In vivo evaluation of the persistant and residual antimicrobial properties of three hand-scrub and hand-rub regimes in a simulated surgical environment.

BACKGROUND: The use of antimicrobial formulations for disinfecting hands prior to surgery has been shown to reduce the incidence of surgical site infections. Such formulations must demonstrate an immediate reduction of microbial flora on the hands that persists while the hands are gloved. AIM: This study compared persistent and residual antimicrobial effects of three simulated in-use surgical hand-cleansing procedures, one using a scrub followed by a hand rub with products containing chlorhexidine gluconate (CHG), and two using a scrub with a cleansing soap followed by a hand rub with one of two alcohol-based products. METHODS: The study was executed in two phases. In phase 1, persistent antimicrobial effects versus the resident microbial flora of volunteer subjects' hands were evaluated. In phase 2, the residual antimicrobial effects were challenged with the application of Staphylococcus aureus (ATCC 6538) on to the hands of volunteer subjects. FINDINGS: Phase 1 testing showed that significantly greater reductions of normal flora (P ≤ 0.00) persisted with a scrub with the CHG product followed by alcohol/CHG hand rub, than were achieved by scrubs with soap followed by application of either of the other hand rubs. Through all protocols of phase 2, the CHG scrub and alcohol/CHG hand rub produced significantly greater reductions of the S. aureus population (P ≤ 0.00) than did a soap scrub in combination with the other two hand rubs. CONCLUSION: The combination of a scrub and rub with products containing CHG and alcohol was shown to reduce significantly and persistently both the resident flora and contaminating transient bacteria on skin beneath surgical gloves.

A close look at alcohol gel as an antimicrobial sanitizing agent.

BACKGROUND: Hand transmission of microbes by health care workers is a primary cause of nosocomial infections in both long-term and acute care facilities. Compliance with effective handwashing and hand sanitization regimens can break this cycle. METHODS: We investigated the antimicrobial efficacy and irritation potential of 5 handwash product regimens: a nonantimicrobial lotion soap, an antimicrobial lotion soap, an alcohol gel sanitizer, a nonantimicrobial lotion soap with an alcohol gel sanitizer, and an antimicrobial lotion soap with an alcohol gel sanitizer. The regimens were evaluated by using a Healthcare Personnel Handwash procedure, and irritation was assessed by using expert hand evaluation after 25 consecutive washes. RESULTS: The Healthcare Personnel Handwash data showed that the mean log reductions from baseline were greatest for the lotion soaps with alcohol gel sanitizer, less for the alcohol and the antimicrobial soap alone, and least for the bland soap. All of the product regimens showed a low potential for skin irritation. CONCLUSION: In terms of both microorganism reduction and skin irritation, the most effective product regimens were the use of alcohol gel sanitizer in combination with either an antimicrobial or a plain lotion soap.

Comparative evaluation of five surgical hand scrub preparations.

Surgical hand scrubs should remove microorganisms from health care professionals' hands and forearms and maintain the lowest possible microbial counts during surgical procedures. This study evaluated the immediate, persistent, and residual efficacy of five surgical hand scrub products. The two chlorhexidine gluconate (CHG) products achieved significant immediate reduction in the microorganism count and demonstrated persistent and residual efficacy. The iodophor product exhibited effective immediate and persistent antimicrobial properties but failed to show significant residual effects. The parachlorometaxylenol products demonstrated low levels of immediate and persistent effects and no residual antimicrobial effects. The alcohol product demonstrated low immediate, persistent, and residual effects. The investigator concludes that CHG products are the most favorable surgical hand scrub preparations.

Efficacy evaluation of a 4% chlorhexidine gluconate as a full-body shower wash.

A 4% chlorhexidine gluconate (Xttrium Laboratories, Chicago, Ill.) was used in a shower bath application to evaluate its merits in reducing resident skin microorganisms. Five volunteers completed a 14-day microbial stabilization period, a 7-day baseline period, and a 5-day test period. Subjects followed a standard protocol, performed five shower washes and were sampled at both the abdominal and inguinal regions immediately after the shower wash as well as at 3 and 6 hours later on days 1, 2, and 5. Chlorhexidine gluconate provided significant microbial reductions from baseline, with greater reductions noted as the study progressed. Use of chlorhexidine gluconate in a shower wash application in conjunction with a preoperative skin-preparation procedure may reduce the probability of surgically associated infections.