Hand hygiene.pdf

concluded that chloroxylenol is not as rapidly active as chlorhexidine gluconate or iodophors,
and that its residual activity is less pronounced than that observed with chlorhexidine
gluconate 12,277 . In 1994, the FDA TFM tentatively classified chloroxylenol as a Category IIISE
active agent (insufficient data to classify as safe and effective) 135 . Further evaluation of this
agent by the FDA is ongoing.
The antimicrobial activity of chloroxylenol is minimally affected by the presence of organic
matter, but is neutralized by non-ionic surfactants. Chloroxylenol is absorbed through the
skin 12,277 . Chloroxylenol is generally well tolerated, and allergic reactions are relatively
uncommon. Chloroxylenol is available in concentrations ranging from 0.3% to 3.75%. Inuse
contamination of a chloroxylenol-containing preparation has been reported 282 .
9.6 HEXACHLOROPHENE
Hexachlorophene is a bisphenol composed of two phenolic groups and three chlorine
moieties. In the 1950s and early 1960s, emulsions containing 3% hexachlorophene were
widely used for hygienic handwashing, as surgical scrubs, and for routine bathing of infants
in hospital nurseries. The antimicrobial activity of hexachlorophene is related to its ability to
inactivate essential enzyme systems in microorganisms. Hexachlorophene is bacteriostatic,
with good activity against S. aureus, and relatively weak activity against Gram-negative
bacteria, fungi and mycobacteria 12 .
Studies of hexachlorophene as a hygienic handwash or surgical scrub demonstrated only
modest efficacy after a single handwash 71,239,283 . Hexachlorophene has residual activity
for several hours after use and gradually reduces bacterial counts on hands after multiple
uses (cumulative effect) 1,194,283,284 . In fact, with repeated use of 3% hexachlorophene
preparations, the drug is absorbed through the skin. Infants bathed with hexachlorophene
and caregivers regularly using a 3% hexachlorophene preparation for handwashing have
blood levels of 0.1–0.6 parts per million (ppm) hexachlorophene 285 . In the early 1970s,
infants bathed with hexachlorophene sometimes developed neurotoxicity (vacuolar degeneration)
286 . As a result, in 1972, the FDA warned that hexachlorophene should no longer be
used routinely for bathing infants. After routine use of hexachlorophene for bathing infants in
nurseries was discontinued, a number of investigators noted that the incidence of S. aureus
infections associated with health care in hospital nurseries increased substantially 287,288 . In
several instances, the frequency of infections decreased when hexachlorophene bathing of
infants was reinstituted. However, current guidelines recommend against routine bathing of
neonates with hexachlorophene because of its potential neurotoxic effects 289 . The agent is
classified by the FDA TFM as not generally recognized as safe and effective for use as an
antiseptic handwash 135 . Hexachlorophene should not be used to bathe patients with burns
or extensive areas of abnormal, sensitive skin. Soaps containing 3% hexachlorophene are
available by prescription only 12 . Because of its high rate of dermal absorption and subsequent
toxic effects 26,290 , hexachlorophene-containing products should be avoided.
Hexachlorohene has been banned worldwide because of its high rates of dermal absorption
and subsequent toxic effects 26,290 .
9.7 IODINE AND IODOPHORS
Iodine has been recognized as an effective antiseptic since the 1800s. However, because
iodine often causes irritation and discolouring of skin, iodophors have largely replaced
iodine as the active ingredient in antiseptics.
Iodine molecules rapidly penetrate the cell wall of microorganisms and inactivate cells
by forming complexes with amino acids and unsaturated fatty acids, resulting in impaired