Hand hygiene.pdf

In all the studies that included plain soap, alcohols were more effective than soap. In
all but two of the trials comparing alcohol-based solutions with antimicrobial soaps or
detergents, alcohol reduced bacterial counts on hands to a greater extent than washing
hands with soaps or detergents containing hexachlorophene, povidone-iodine, 4% chlorhexidine,
or triclosan. A cross-over study comparing plain soap with one containing 4%
chlorhexidine gluconate showed higher final CFU counts after chlorhexidine as compared
with plain soap, but the comparative CFU log reduction was not provided to permit conclusions
concerning relative efficacy 341 . However, a recent randomized clinical trial comparing
the efficacy of handrubbing versus conventional handwashing with antiseptic soap showed
that the median percentage reduction in bacterial contamination was significantly higher
with handrubbing than with hand antisepsis with medicated soap (chlorhexidine gluconate
4%) and water 342 . In another trial to compare microbiological efficacy of handrubbing
with alcohol-based solution and handwashing with water and unmedicated soap in HCWs
from different wards, with particular emphasis on transient flora, handrubbing was more
efficacious than handwashing for the decontamination of HCWs’ hands 94 . In studies dealing
with antimicrobial-resistant organisms, alcohol-based products reduced the number of
multidrug-resistant pathogens recovered from the hands of HCWs more effectively than
handwashing with soap and water 160,298,343 . An observational study was conducted to
assess the effect of alcohol-gel hand antiseptic on infection rates attributable to the three
most common multidrug-resistant bacteria (S. aureus, K. pneumoniae and P. aeruginosa)
in Argentina 344 . Two periods were compared, 12 months before (handwashing with water
and soap) and 12 months after starting alcohol gel use. The second period (alcohol gel use)
showed a significant reduction in incidence rates of K. pneumoniae with extended spectrum
beta-lactamase (ESBL) overall infections and particularly bacteremias. Nevertheless, on the
basis of this study, the authors could not conclude whether the result was a result of alcohol
gel itself or of an increase in hand hygiene compliance.
The efficacy of alcohols for surgical hand antisepsis has been addressed in numerous
studies 1,194,197,206-212,227,239,242,345-348 . In many of these studies, bacterial counts on the hands
were determined immediately after using the product and again 1–3 hours later. The delayed
testing is performed to determine if regrowth of bacteria on the hands is inhibited during
operative procedures. The relative efficacy of plain soap, antimicrobial soaps, and alcohol-based
solutions to reduce the number of bacteria recovered from hands immediately
after use of products for surgical hand preparation is shown in Table I.9.6. A comparison
of five surgical hand antisepsis products – two alcohol-based handrubs and three handwashes
(active ingredient triclosan, chlorhexidine or povidone-iodine) – by prEN 12791, an
in vivo test, showed that preparations containing povidone-iodine and triclosan failed the
test although all products passed the in vitro suspension test prEN 12054. Better results were
achieved with the alcohol-based handrubs 349 . Alcohol-based solutions were more effective
than washing hands with plain soap in all studies, and reduced bacterial counts on hands
to a greater extent than antimicrobial soaps or detergents in most experiments 194,197,206-
212,227,239,242,346-348 . Table I.9.7 shows the log 10
reductions in the release of resident skin
flora from clean hands immediately and three hours after use of surgical handrub products.
Alcohol-based preparations proved more efficacious than plain soap and water and, with
most formulations, were superior to povidone-iodine or chlorhexidine. Among the alcohols,
a clear positive correlation with their concentration is noticeable and, when tested at
the same concentration, the range of order in terms of efficacy is ethanol < isopropanol <
n-propanol.