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224. Krilov LR et al. Inactivation of respiratory syncytial virus by detergents and disinfectants. Pediatric Infectious Diseases, 1993, 2:582-584. 225. Sattar SA et al. Preventing the spread of hepatitis B and C viruses: where are germicides relevant? American Journal of Infection Control, 2001, 29:187-197. 226. Pillsbury DM et al. Bacterial flora of the normal skin. Archives of Dermatology, 1942, 45:61-80. 227. Lowbury EJL et al. Preoperative disinfection of surgeon’s hands: use of alcoholic solutions and effects of gloves on skin flora. BMJ, 1974, 4:369-372. 228. Lilly HA et al. Delayed antimicrobial effects of skin disinfection by alcohol. Journal of Hygiene (Cambridge), 1979, 82:497-500. 229. Gaonkar TA et al. An alcohol hand rub containing a synergistic combination of an emollient and preservatives: prolonged activity against transient pathogens. Journal of Hospital Infection, 2005, 59:12-8. 230. Ansari SA et al. In vivo protocol for testing efficacy of hand-washing agents against viruses and bacteria: experiments with rotavirus and Escherichia coli. Applied Environmental Microbiology, 1989, 55:3113-3118. 231. Sattar SA et al. Activity of an alcohol-based hand gel against human adeno-, rhino-, and rotaviruses using the fingerpad method. Infection Control and Hospital Epidemiology, 2000, 21:516-519. 232. Wolff MH. Hepatitis A virus: a test method for virucidal activity. Journal of Hospital Infection, 2001, 48(Suppl. A):S18-S22. 233. Steinmann J et al. Two in-vivo protocols for testing virucidal efficacy of handwashing and hand disinfection. Zentralblatt Hygiene Umweltmedizin, 1995, 196:425-436. 234. Mbithi JN et al. Comparative in vivo efficiencies of hand-washing agents against hepatitis A virus (HM-175) and poliovirus type 1 (Sabin). Applied Environmental Microbiology, 2000, 59:3463-3469. 235. Schurmann W et al. Antiviral activity of an alcoholic hand disinfectant: comparison of the in vitro suspension test with in vivo experiments on hands, and on individual fingertips. Antiviral Research, 1983, 3:25-41. 236. Steinmann J. Surrogate viruses for testing virucidal efficacy of chemical disinfectants. Journal of Hospital Infection, 2004, 56 (Suppl. 2):S49-54. 237. Sickbert-Bennett EE et al. Comparative efficacy of hand hygiene agents in the reduction of bacteria and viruses. American Journal of Infection Control, 2005, 3:67-77. 238. Larson E et al. Effective hand degerming in the presence of blood. Journal of Emergency Medicine, 1992, 10:7-11. 239. Dineen P et al. Antiseptic care of the hands. In: Maibach HI, Hildick-Smith G, eds. Skin bacteria and their role in infection. New York, McGraw-Hill, 1965:291-309. 240. Rotter M et al. Povidone-iodine and chlorhexidine gluconate-containing detergents for disinfection of hands. Journal of Hospital Infection, 1980, 1:149-158. 241. Rotter ML. Hygienic hand disinfection. Infection Control, 1984, 1:18-22. 242. Blech M-F et al. Activity of non antiseptic soaps and ethanol for hand disinfection. Zentralblatt für Bakteriologie Mikrobiologie und Hygiene, 1985, 181:496-512. 243. Leyden JJ et al. Computerized image analysis of full-hand touch plates: a method for quantification of surface bacteria on hands and the effect of antimicrobial agents. Journal of Hospital Infection, 1991, 18:13-22. 244. Zaragoza M et al. Handwashing with soap or alcoholic solutions? A randomized clinical trial of its effectiveness. American Journal of Infection Control, 1999, 27:258-261. 245. Paulson DS et al. A close look at alcohol gel as an antimicrobial sanitizing agent. American Journal of Infection Control, 1999, 27:332-338. 246. Cardoso CL et al. Effectiveness of hand-cleansing agents for removing Acinetobacter baumannii strain from contaminated hands. American Journal of Infection Control, 1999, 27:327-331. 247. Lilly HA, Lowbury EJL. Transient skin flora: their removal by cleansing or disinfection in relation to their mode of deposition. Journal of Clinical Pathology, 1978, 31:919-922. 248. Jones MV et al. The use of alcoholic paper wipes for routine hand cleansing: results of trials in two hospitals. Journal of Hospital Infection, 1986, 8:268-274.
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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
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i. ii. iii. iv. v. vi. a) b) Educat
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tion precautions 580 . There are al
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follow the intent 588 . Studies hav
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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 128 and 129: 23. Lee YL et al. Colonization by S
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 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
Page 179 and 180: Table l.20.1: Possible problems and
Page 181 and 182: Table I.21.1. Hand hygiene research
Page 183 and 184: Table I.21.1: Hand hygiene research
Page 185 and 186: 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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