WHO Guidelines on Hand Hygiene in Health Care - Safe Care ...

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<strong>WHO</strong> GUIDELINES ON HAND HYGIENE IN HEALTH CARE Table I.11.10 Efficacy of surgical handrub solutions in reducing the release of resident skin flora from clean hands Rub Concentration a (%) Time (min) Mean log reduction Immediate Persistent (3h) n-Propanol 60 5 2.9 b 1.6 b 5 2.7 b NA 5 2.5 b 1.8 b 5 2.3 b 1.6 b 3 2.9 c NA 3 2.0 b 1.0 b 1 1.1 b 0.5 b Isopropanol 90 3 2.4 c 1.4 c 80 3 2.3 c 1.2 c 70 5 2.4 b 2.1 b 5 2.1 b 1.0 b 3 2.0 c 0.7 c 3 1.7 c NA 3 1.5 b 0.8 b 2 1.2 0.8 1 0.7 b 0.2 1 0.8 NA 60 5 1.7 1.0 Isopropanol + chlorhexidine gluc. (m/v) 70 + 0.5 5 2.5 b 2.7 b 2 1.0 1.5 Ethanol 95 2 2.1 NA 85 3 2.4 c NA 80 2 1.5 NA 70 2 1.0 0.6 Ethanol + chlorhexidine gluc. (m/v) 95 + 0.5 2 1.7 NA 77 + 0.5 5 2.0 1.5 d 70 + 0.5 2 0.7 1.4 Chlorhexidine gluc. (aq. Sol., m/v) 0.5 2 0.4 1.2 Povidone-iodine (aq. Sol., m/v) 1.0 5 1.9 b 0.8 b Peracetic acid (m/v) 0.5 5 1.9 NA NA = not available. a v/v unless otherwise stated. b Tested according to the Deutsche Gesellschaft fur Hygiene and Mikrobiologic (German Society of Hygiene and Microbiology). c Tested according to European Standard EN 12791. d After 4 hours. Source: reprinted with permission from Rotter, 1999. 48 48
PART I. REVIEW OF SCIENTIFIC DATA RELATED TO HAND HYGIENE 12. <strong>WHO</strong>-recommended handrub formulations 12.1 General remarks To help countries and health-care facilities to achieve system change and adopt alcohol-based handrubs as the gold standard for hand hygiene in health care, <strong>WHO</strong> has identified formulations for their local preparation. Logistic, economic, safety, and cultural and religious factors have all been carefully considered by <strong>WHO</strong> before recommending such formulations for use worldwide (see also Part I, Section 14). At present, alcohol-based handrubs are the only known means for rapidly and effectively inactivating a wide array of potentially harmful microorganisms on hands. 60,221,329,484-487 <strong>WHO</strong> recommends alcohol-based handrubs based on the following factors: 1. evidence-based, intrinsic advantages of fast-acting and broad-spectrum microbicidal activity with a minimal risk of generating resistance to antimicrobial agents; 2. suitability for use in resource-limited or remote areas with lack of accessibility to sinks or other facilities for hand hygiene (including clean water, towels, etc.); 3. capacity to promote improved compliance with hand hygiene by making the process faster and more convenient; 4. economic benefit by reducing annual costs for hand hygiene, representing approximately 1% of extra-costs generated by HCAI (see also Part III, Section 3); 488-490 5. minimization of risks from adverse events because of increased safety associated with better acceptability and tolerance than other products (see also Part I, Section 14). 491-498 For optimal compliance with hand hygiene , handrubs should be readily available, either through dispensers close to the point of care or in small bottles for on-person carriage. 335,485 Health-care settings currently using commercially-available handrubs should continue to use them, provided that they meet recognized standards for microbicidal efficacy (ASTM or EN standards) and are well accepted/tolerated by HCWs (see also Implementation Toolkit available at http://www.who.int/ gpsc/en/). It is obvious that these products should be regarded as acceptable, even if their contents differ from those of the <strong>WHO</strong>-recommended formulations described below. <strong>WHO</strong> recommends the local production of the following formulations as an alternative when suitable commercial products are either unavailable or too costly. 12.1.1 Suggested composition of alcohol-based handrub formulations for local production The choice of components for the <strong>WHO</strong>-recommended handrub formulations takes into account cost constraints and microbicidal activity. The following two formulations are recommended for local production with a maximum of 50 litres per lot to ensure safety in production and storage. Formulation I To produce final concentrations of ethanol 80% v/v, glycerol 1.45% v/v, hydrogen peroxide (H 2 O 2 ) 0.125% v/v. Pour into a 1000 ml graduated flask: a) ethanol 96% v/v, 833.3 ml b) H 2 O 2 3%, 41.7 ml c) glycerol 98% ,14.5 ml Top up the flask to 1000 ml with distilled water or water that has been boiled and cooled; shake the flask gently to mix the content. Formulation II To produce final concentrations of isopropyl alcohol 75% v/v, glycerol 1.45% v/v, hydrogen peroxide 0.125% v/v: Pour into a 1000 ml graduated flask: a) isopropyl alcohol (with a purity of 99.8%), 751.5 ml b) H 2 O 2 3%, 41.7 ml c) glycerol 98%, 14.5 ml Top up the flask to 1000 ml with distilled water or water that has been boiled and cooled; shake the flask gently to mix the content. Only pharmacopoeial quality reagents should be used (e.g. The International Pharmacopoeia) and not technical grade products. 12.1.2 Method for local production 12.1.2.1 Volume of production, containers • 10-litre preparations: glass or plastic bottles with screwthreaded stoppers can be used. • 50-litre preparations: large plastic (preferably polypropylene, translucent enough to see the liquid level) or stainless steel tanks with an 80 to100 litre capacity should be used to allow for mixing without overflowing. The tanks should be calibrated for the ethanol/isopropyl alcohol volumes and for the final volumes of either 10 or 50 litres. It is best to mark plastic tanks on the outside and stainless steel ones on the inside. 12.1.2.2 Preparation 1) The alcohol for the chosen formulation is poured into the large bottle or tank up to the graduated mark. 49
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