Subungual Bacteria of the Hand: Contribution to the Glove Juice Test; Efficacy of Antimicrobial Detergents

Abstract

Methodologies for evaluating the efficacy of antimicrobial agents in the bacterial flora of the hand involve variations of the "glove juice" or "sterile bag" procedures. In this study we demonstrate that the subungual flora contribute significantly to the recovery of bacteria in these procedures. Culturing hands that had the subungual spaces sealed with acrylic polish demonstrated a decay type of curve for the number of bacteria recovered in successive samplings with 10(6) colony forming units (CFU) bacteria recovered in the first sampling and 10(3) in the sixth while the opposite hand on which the subungual spaces were not sealed demonstrated a continuous recovery of 10(6) CFU. Serial scrubbings of three minutes with plain detergent, 10% povidone-iodine or 4% chlorhexidine demonstrated a three logarithm reduction for povidone-iodine and four logarithm reduction compared to plain detergent alone for chlorhexidine in hands that had subungual spaces sealed, while the opposite hand showed only a 0.5 to 1.0 logarithm reduction. Povidone-iodine produced a 0.6 logarithm reduction and 4% chlorhexidine or 1.4 logarithm reduction in the density of subungual bacteria.

An Epidemiological Study of Methicillin‐resistant Staphylococcus aureus (MRSA) Isolated from Medical Staff, Inpatients, and Hospital Environment in One Ward at Our Hospital

“…Additionally, medical staff should wash their hands thoroughly with effective antimicrobial agents (8)(9)(10). We previously reported a study of'ehe efficacy of several kinds of Japanese detergents (11).…”

Bacterial Recolonization During Foot Surgery: A Prospective Randomized Study of Toe Preparation Techniques

“…A further reservoir of bacteria exists in the nail folds that may not be penetrated by topical agents. 8,13 In addition to standard preoperative disinfection with topical antiseptic agents, measures to reduce the risk of contamination during foot surgery may include formally scrubbing each toe cleft in turn and separately covering the forefoot in a sterile wrap. There is little evidence to suggest whether these additional techniques are effective in reducing the levels of bacteria on the skin during surgery.…”

Quantifying School Officials’ Exposure to Bacterial Pathogens at Graduation Ceremonies Using Repeated Observational Measures

“…Culturette swabs soaked with modified Stuart’s medium™ were then applied to collect bacterial samples. Hand culture protocols in which participants immerse their hands in an enrichment broth solution are superior in assessing total bacterial load on hand surfaces (Leyden, McGinley, Kates, & Myung, 1989) but would have been inappropriate for school officials eager to conduct a graduation ceremony. Furthermore, hand culture protocols are heavily influenced by bacteria around the fingernail (Leyden et al, 1989) although fingernails play no role in a typical handshake.…”

“…Hand culture protocols in which participants immerse their hands in an enrichment broth solution are superior in assessing total bacterial load on hand surfaces (Leyden, McGinley, Kates, & Myung, 1989) but would have been inappropriate for school officials eager to conduct a graduation ceremony. Furthermore, hand culture protocols are heavily influenced by bacteria around the fingernail (Leyden et al, 1989) although fingernails play no role in a typical handshake. Each of the participant’s hands was set on a clean drape and swabbed from the base of the thumb to the side of index finger and then around the edges of the other fingers to account for all possible areas for hand contamination during a handshake (Figure 1 ).…”