Epidemiologic Background of Hand Hygiene and Evaluation of the Most Important Agents for Scrubs and Rubs

Abstract

The etiology of nosocomial infections, the frequency of contaminated hands with the different nosocomial pathogens, and the role of health care workers' hands during outbreaks suggest that a hand hygiene preparation should at least have activity against bacteria, yeasts, and coated viruses. The importance of efficacy in choosing the right hand hygiene product is reflected in the new Centers for Disease Control and Prevention guideline on hand hygiene (J. M. Boyce and D. Pittet, Morb. Mortal. Wkly. Rep. 51:1-45, 2002). The best antimicrobial efficacy can be achieved with ethanol (60 to 85%), isopropanol (60 to 80%), and n-propanol (60 to 80%). The activity is broad and immediate. Ethanol at high concentrations (e.g., 95%) is the most effective treatment against naked viruses, whereas n-propanol seems to be more effective against the resident bacterial flora. The combination of alcohols may have a synergistic effect. The antimicrobial efficacy of chlorhexidine (2 to 4%) and triclosan (1 to 2%) is both lower and slower. Additionally, both agents have a risk of bacterial resistance, which is higher for chlorhexidine than triclosan. Their activity is often supported by the mechanical removal of pathogens during hand washing. Taking the antimicrobial efficacy and the mechanical removal together, they are still less effective than the alcohols. Plain soap and water has the lowest efficacy of all. In the new Centers for Disease Control and Prevention guideline, promotion of alcohol-based hand rubs containing various emollients instead of irritating soaps and detergents is one strategy to reduce skin damage, dryness, and irritation. Irritant contact dermatitis is highest with preparations containing 4% chlorhexidine gluconate, less frequent with nonantimicrobial soaps and preparations containing lower concentrations of chlorhexidine gluconate, and lowest with well-formulated alcohol-based hand rubs containing emollients and other skin conditioners. Too few published data from comparative trials are available to reliably rank triclosan. Personnel should be reminded that it is neither necessary nor recommended to routinely wash hands after each application of an alcohol-based hand rub. Long-lasting improvement of compliance with hand hygiene protocols can be successful if an effective and accessible alcohol-based hand rub with a proven dermal tolerance and an excellent user acceptability is supplied, accompanied by education of health care workers and promotion of the use of the product

Is there a role for triclosan/copolymer toothpaste in the management of periodontal disease?

“…Initially developed in the 1960s, it has been used in a wide range of personal care and health related products for over 40 years, more recently including toothpastes. 12,52,53 Triclosan is effective against both Gram positive and Gram negative bacteria and has low toxicity. When compared to chlorhexidine, it has a lower level of anti-microbial activity, however, it has the advantages of being compatible with other toothpaste ingredients such as ionic surfactants and sodium fl uoride and having an acceptable taste.…”

Brote por Serratia marcescens en una Unidad de Cuidados Intensivos Neonatales: Guayaquil-Ecuador

“…El bajo peso al nacer, la estancia prolongada, el uso de dispositivos médi-cos invasores y la utilización previa de antimicrobianos son considerados factores de riesgo para su adquisición 3 . Su transmisión ocurre a través de las manos del personal de salud desde reservorios inanimados o a partir de neonatos con colonización gastrointestinal 4 .…”

Empfehlung zur Prävention nosokomialer Infektionen bei neonatologischen Intensivpflegepatienten mit einem Geburtsgewicht unter 1500 g

“…B. Blutentnahmen, Injektionen, Punktionen) muss ein Hautantiseptikum aufgetragen und die deklarierte Einwirkzeit eingehalten werden (Haut trocknen lassen). Es empfiehlt sich die Begrenzung auf Präpa-rate mit möglichst geringem resorptivem Risiko [207,208].…”