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Table I.9.3: Virucidal activity of antiseptic agents (Cont.) Non-enveloped viruses Reference Test method Viruses Agent Results 739 235 738 234 198 Suspension Rotavirus 4% CHG 10% Povidone-iodine 70% IPA/0.1% HCP Hand test Finger test Adenovirus Poliovirus Coxsackie Adenovirus Poliovirus Coxsackie 95% EA 95% EA 95% EA 95% EA 95% EA 95% EA Suspension ECHO virus 95% EA 75% EA 95% IPA 70% IPA+0.5%CHG Finger pad HAV 70% EA 62% EA foam Plain soap 4% CHG 0.3% Triclosan Finger tips Bovine rotavirus n-propanol+IPA 70% IPA 70% EA 2% Triclosan Water (control) 7.5% povidone-iodine Plain soap 4% CHG 183 Finger pad Human rotavirus 230 Finger pad Human rotavirus 231 Finger pad Rotavirus Rhinovirus Adenovirus 70% IPA Plain soap 70% IPA Plain soap 60% EA gel 60% EA gel 60% EA gel 233 Finger pad Poliovirus 70% EA 70% IPA 296 Finger tips Poliovirus Plain soap 80% EA LR3.0 LR>3.0 LR> 1.4 LR=0.2–1.0 LR=1.1–1.3 LR> 2.3 LR=0.7–2.5 LR=2.9 LR> 3.0 in 1 min LR3.0 in 10 s LR>3.0 LR>3.0 LR=1.6 in 10 s LR=0.8 LR=2.1 LR=0.4 HIV = human immunodeficiency virus; EA = ethanol; LR = Log 10 Reduction; IPA = isopropanol; CHG = chlorhexidine gluconate; HBV = hepatitis B virus; RSV = respiratory syncytial virus; HSV = herpes simplex virus; HAV = hepatitis A virus.
Table I.9.4: Studies comparing the relative efficacy (based on log 10 reductions achieved) of plain soap or antimicrobial soaps versus alcohol-based antiseptics in reducing counts of viable bacteria on hands Reference 239 212 199 247 200 240 71 201 202 241 242 203 156 82 44 243 204 158 205 244 245 246 Year Skin contamination Assay method Time (s) Relative efficacy 1965 Existing hand flora Finger tip agar culture 60 Plain soap < HCP < 50% EA foam 1975 Existing hand flora Handrub broth culture -- Plain soap < 95% EA 1978 Artificial contamination Finger tip broth culture 30 Plain soap < 4% CHG < P-I < 70% EA = alc. CHG 1978 Artificial contamination Finger tip broth culture 30 Plain soap < 4% CHG < 70% EA 1979 Existing hand flora Handrub broth culture 120 1980 Artificial contamination Finger tip broth culture 60- 120 Plain soap < 0.5% aq. CHG < 70% EA < 4% CHG < alc.CHG 4% CHG < P-I < 60% IPA 1980 Artificial contamination Finger tip broth culture 15 Plain soap < 3% HCP < P-I < 4% CHG < 70% EA 1982 Artificial contamination Glove juice test 15 P-I < alc. CHG 1983 Artificial contamination Finger tip broth culture 120 0.3-2% triclosan = 60% IPA = alc. CHG < alc. Triclosan 1984 Artificial contamination Finger tip agar culture 60 Phenolic < 4% CHG < P-I < EA < IPA < n-P 1985 Existing hand flora Finger tip agar culture 60 Plain soap < 70% EA < 95% EA 1986 Artificial contamination Finger tip broth culture 60 Phenolic = P-I < alc. CHG < n-P 1986 Existing hand flora Sterile broth bag technique 1988 Artificial contamination Finger tip broth culture 30 1991 Patient contact Glove juice test 15 Plain soap < IPA-H 1991 Existing hand flora Agar plate/image analysis 15 Plain soap < IPA < 4% CHG = IPA-H = alc. CHG Plain soap < triclosan < P-I < IPA < alc. CHG < n-P 30 Plain soap < 1% triclosan < P-I < 4% CHG < IPA 1992 Artificial contamination Finger tip agar culture 60 Plain soap < IPA < EA < alc. CHG 1992 Artificial contamination Finger tip broth culture 60 Plain soap < 60% n-P 1994 Existing hand flora Agar plate/image analysis 30 Plain soap < alc. CHG 1999 Existing hand flora Agar plate culture N.S. Plain soap < commercial alcohol mixture 1999 Artificial contamination Glove juice test 20 Plain soap < 0.6% PCMX < 65% EA 1999 Artificial contamination Finger tip broth culture 30 4% CHG < plain soap < P-I < 70% EA Existing hand flora = without artificially contaminating hands with bacteria. alc. CHG = alcohol-based chlorhexidine gluconate; aq. CHG = aqueous chlorhexidine gluconate; 4% CHG = chlorhexidine gluconate detergent; EA = ethanol; HCP = hexachlorophene soap/detergent; IPA = isopropanol; IPA-H = isopropanol + humectants; n-P = n-propanol; PCMX = para-chloro-meta-xylenol detergent; P-I = povidone-iodine detergent; N.S. = not stated. Hexachlorophene has been banned worldwide because of its high rate of dermal absorption and subsequent toxic effects 26,290 .
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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
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HCWs routinely to wear vinyl gloves
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quality gloves, reuse, shortage of
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• To test for holes, gloves shoul
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Figure l.20.2: Blood safety: crucia
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Consensus recommendations are that
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D. Wash hands with either plain or
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5. SKIN CARE A. B. C. Include infor
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PART III. OUTCOME MEASUREMENTS 1. M
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2. HAND HYGIENE AS A QUALITY INDICA
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can be seen during routine work. Da
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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 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: Table I.9.3: Virucidal activity of
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
Page 191 and 192: Table V.4.1: Examples of national p
Page 193: Table V.5.1: The public information
Page 197 and 198: APPENDIX 1. DEFINITIONS OF HEALTH-C
Page 199: APPENDIX 2. HAND AND SKIN SELF-ASSE
Page 202: Data in coloured cells can be chang
Page 206: NHS NICU n-P NPSA NA NS OPD PACU PA
Page 211 and 212: AUTHORS: John Boyce Saint Raphael H
Page 213 and 214: Garance Upham People’s Health Mov
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