Tolerance and acceptability of 14 surgical and hygienic alcohol-based hand rubs

Girard, R.; Bousquet, Emilie; Carré, E.; Bert, C.; Coyault, C.; Coudrais, Stéphanie; Regard, Anne; Garcia, E. Laprugne; Valdeyron, M.L.; Pergay, V.

doi:10.1016/j.jhin.2006.01.017

Cited by 22 publications

(16 citation statements)

References 15 publications

(7 reference statements)

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“…These agents have a rapid-kill effect due to their alcohol content, and often contain another antiseptic agent such as CH that remains on the skin and provides a more prolonged antimicrobial effect [7,11,21]. They take less time to apply, and perhaps most importantly are the least traumatic means of reducing the microbial flora of the hands, particularly with repeated use, when compared to traditional soap-and-water scrub [7].…”

Section: Discussionmentioning

confidence: 99%

Observational study of patient and surgeon preoperative preparation in ten companion animal clinics in Ontario, Canada

2013

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BackgroundSurgical site infections (SSIs) are a recognized risk of any surgical procedure in veterinary medicine. One of the keys to prevention of SSIs is reducing exposure of the surgical site to endogenous and exogenous microbes, beginning in the preoperative period. While guidelines are available for preoperative preparation procedures, there has been no objective investigation of compliance with these recommendations in veterinary practices. The objectives of this pilot study were to describe preoperative patient and surgeon preparation practices in a sample of non-equine companion animal veterinary clinics, and to determine if there were any areas that consistently did not meet current guidelines.ResultsObservation of preparation practices was performed in 10 clinics over 9–14 days each using up to 3 small wireless surveillance cameras. Data were coded for 148 surgical patients, and 31 surgeons performing 190 preoperative preparations. When patient hair removal was observed, it was most commonly done using clippers (117/133, 88%), and in only one case was it performed prior to anesthetic induction. Patient contact time with soap ranged from 10-462 s (average of clinic means 75 s, average of clinic medians 67 s), and with alcohol from 3-220 s (average of clinic means 44 s, average of clinic medians 37 s). Alcohol-based hand rub (AHR) was used preoperatively in 2/10 facilities, but soap-and-water hand scrub was most commonly used at all clinics. Proximal-to-distal scrubbing was noted in 95/142 (67%) of soap-and-water scrubs. Contact time during surgeon hand preparation ranged from 7-529 s (average mean 121 s, average median 122 s) for soap-and-water and from 4-123 s (average mean 25 s, average median 19 s) for AHR. No significant changes in practices were identified over time during the observation period. Practices that did not conform to guidelines available in major companion animal surgical textbooks were commonly observed.ConclusionsSome preoperative preparation practices were relatively consistent between clinics in this study, while others were quite variable. Contact times with preoperative preparatory solutions for both patients and surgeons were often shorter than recommended. Evidence-based guidelines for these procedures in veterinary medicine should be established and implemented in order to help reduce preventable SSIs, while maintaining efficiency and cost-effectiveness.

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Section: Discussionmentioning

confidence: 99%

Observational study of patient and surgeon preoperative preparation in ten companion animal clinics in Ontario, Canada

2013

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“…Studies particularly from high income countries and a few from low-middle income countries focus on prevention and control of HAIs. Of those even fewer propose any suitable and valid methods to test the level of confidence, tolerability and acceptability of a hand hygiene product under real work conditions [ 7 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

A step-wise approach towards introduction of an alcohol based hand rub, and implementation of front line ownership- using a, rural, tertiary care hospital in central India as a model

Sharma

Joshi

Shah

et al. 2015

BMC Health Serv Res

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BackgroundAppropriate hand hygiene is a gold standard to combat healthcare associated infections (HAIs). The World Health Organization (WHO) has recommended alcohol based hand rub (ABHR) as the most effective tool to maintain hand hygiene. In resource poor settings commercially available ABHR is not “economically accessible”. The objectives of this study were to assess the acceptability of, and to build confidence for an in-house prepared (based on WHO guidelines) alcohol based hand rub among healthcare workers (HCWs) using a rural, tertiary care hospital in central India as an example.MethodsA series of activities were developed and conducted based on the Precede-Proceed model, the Trans Theoretical model of behaviour change, Front line ownership and Social marketing. A modified WHO-ABHR formulation, the ‘test product’ and ‘WHO product evaluation form’ were used for self assessment of acceptability of the ‘test product’. Confidence building activities, as finger tip culture, visual portrayal method and handmade posters, were used in high-risk wards for HAIs, to build confidence for the ‘test product’ in removing transient flora from the hands. A locally developed feedback from was used to evaluate the impact of the activities conducted.ResultsOverall 183 HCWs were enrolled for the assessment of the ‘test product’ (130- doctors and 53 nurses). Out of these 83% (108/130) doctors and 94% (50/53) nurses were satisfied with the ‘test product’. The confidence building activity was conducted with 116 participants (49 doctors). After single use of the ‘test product’, overall a significant reduction was observed for the CFUs on the blood agar plates (0.77 Log10, p < 0.001). A complete reduction (100%) in colony forming units on incubated blood agar plates was seen for 13% (15/116) participants. Eighty two percent (95/116) participants expressed their confidence in the ‘test product’.ConclusionThe self reported acceptance level for the ‘test product’ was high. The use of finger tip culture coupled with the visual portrayal was perceived as a convincing and highly effective way to develop confidence in HCWs. Thus, is the foremost step towards successful introduction of ABHR and can be seen as a model for similar settings.

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“…578 Numerous reports confirm that alcohol-based formulations are well tolerated and often associated with better acceptability and tolerance than other hand hygiene products. 504,548,[579][580][581][582][583][584] In general, irritant contact dermatitis is more commonly reported with iodophors 220 Other antiseptic agents that may cause irritant contact dermatitis, in order of decreasing frequency, include chlorhexidine, chloroxylenol, triclosan, and alcoholbased products. Skin that is damaged by repeated exposure to detergents may be more susceptible to irritation by all types of hand antisepsis formulations, including alcohol-based preparations.…”

Section: Frequency and Pathophysiology Of Irritant Contact Dermatitismentioning

confidence: 99%

“…If more than one new product is to be tested, either a period with the routine product or, preferably, a minimum of a 2-day washout period should be observed between test periods. 504,579 When considering the replacement of a product, the new product should be at least as good as the previous one. An inferior product could be responsible for a decrease in hand hygiene compliance.…”

Section: Pilot Testingmentioning

confidence: 99%

“…This difference in consistency has not been associated with better objective tolerance or higher compliance with hand cleansing in a controlled study. 579 A prospective intervention study and a comparison study have shown that the use of a gel formulation was associated with better skin condition, superior acceptance, and a trend towards improved compliance. 493,496 Nevertheless, it is worth recalling that first generations of gel formulations have reduced antimicrobial efficacy compared with solutions.…”

Section: Consistency (Texture)mentioning

confidence: 99%

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