Hand disinfection: a comparison of various agents in laboratory and ward studies

Predicting and explaining behavioral intention and hand sanitizer use among US Army soldiers

“…Settings and stated that alcohol-based hand sanitizers are more effective for standard handwashing or hand antisepsis by healthcare workers than soap or antimicrobial soaps (Ayliffe, Babb, Davies, & Lilly, 1988;Boyce & Pittet, 2002;Cardoso, Pereiraa, Zequimb, & Guilhermettia, 1999;Larson, 1986;Ojajarvi, 1980;Paulson, Fendler, Dolan, & Williams, 1999;Rotter & Koller, 1992;Zaragoza, Salles, Gomez, Bayas, & Trilla, 1999).…”

Hand Hygiene

“…Table I.11.6 summarizes a number of studies that have compared alcohol-based products with plain or antimicrobial soaps to determine which was more effective for standard handwashing or hand antisepsis by HCWs (for details see Part I, Section 11.13). 88,125,137,221,223,[273][274][275][276][277][278][279]286,[313][314][315][316][317][318][319][320][321] The efficacy of alcohol-based hand hygiene products is affected by a number of factors including the type of alcohol used, concentration of alcohol, contact time, volume of alcohol used, and whether the hands are wet when the alcohol is applied. Small volumes (0.2-0.5 ml) of alcohol applied to the hands are no more effective than washing hands with plain soap and water.…”

“…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.…”

“…78,79,94,[132][133][134][135][136][137][138][139][140][141][142] For example, in studies conducted before glove use was common among HCWs, Ayliffe and colleagues 137 found that 15% of nurses working in an isolation unit carried a median of 1x 10 4 CFU of S. aureus on their hands; 29% of nurses working in a general hospital had S. aureus on their hands (median count, 3.8 x 10 3 CFU), while 78% of those working in a hospital for dermatology patients had the organism on their hands (median count, 14.3 x 10 6 CFU). The same survey revealed that 17-30% of nurses carried Gram-negative bacilli on their hands (median counts ranged from 3.4 x 10 3 CFU to 38 x 10 3 CFU).…”

Hand Hygiene in the New Millennium: Drawing the Distinction Between Efficacy and Effectiveness

“…841 The results of studies involving the random sampling of healthcare workers during their work shifts (ie, without any assurance that hand hygiene had been performed any time recently) suggest that under certain circumstances the entire hands of healthcare workers may become colonized with as many as 10 6 colony-forming units (CFU) of potential pathogens. 10 However, studies focusing on the degree of contamination resulting from a single "episode" of patient care generally indicate 10 3 CFU to be the maximum microbial burden that an alcohol hand rub should be expected to eradicate. 8911 In one study, the microbial load on the five fingertips of one hand was as high as 300 CFU following certain high-risk patient care activities; however, the median degree of contamination following the care of any individual patient was only 39 CFU.…”