035) and after spending time in ICU common areas (1.81 ± 0.07 and 2.17 ± 0.05 log10 CFU; P<.0001). Both the antiseptics were well tolerated by HCWs.

CONCLUSIONS

In comparison to the ethanol-only product, the ethanol plus CHG sanitizer was associated with significantly lower aerobic bacterial counts on hands of HCWs, both immediately after use and after spending time in ICU common areas.

CLINICAL TRIAL IDENTIFIER

Clinicaltrials.gov identifier NCT02258412

Infect Control Hosp Epidemiol 2018;39:267–271