Hand hygiene.pdf

CONTENTS
INTRODUCTION . ...............................................7
PART I. REVIEW OF SCIENTIFIC DATA RELATED TO HAND HYGIENE . ......9
1. Definition of terms ......................................9
2. Historical perspective on hand hygiene in health care ..........11
3. Normal bacterial flora on hands . ..........................12
4. Physiology of normal skin ................................13
5. Transmission of pathogens on hands .......................14
5.1 Organisms present on patients’ skin or in the inanimate
environment .......................................14
5.2 Organisms transferred to heatlh-care workers’ hands ..........14
5.3 Organisms capable of surviving on hands ..................16
5.4 Defective hand cleansing resulting in hands remaining
contaminated .......................................16
5.5 Cross-transmission of organisms by contaminated hands .......17
6. Models of hand transmission .............................18
6.1 Experimental models .................................18
6.2 Mathematical models .................................18
7. Relationship between hand hygiene and the acquisition of health
care-associated pathogens ...............................19
8. Methods to evaluate the antimicrobial efficacy of handrub and
handwash agents and formulations for surgical hand preparation .21
8.1 Current methods .....................................21
8.2 Shortcomings of traditional test methods ...................24
8.3 New methods for the future ............................26
9. Review of preparations used for hand hygiene ................27
9.1 Water .............................................27
9.2 Plain (non-antimicrobial) soap ...........................30
9.3 Alcohols ...........................................30
9.4 Chlorhexidine .......................................33
9.5 Chloroxylenol ......................................34
9.6 Hexachlorophene ....................................35
9.7 Iodine and iodophors .................................35
9.8 Quaternary ammonium compounds ......................36
9.9 Triclosan ...........................................37