Failure of hand disinfection with frequent hand washing: a need for prolonged field studies

Abstract

SUNMARYIn a prolonged field trial a 4% chlorhexidine digluconate detergent scrub (HibiscrubR), that had earlier proved to be an effective hand disinfectant, was studied in hospital wards. Finger tips were found to harbour more bacteria than the hand dorsum and the samples collected from them yielded more information on the bacteriological and dermatological effects of hand disinfectants in practice.In wards with a relatively low hand-washing frequency (less than 20 times in 8 hours) the bacteriological results resembled those obtained by in-use tests with volunteers. In the neonatal unit where the hand washing frequency was remarkably high, even occasionally over 100 times/8 h shift, an increase in the bacterial colony counts of the majority of the staff was recorded both before and after hand washing already after using the preparation for 1 week. Age, occupation and handwashing frequency all correlated with the bacteriological results. Twenty-seven out of 37 persons complained of side effects such as wounds of finger tips and redness or heavy drying of the skin. Wounds, particularly on finger tips, resulted in the failure of disinfection. An increase in bacterial counts was sometimes noted without any dermatological or subjective changes. Drying of the skin was complained of less often when no increase in skin bacteria occurred.After the changeover of washing practice to a detergent followed by a rinse with spirit solution containing chlorhexidine and glycerol a decrease was recorded in the bacterial counts. It is concluded that more attention should be paid to long-term testing of hand washing and disinfection methods to ensure optimum final results in practice. It is obvious that the knowledge obtained from short time in-use testing cannot be applied to all conditions of use.

Using Alcohol for Hand Antisepsis: Dispelling Old Myths

“…Numerous investigators have dealt with this issue by incorporating 1% to 3% glycerol or other emollients into alcohol hand rinses or gels to help reduce skin dryness. 7 ' 912 ' 17,27 ' 29 Several studies have documented that such preparations are well tolerated by healthcare workers. 6 ' 18 ' 19 ' 2230 ' 31 Unfortunately, most healthcare workers are not familiar with these studies, and the view that frequent use of alcoholbased hand antiseptics will lead to excessive skin dryness has persisted in many hospitals in the United States.…”

Hand Hygiene

“…For example, the drying effect of alcohol can be reduced or eliminated by adding 1-3% glycerol or other skin conditioning agents. 219,221,267,268,273,301,313,326,327 Moreover, in prospective trials, alcohol-based solutions or gels containing humectants caused significantly less skin irritation and dryness than the soaps or antimicrobial detergents tested. 262,264,328,329 These studies, which were conducted in clinical settings, used a variety of subjective and objective methods for assessing skin irritation and dryness.…”

“…577 Damage to the skin also changes skin flora, resulting in more frequent colonization by staphylococci and Gram-negative bacilli. 79,219 Although alcohols are safer than detergents, 262 they can cause dryness and skin irritation. 48,578 The lipid-dissolving effect of alcohols is inversely related to their concentration, 577 and ethanol tends to be less irritating than n-propanol or isopropanol.…”

“…In observational studies conducted in hospitals, HCWs cleaned their hands on average from 5 to as many as 42 times per shift and 1.7-15.2 times per hour (Table I.16.1). 79,137,[217][218][219]262,264,611,613,623,624,[647][648][649][650][651][652][653][654][655] The average frequency of hand hygiene episodes fluctuates with the method used for monitoring (see Part III, Section 1.1) and the setting where the observations were conducted; it ranges from 0.7 to 30 episodes per hour (Table I.16.1). On the other hand, the average number of opportunities for hand hygiene per HCW varies markedly between hospital wards; nurses in paediatric wards, for example, had an average of eight opportunities for hand hygiene per hour of patient care, compared with an average of 30 for nurses in ICUs.…”

“…Provide HCWs with efficacious hand hygiene products that have low irritancy potential (IB). 219,220,262,264,329,548,549,572,607 B. To maximize acceptance of hand hygiene products by HCWs, solicit their input regarding the skin tolerance, feel, and fragrance of any products under consideration (IB).…”