A test procedure for evaluating surgical hand disinfection

Hand Hygiene

“…Despite both in vitro and in vivo studies demonstrating that it is less efficacious than chlorhexidine, povidone-iodine remains one of the widely-used products for surgical hand antisepsis, induces more allergic reactions, and does not show similar residual effects. 271,463 At the end of a surgical intervention, iodophortreated hands can have even more microorganisms than before surgical scrubbing. Warm water makes antiseptics and soap work more effectively, while very hot water removes more of the protective fatty acids from the skin.…”

“…464 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. 268,271,[280][281][282][283][284][285][286]301,313,316,[461][462][463] Table I.11.10 shows the log 10 reductions in the release of resident skin flora from clean hands immediately and 3 hours after use of surgical handrub products. Alcohol-based preparations proved more efficacious than plain soap and water, and most formulations were superior to povidone-iodine-or CHG-containing detergents.…”

“…Concentrations are given as either percentage of volume (= ml/100 ml, abbreviated % v/v), percentage of weight (= g/100 g, abbreviated % m/m), or percentage of weight/volume (= g/100 ml, abbreviated % m/v). Studies of alcohols have evaluated either individual alcohols in varying concentrations (most studies), combinations of two alcohols, or alcohol solutions containing small amounts of hexachlorophene, quaternary ammonium compounds (QAC), povidone-iodine, triclosan or CHG. 137,221,[267][268][269][270][271][272][273][274][275][276][277][278][279][280][281][282][283][284][285][286] The antimicrobial activity of alcohols results from their ability to denature proteins. 287 Alcohol solutions containing 60-80% alcohol are most effective, with higher concentrations being less potent.…”

“…48,268,271,[280][281][282][283][284][285][286]301,313,316,[460][461][462][463] 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; this has been shown to be questionable by in vivo experiments only if a suitable neutralizer is used to stop any prolonged activity in the sampling fluids and on the counting plates.…”

“…137,284,375 In studies where bacterial counts were obtained after individuals wore gloves for 1-4 hours after washing, however, iodophors demonstrated poor persistent activity. 48,271,282,360,[376][377][378][379][380][381] The in vivo antimicrobial activity of iodophors is significantly reduced in the presence of organic substances such as blood or sputum. 204 Povidone iodine has been found to be less effective than alcohol 60% (v/v) and hydrogen peroxide 3% and 5% on S. epidermidis biofilms.…”