Bactericidal efficacy of a 1.5min surgical hand-rubbing protocol under in-use conditions.

In healthy volunteers, surgical hand rubbing with Sterillium for 1.5min has been shown to be as effective as a 3min procedure. The aim of this study was to assess whether this result was reproducible under in-use conditions. During nine weeks in the ambulatory surgery theatre of a 750-bed tertiary care university hospital, the two surgical hand-rubbing procedures were compared with each other, and with a hand-scrubbing procedure using a povidone-iodine (4%) scrub prior to and after 25 different surgical operations for each. Imprints of the surgeon's dominant hand were taken on culture plates before and within 1min following the end of the hand-rubbing/scrubbing procedures (immediate effect) and at the end of surgery (sustained effect). Plates were incubated aerobically at 37 degrees C for 48h. Colonies were counted at 24h and 48h. Results were expressed as the number of colony-forming units per hand. No significant difference in baseline hand bacterial load was found before the hand-rubbing/scrubbing procedures among the three groups (P=0.19). With respect to immediate and sustained antimicrobial effects, a significantly greater reduction in microbial loads on the hands was achieved with the 3min hand-rubbing protocol as opposed to hand-scrubbing protocol (P=0.04 and P=0.02, respectively), but there was no difference between the reductions obtained with 1.5 and 3min rubbing protocols (P=0.41 and P=0.36, respectively). Surgical hand rubbing with Sterillium using a 1.5min protocol should be considered as an attractive alternative method for surgical hand disinfection.

Evaluation of a new disinfection procedure for ultrasound probes using ultraviolet light.

Following 183 ultrasound examinations, a randomized trial was conducted to compare three procedures for disinfection of probes under routine conditions: dry wiping with a soft, dry, non-sterile paper towel, antiseptic wiping with a towel impregnated with disinfectant spray and dry wiping followed by a 10 min ultraviolet C (UVC) cycle in a disinfection chamber. After ultrasonography, swabs were taken from transducer heads before and after cleaning and streaked onto plates that were then cultured. The number of colonies per plate was counted and organisms identified. The median microbial reduction was 100% for UVC, 98.4% for antiseptic wiping and 87.5% for dry wiping (P<0.001). The percentage of negative specimens was 88% for UVC, 16% for antiseptic wiping and 4% for dry wiping (P<0.0001). Microbial flora was isolated from 12 probes (6.6%) before cleaning, whereas specimens obtained after cleaning contained no pathogens except in one case after antiseptic wiping. UVC disinfection of ultrasound probe may provide a useful method for reducing the bacterial load under routine conditions.

Microbiological evaluation of two hand hygiene procedures achieved by healthcare workers during routine patient care: a randomized study.

The aim of this study was to evaluate the comparative microbiological efficacy of hand rubbing and handwashing in healthcare workers from different wards, with particular emphasis on transient flora, and to assess predisposing factors for hand contamination after patient care in everyday practice. Over a six-month period, 50 healthcare workers were randomly assigned, using a crossover design, to perform handwashing with unmedicated soap and hand rubbing with an alcoholic solution following a healthcare procedure. Imprints of palms and fingertips were taken separately before and after each hand hygiene procedure. The number of colonies per plate was counted and transient pathogens were identified. Risk factors for hand contamination were determined. Hand rubbing produced a significantly greater reduction in microbiological load than handwashing (P<0.0001 for palms and P=0.0003 for fingertips). In multivariate analysis, working in a medical ward rather than in an intensive care unit was significantly associated with increased hand contamination (P=0.03 for palms and P=0.02 for fingertips). Transient pathogens were found on 15% of healthcare workers' hands before hand hygiene. The only factor associated with hand contamination by transient pathogens was the absence of gloving during the healthcare procedure (odds ratio 4.8; 95% confidence interval 1.2-19; P=0.03). After hand rubbing, no transient pathogens were recovered, while these were found in two cases after handwashing. Hand rubbing is more efficacious than handwashing for the decontamination of healthcare workers' hands following contact with patients and patients' environments. Gloving may reduce microbiological hand contamination by transient pathogens.

[Ultrasonographic fetal growth curves in the West Indies. Apropos of 2930 measures of 889 fetuses]. / Courbes échographiques de croissance foetale aux Antilles. A propos de 2,930 mesures portant sur 889 foetus.

OBJECTIVE: To establish the echographic foetal growth curves between 20 and 40 weeks amenorrhoea in the specific population of the West Indies. SITE. Gynecology-Obstetrics Unit, Redoute Hospital, Fort-de-France. POPULATION: All echographies performed between the 20th and 40th week of amenorrhoea in single foetus pregnancies in women of local origin who had undergone an echography before 15 weeks of amenorrhoea were included. Major malformations and chromosomic abnormalities were excluded. METHODS: A total of 2,930 measurements of the biparietal, transverse abdominal diameters and length of femur were recorded in 889 foetuses. The curves for the 10th, 50th and 90th percentiles were constructed by smoothing with a second end linear curve for each of the echographic parameters. For each parameter, the growth curves were compared with the curves established by Leroy and Bessis for the French population. The difference in the growth curves between the two populations were correlated to gestational age in order to establish whether there is a difference between the West Indies population and the metropolitan French population. RESULTS: Comparison with the Leroy and Bessis curves revealed that the rate of growth in the transverse abdominal diameter and the length of femur was significantly different between the West Indies population and the French population (p < 0.01). Inversely, the rate of growth of the biparietal diameter was comparable for the two populations. CONCLUSION: These growth curves provide echographists and obstetricians who examine patients of West Indies origin to adapt their obstetrical management. An ethnic factor cannot be excluded in explaining the difference between the two populations. This study confirms the requirement to establish foetal growth curves of each separate region.