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23. Lee YL et al. Colonization by Staphylococcus species resistant to methicillin or quinolone on hands of medical personnel in a skilled-nursing facility. American Journal of Infection Control, 1994, 22:346-351. 24. Evans CA et al. Bacterial flora of the normal human skin. Journal of Investigative Dermatology, 1950, 15:305-324. 25. Hay RJ. Fungi and fungal infections of the skin. In: Noble WC, ed. The skin microflora and microbial skin disease. Cambridge, Cambridge University Press, 1993: 232-263. 26. Kampf G et al. Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clinical Microbiology Review, 2004, 17:863-893. 27. Lark RL et al. An outbreak of coagulase-negative staphylococcal surgical-site infections following aortic valve replacement. Infection Control and Hospital Epidemiology, 2001, 22:618-623. 28. Pittet D et al. Bacterial contamination of the hands of hospital staff during routine patient care. Archives of Internal Medicine, 1999, 159:821-826. 29. Pessoa-Silva CL et al. Dynamics of bacterial hand contamination during routine neonatal care. Infection Control and Hospital Epidemiology, 2004, 25:192-197. 30. Marples RR et al. A laboratory model for the investigation of contact transfer of micro-organisms. Journal of Hygiene (Cambridge), 1979, 82:237-248. 31. Patrick DR et al. Residual moisture determines the level of touch-contact-associated bacterial transfer following hand washing. Epidemiology of Infection, 1997, 119:319-325. 32. Adams BG et al. Hand carriage of aerobic gram-negative rods may not be transient. Journal of Hygiene (London), 1982, 89:33-46. 33. Selwyn S. Microbiology and ecology of human skin. The Practitioner, 2000, 224:1059-1062. 34. Larson E. Effects of handwashing agent, handwashing frequency, and clinical area on hand flora. American Journal of Infection Control, 1984, 11:76-82. 35. Larson EL et al. Changes in bacterial flora associated with skin damage on hands of health care personnel. American Journal of Infection Control, 1998, 26:513-521. 36. Maki D. Control of colonization and transmission of pathogenic bacteria in the hospital. Annals of Internal Medicine, 1978, 89 (Part 2):777-780. 37. Sprunt K et al. Antibacterial effectiveness of routine hand washing. Pediatrics, 1973, 52:264-271. 38. Lowbury EJL. Gram-negative bacilli on the skin. British Journal of Dermatology, 1969, 81:55-61. 39. Noble WC. Distribution of the Micrococcaceae. British Journal of Dermatology, 1969, 81:27-31. 40. McBride ME et al. Microbial skin flora of selected cancer patients and hospital personnel. Journal of Clinical Microbiology, 1976, 3:14-20. 41. Casewell MW. The role of hands in nosocomial gram-negative infection. In: Maibach HI, Aly R, eds. Skin microbiology relevance to clinical infection, New York, Springer-Verlag, 1981:192-202. 42. Larson EL, et al. Differences in skin flora between inpatients and chronically ill patients. Heart and Lung, 2000, 29:298-305. 43. Larson EL et al. Composition and antimicrobic resistance of skin flora in hospitalized and healthy adults. Journal of Clinical Microbiology, 1986, 23:604-608. 44. Ehrenkranz NJ et al. Failure of bland soap handwash to prevent hand transfer of patient bacteria to urethral catheters. Infection Control and Hospital Epidemiology, 1991, 12:654-662. 45. Sanderson PJ et al. Recovery of coliforms from the hands of nurses and patients: activities leading to contamination. Journal of Hospital Infection, 1992, 21:85-93. 46. Coello R et al. Prospective study of infection, colonization and carriage of methicillin-resistant Staphylococcus aureus in an outbreak affecting 990 patients. European Journal of Clinical Microbiology, 1994, 13:74-81. 47. Sanford MD et al. Efficient detection and long-term persistence of the carriage of methicillinresistant Staphylococcus aureus. Clinical Infectious Diseases, 1994, 19:1123-1128. 48. Bertone SA et al. Quantitative skin cultures at potential catheter sites in neonates. Infection Control and Hospital Epidemiology, 1994, 15:315-318.
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The WHO Guidelines on Hand Hygiene
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CONTENTS INTRODUCTION . ...........
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17. Organizing an education program
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INTRODUCTION The WHO Advanced Draft
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Handwashing. Washing hands with pla
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still considered the standard of ca
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treatment selectively removes glyce
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of the organism on their hands. Mak
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6. MODELS OF HAND TRANSMISSION 6.1
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In the 1960s, a prospective, contro
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for its ability to reduce the relea
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8.2 SHORTCOMINGS OF TRADITIONAL TES
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tions of short-chain aliphatic alco
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9.1.3 WATER QUALITY The physical, c
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Case study: experience of Egypt The
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and both reduced viral counts on ha
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activity of chlorhexidine is not se
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protein synthesis and alteration of
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in micelle structures formed by sur
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In all the studies that included pl
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isopropyl alcohol) were applied to
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3) Glycerol is added using a measur
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in 2005 the costs of an alcohol-bas
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infection, risk factors that are la
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11.4.4 SIDE-EFFECTS OF THE SURGICAL
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• Repeat the process on the other
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12.2 ALLERGIC CONTACT DERMATITIS RE
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particularly when resources are lim
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Handrubs are available as gels, sol
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14. HAND HYGIENE PRACTICES AMONG HE
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quantified in observational studies
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According to behavioural theories (
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of water with special leaves) outsi
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Furthermore, according to Phra Depv
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16. BEHAVIOURAL CONSIDERATIONS 16.1
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and community factors must be consi
Page 78 and 79: i. ii. iii. iv. v. vi. a) b) Educat
Page 80 and 81: tion precautions 580 . There are al
Page 82 and 83: follow the intent 588 . Studies hav
Page 84 and 85: 18. FORMULATING STRATEGIES FOR HAND
Page 86 and 87: 18.2 DEVELOPING A STRATEGY FOR GUID
Page 88 and 89: 1998 (P
Page 90 and 91: HCWs routinely to wear vinyl gloves
Page 92 and 93: quality gloves, reuse, shortage of
Page 94 and 95: • To test for holes, gloves shoul
Page 96 and 97: Figure l.20.2: Blood safety: crucia
Page 98 and 99: Consensus recommendations are that
Page 100 and 101: D. Wash hands with either plain or
Page 102 and 103: 5. SKIN CARE A. B. C. Include infor
Page 107 and 108: PART III. OUTCOME MEASUREMENTS 1. M
Page 109 and 110: 2. HAND HYGIENE AS A QUALITY INDICA
Page 111 and 112: can be seen during routine work. Da
Page 113 and 114: Case study: United Kingdom national
Page 115 and 116: PART IV. PROMOTING HAND HYGIENE ON
Page 117 and 118: ated to reinforce its principles (t
Page 119: 6. PRINCIPLES OF COUNTRYWIDE HAND H
Page 122 and 123: As many international and national
Page 124: debate that resulted in increasing
Page 130 and 131: Interscience Conference on Antimicr
Page 132 and 133: 122. Vicca AF. Nursing staff worklo
Page 134 and 135: 171. Kauppinen J et al. Hospital wa
Page 136 and 137: 224. Krilov LR et al. Inactivation
Page 138 and 139: 276. Thomas L et al. Development of
Page 140 and 141: 326. Johnson S et al. Prospective,
Page 142 and 143: 34th Interscience Conference on Ant
Page 144 and 145: 423. Kampf G, et al. Influence of a
Page 146 and 147: 474. West DP et al. Evaluation of a
Page 148 and 149: 524. Muto C et al. Hand hygiene rat
Page 150 and 151: 578. Babcock HM et al. An education
Page 152 and 153: Interscience Conference on Antimicr
Page 154 and 155: 679. Hirschmann H et al. The influe
Page 156: 729. Martin LS, McDougal JS, Loskos
Page 161 and 162: Table I.8.1: Basic experimental des
Page 163 and 164: Table I.9.1: Waterborne pathogens a
Page 165 and 166: Table I.9.3: Virucidal activity of
Page 167 and 168: Table I.9.4: Studies comparing the
Page 169 and 170: Table I.9.6: Studies comparing the
Page 171 and 172: Table I.14.1: Hand hygiene frequenc
Page 173 and 174: Table I.14.2: Hand hygiene adherenc
Page 175 and 176: Table I.15.1: Hand hygiene indicati
Page 177 and 178: Table I.18.1: Strategies for succes
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Table l.20.1: Possible problems and
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Table I.21.1. Hand hygiene research
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Table I.21.1: Hand hygiene research
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Table I.21.2: Unsolved issues for r
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Table III.2.1: Quality indicators r
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Table V.3.1: Examples of public inf
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Table V.4.1: Examples of national p
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Table V.5.1: The public information
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APPENDIX 1. DEFINITIONS OF HEALTH-C
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APPENDIX 2. HAND AND SKIN SELF-ASSE
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Data in coloured cells can be chang
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NHS NICU n-P NPSA NA NS OPD PACU PA
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AUTHORS: John Boyce Saint Raphael H
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Garance Upham People’s Health Mov
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