Hand hygiene.pdf

Case study: experience of Egypt
The national infection control programme started in Egypt in 2000. One of the
important initiatives was promoting hand hygiene in hospitals. Routine handwashing
was encouraged and required the availability of critical supplies such as soap and hand
drying materials. The high consumption of hand drying materials stimulated hospital
infection control teams to search for cost-effective alternatives. Many hospitals started
by purchasing cheap disposable paper towels. The low quality of paper discouraged
HCWs from using it, as it lacked the required thickness and strength to achieve effective
hand drying. Another option was the use of single-use cloth towels where old hospital
linen was divided into small-sized towels and reprocessed after single use. Although
this was considered as cost-saving from the perspective of the hospital administration,
not all hospital staff liked this option. Some HCWs refused to dry hands with previously
used linen, even after reprocessing. A better option identified was the purchasing of
cheap cloth material (in metres) that was cut into small-sized towels and used the same
way as the old linen. The use of single-use cloth towels was welcomed by almost all
hospitals; the price of the material was acceptable for the hospital administration and
there were plenty of towels for HCWs to use in all required opportunities.
9.2 PLAIN (NON-ANTIMICROBIAL) SOAP
Soaps are detergent-based products that contain esterified fatty acids and sodium or
potassium hydroxide. They are available in various forms including bar soap, tissue, leaf and
liquid preparations. Their cleansing activity can be attributed to their detergent properties,
which result in removal of lipid and adhering dirt, soil and various organic substances from
the hands. Plain soaps have minimal, if any, antimicrobial activity. However, handwashing
with plain soap can remove loosely adherent transient flora. For example, handwashing
with plain soap and water for 15 seconds reduces bacterial counts on the skin by 0.6–1.1
log 10
, whereas washing for 30 seconds reduces counts by 1.8–2.8 log 101
. In several studies,
however, handwashing with plain soap failed to remove pathogens from the hands of
HCWs 44,63,186 . Handwashing with plain soap can result in a paradoxical increase in bacterial
counts on the skin 155,187-189 . Since soaps may be associated with considerable skin
irritation and dryness 155,188,190 , adding humectants to soap preparations may reduce their
propensity to cause irritation. Occasionally, plain soaps have become contaminated, which
may lead to the colonization of hands of HCWs with Gram-negative bacilli 101 . Still, there is
some evidence that the actual hazard of transmitting microorganisms through handwashing
with previously used soap bars is negligible 191,192 .
9.3 ALCOHOLS
Most alcohol-based hand antiseptics contain either ethanol, isopropanol or n-propanol,
or a combination of two of these products. Concentrations are given as either percentage
of volume (= ml/100 ml), abbreviated % V/V; percentage of weight (= g/100 g), abbr.
% m/m; or percentage of weight/volume (= g/100 ml), abbr. % m/V. Studies of alcohols
have evaluated either individual alcohols in varying concentrations (a majority of studies),
combinations of two alcohols, or alcohol solutions containing small amounts of hexachlorophene,
quaternary ammonium compounds, povidone-iodine, triclosan or chlorhexidine
gluconate 82,156,193-212 .
The antimicrobial activity of alcohols results from their ability to denature proteins 213 .
Alcohol solutions containing 60–80% alcohol are most effective, with higher concentrations
being less potent 214,215 . This paradox results from the fact that proteins are not denatured