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326. Johnson S et al. Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission. American Journal of Medicine, 1990, 88:137-140. 327. Weber DJ et al. Efficacy of selected hand hygiene agents used to remove Bacillus atrophaeus (a surrogate of Bacillus anthracis) from contaminated hands. JAMA, 2003, 289:1274-1277. 328. Russell AD. Mechanisms of bacterial insusceptibility to biocides. American Journal of Infection Control, 2001, 29:259-261. 329. Cookson BD et al. Chlorhexidine resistance in methicillin-resistant Staphylococcus aureus or just an elevated MIC? An in vitro and in vivo assessment. Antimicrobial Agents and Chemotherapy, 1991, 35:1997-2002. 330. McMurry LM et al. Overexpression of marA, soxS, or acrAB produces resistance to triclosan in laboratory and clinical strains of Escherichia coli. FEMS Microbiology Letters, 1998, 166:305-309. 331. Chuanchuen R et al. Cross-resistance between triclosan and antibiotics in Pseudomonas aeruginosa is mediated by multidrug efflux pumps: exposure of a susceptible mutant strain to triclosan selects nfxB mutants overexpressing MexCD-OprJ. Antimicrobial Agents and Chemotherapy, 2001, 45:428-432. 332. Cookson BD et al. Transferable resistance to triclosan in MRSA. Lancet, 1991, 337:1548-1549. 333. Sasatsu M et al. Triclosan-resistant Staphylococcus aureus. Lancet ,1993, 341:756. 334. Chuanchuen R et al. High-level triclosan resistance in Pseudomonas aeruginosa is solely a result of efflux. American Journal of Infection Control, 2003, 31:124-127. 335. Chuanchuen R et al. The MexJK efflux pump of Pseudomonas aeruginosa requires OprM for antibiotic efflux but not for efflux of triclosan. Journal of Bacteriology, 2002, 184:5036-5044. 336. Brenwald NP et al. Triclosan resistance in methicillin-resistant Staphylococcus aureus (MRSA). Journal of Hospital Infection, 2003, 55:141-144. 337. Schmid MB et al. Reduced triclosan susceptibility in methicillin-resistant. Antimicrobial Agents and Chemotherapy, 2004, 48:1397-1399. 338. Aiello AE et al. Relationship between triclosan and susceptibilities of bacteria isolated from hands in the community. Antimicrobial Agents and Chemotherapy, 2004, 48:2973-2979. 339. Cookson B. Clinical significance of emergence of bacterial antimicrobial resistance in the hospital environment. Journal of Applied Bacteriology, 2005, 99: 989-996. 340. Guilhermetti M et al. Effectiveness of hand-cleansing agents for removing methicillinresistant Staphylococcus aureus from contaminated hands. Infection Control and Hospital Epidemiology, 2001, 22:105-108. 341. Marena C et al. Assessment of handwashing practices with chemical and microbiologic methods: preliminary results from a prospective crossover study. American Journal of Infection Control, 2002, 30:334-430. 342. Girou E et al. Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial. BMJ, 2002, 325:362. 343. Wade JJ et al. Hygienic hand disinfection for the removal of epidemic vancomycin-resistant Enterococcus faecium and gentamicin-resistant Enterobacter cloacae. Journal of Hospital Infection, 1991, 18:211-218. 344. Bermejo J et al. [Effect of alcohol-gel hand hygiene on nosocomial infections due to multiresistant Klebsiella pneumoniae]. Medicina (Buenos Aires), 2003, 63:715-20. 345. Lowbury EJL et al. Disinfection of the hands of surgeons and nurses. BMJ, 1960, 1445-1450. 346. Berman RE et al. Evaluation of hand antisepsis. Archives of Environmental Health, 1969, 18:781-783. 347. Rotter ML et al. Surgical hand disinfection with alcohols at various concentrations: parallel experiments using the new proposed European standards method. Infection Control and Hospital Epidemiology, 1998,19:778-781. 348. Hobson DW et al. Development and evaluation of a new alcohol-based surgical hand scrub formulation with persistent antimicrobial characteristics and brushless application. American Journal of Infection Control, 1998, 26:507-512. 349. Marchetti MG et al. Evaluation of the bactericidal effect of five products for surgical hand disinfection according to prEN 12054 and prEN 12791. Journal of Hospital Infection, 2003, 54:63-7.
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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
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18.2 DEVELOPING A STRATEGY FOR GUID
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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 136 and 137: 224. Krilov LR et al. Inactivation
Page 138 and 139: 276. Thomas L et al. Development of
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
Page 187 and 188: Table III.2.1: Quality indicators r
Page 189 and 190: 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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