Hand disinfection

Tests have been developed that test different products for their effectiveness as a healthcare personnel handwash (327) evaluate hand disinfectants for use in surgery (333) determine the effectiveness of a surgical hand scmb, ie, the glove juice test (311,329) evaluate antiseptics for the oral cavity to be used in mouthwashes (334,335) and test antiseptics for the periurethral area and appHcation to catheters (336,337). A method used for a test comparing four antiseptic products was adopted as recommended practice by the Association of Practitioners of Infection Control (338). 

Eggers H.J. (1990) Experiments on antiviral activity of hand disinfectants. Some theoretical and practical considerations. ZentralblattBakt, 273, 36-51. 

Hygienic hand disinfection. Hygienic hand disinfection is a term used to denote the killing and removal of transient microorganisms on the skin, i.e. those germs that literally come and go and which do not therefore form part of the resident skin population. Essentially, hygienic hand disinfection is a measure to prevent the transmission of these organisms. It can be achieved in two ways. 

Surgical hand disinfection. This term refers to the pre-operative disinfeetion of surgeons hands, with the aim of preventing surgieal wound infection. The most important criteria associated with surgical hand disinfection are ... 

The principle of tests evaluating the efficacy of surgical hand disinfectants is to sample the resident flora of the hands before and after surgical hand disinfection. 

Jones M.V., Bellamy K., Alcock R. Hudson R. (1991) The use of bacteriophage MS2 as a model system to evaluate virucidal hand disinfectants. JHosp Infect, 17, 270-285. 

The authors describe experiments on six NR compounds commonly used for latex gloves to determine the potential hazards of skin contact with reference to curing compounds and accelerators, including mercaptobenzthiazole and zinc dialkyldithiocarbamates. Simulation methods and the influence of a common hand disinfectant were investigated. In the case of tetramethylthiuram disulphide, it was discovered that decomposition products could be formed on the skin which are not present in the original rubber. 6 refs. Articles from this journal can be requested for translation by subscribers to the Rapra produced International Polymer Science and Technology. Accession no.849747... 

Hygienic and surgical hand disinfection The former is required after a suspected contamination, the latter before surgical procedures. Alcohols, mixtures of alcohols and phenols, cationic surfactants, or acids are available for this purpose. Admixture of other agents prolongs duration of action and reduces flammability. 

The application of povidone-iodine formulations cannot be recommended for surgical hand disinfection, since active iodine-free formulations are available. 

Ojajarvi, J., Makela, P., and Rantsalo, I., Failure of hand disinfection with frequent hand washing a need for prolonged field studies. J. Hyg. (Camb) 79, 107-119,1977. 

Systemic absorption has been reported following regular use of a hand disinfectant soap containing 0.04% phenylmercuric borate, resulting in an increase in the estimated total daily body load of mercury from 30-100 pg per 24 hours. ... 

Simulated use tests involve deliberate contamination of instruments, inanimate surfaces, or even skin surfaces, with a microbial suspension. This may either be under clean conditions or may utilize a diluent containing organic (e.g. albumin) material—dirty condition. After being left to dry, the contaminated surface is exposed to the test disinfectant for an appropriate time interval. The microbes are then removed (e.g. by rubbing with a sterile swab), resuspended in suitable neutralizing medium, and assessed for viability as for suspension tests. New products are often compared with a known comparator compound (e.g. 1 minute application of 60% v/v 2-propanol for hand disinfection products— see EN1500) to show increased efficacy of the novel product. 

Kampf, G., Rudolf, M., Labadie, J-C. Barrett, S. P. (2002) Spectrum of antimicrobial activity and user acceptability of the hand disinfectant agent Sterillium Gel. J ELosp Infect, 52,141—147. 

In recognition of the need for broad spectrum hand disinfectants, new formulations of sanitary mbs have been tested for vimcidal activity. Enveloped vimses including VACV were exposed to three common alcohol-based sanitary mbs containing at least 75% alcohol, at exposure times of 15, 30 and 60 s. Significant viral inactivation (>4 log 10 steps) after 15 s with infectivity reduced to below detectable levels [65], In an earlier study, Schumann and Grossgebauer [95] observed complete disinfection of VACV from hands using 70% isopropyl-alcohol with a 2-5 min exposure. Similarly, VACV embedded in rabbit dermal scabs were completely inactivated after 3 h exposures in... 

Kramer, A., Galabov, A.S., Sattar, S.A., Dohner, L., Pivert, A., Payan, C., Wolff, M.H., Yilmaz, A., and Steinmann, J., 2006. Virucidal activity of a new hand disinfectant with reduced ethanol content comparison with other alcohol-based formulations. J. Hosp. Infect., 62 98—106. 

V Hingst, I luditzki, P Heeg, H-O Sonntag. Evaluation of the efficacy of surgical hand disinfection following a reduced application time of 3 instead of 5 minutes. J Hosp Infect 20 79-86, 1992. 

Additionally, in a survey overview on the effectiveness of handwashing and hand disinfection for the removal of nosocomial pathogens from heavily contaminated hands, 0.5% CHG in 70% isopropanol was most effective, followed by 70% ethanol and, to a lesser extent, 40% isopropanol [5], Comparison of the efficacy of 62% ethanol, 70% isopropanol, and benzylalkonium chloride-based hand sanitizers using the healthcare personnel handwash protocol indicated that all three had equivalent efficacy at greater than 2-log reduction after the first wash, whereas the benzylalkonium chloride hand sanitizer demonstrated residual efficacy. 

The authors concluded that the CHG product reduced the nosocomial infection rate more effectively than did use of alcohol and soap and attributed the results, at least in part, to better handwashing compliance when the CHG product was used. Alcohol preparations kill bacteria rapidly, theoretically permitting briefer washing time. Voss and Widmer stated that alcoholic hand disinfection, with its rapid activity, superior efficacy, and minimal time commitment, allows 100% healthcare worker compliance without interfering with the quality of patient care [24]. Alcohol preparations are inexpensive and can be used without a sink, when sinks are unavailable, or when tap water is contaminated—a major advantage in developing countries. 

ML Rotter, W Roller, G Wewalka, et al. Evaluation of procedures for hygienic hand-disinfection controlled parallel experiments on the Vienna test model. J Hygiene Cambridge 1986 96 27-37. 

G Reybrouck. Handwashing and hand disinfection. J Hosp Infect 8 5-23, 1986. AM Kligman. The bacteriology of normal skin. In HI Maibach, G Hildick-Smith, eds. Skin Bacteria and Their Role in Infection. New York McGraw-Hill 1965, pp. 13-31. 

GAJ Ayliffe, JR Babb and AH Quoraishi. A test for hygienic hand disinfection. J Clin Pathol 31 923-928, 1978. 

ML Rotter. Hygenic hand disinfection. Infect Control 70(5) 18-22, 1984. 

M Rotter, W Koller, G Wewalka. Povidone-iodine and chlorhexidine gluconate-containing detergents for disinfection of hands. J Hosp Infect 2 149-158, 1980. ML Rotter, W Koller, G Wewalka, HP Werner, GAJ Ayliffe, JR Babb. Evaluation of procedures for hygienic hand-disinfection controlled parallel experiments on the Vienna test model. J Hyg Camb 96 27-37, 1986. 

Ayliffe GAJ, Babb JR, Davies JG, and Lilly HA Hand disinfection a comparison of various agents in laboratory and ward studies. J Hosp Infect 11 226-243, 1987. Engelsher HJ. A new surgical scrub brush. Am J Surg 112 964-966, 1966. 

SWB Newsom, C Rowland. Application of the hygienic hand-disinfection test to the gloved hand. J Hosp Infect 14 245-247, 1989. 

AZ Sheena, ME Stiles. Efficacy of germicidal handwash agents in hygienic hand disinfection. J Food Prot 45 713-720, 1982. 

H Reber, M Muntener, K Neck, U Lips. Test methods for surgical hand disinfection (author s transl). Zentralbl Bakteriol (Orig B) 160(6) 601-627, 1975. 

Pittet, D. (2001) Compliance with hand disinfection and its impact on hospital-acquired infections. Journal of Hospital Infection, 48(Suppl A), S40-S46. 

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