Alcohol Sanitizer Research Articles

1518Hand Hygiene for Patients: an Initiative to Study and Promote Hand Hygiene Practice for Hospitalized Patients

1518Hand Hygiene for Patients: an Initiative to Study and Promote Hand Hygiene Practice for Hospitalized Patients

Micrograph Analysis of Disinfectants on Escherichia Coli

RESULTS: Two of the six studies showed a reduction in HAIs with the addition of an alcohol sanitizer, three studies showed no additional benefit, and one study showed that the addition of alcohol sanitizers significantly increased nosocomial infections. The two studies where alcohol showed a benefit were conducted with a PCMX control. In one of the studies where the authors concluded no difference, the raw data showed a 27% increase in HAIs with alcohol. In another, alcohol increased infections over the baseline in 4 of 6 categories studied. LESSON LEARNED: Alcohol sanitizers have not been conclusively demonstrated to reduce HAIs over handwashing, and have never shown superiority over a top-tier handwash. The failure to reduce HAIs, despite increasing compliance, may be due to the lack of persistent activity. As the FDA Monograph states, “Persistence, defined as prolonged activity, is a valuable attribute that assures antimicrobial activity during the interval between washings, and is important to a safe and effective healthcare personnel handwash.”

Impact of Alcohol Sanitizers on Hospital-acquired Infections: A Systematic Literature Review of Controlled Hospital Clinical Trials

Impact of Alcohol Sanitizers on Hospital-acquired Infections: A Systematic Literature Review of Controlled Hospital Clinical Trials

A case of mouthwash as a source of ethanol poisoning: is there a need to limit alcohol content of mouthwash?

A case of mouthwash as a source of ethanol poisoning: is there a need to limit alcohol content of mouthwash?

Some Alcohol Sanitizers No Better than Soap and Water against Norovirus

Rinsing contaminated fingers with water alone, or with triclosan-containing soap and water, was considerably more effective for removing Norwalk virus than was using an alcohol-based hand sanitizer, but the antibacterial soap showed no advantage over water alone, according to a report in the January Applied and Environmental Microbiology (76:394–399). These findings are from the first known direct test of an alcohol-based hand sanitizer against a human norovirus strain, according to Christine Moe and Pengbo Liu of the Rollins School of Public Health at Emory University in Atlanta, Georgia, and their collaborators there and at North Carolina State University, Raleigh.

Resistance of pathogenic bacteria on the surface of stainless steel depending on attachment form and efficacy of chemical sanitizers

Various bacteria including food spoilage bacteria and pathogens can form biofilms on different food processing surfaces, leading to potential food contamination or spoilage. Therefore, the survival of foodborne pathogens (Escherichia coli O157:H7, Listeria monocytogenes, Salmonella typhimurium, Staphylococcus aureus, Cronobacter sakazakii) in different forms (adhered cells, biofilm producing in TSB, biofilm producing at RH 100%) on the surface of stainless steel and stored at various relative humidities (RH 23%, 43%, 68%, 85%, and 100%) at room temperature for 5 days was investigated in this study. Additionally, the efficacy of chemical sanitizers (chlorine-based and alcohol-based commercial sanitizers) on inhibiting various types of biofilms of E. coli O157:H7 and S. aureus on the surface of stainless steel was investigated. The number of pathogens on the surface of stainless steel in TSB stored at 25°C for 7 days or RH 100% at 25°C for 7 days was significantly increased and resulted in the increase of 3 log(10) CFU/coupon after 1 day, and these levels were maintained for 7 days. When stainless steel coupons were stored at 25°C for 5 days, the number of pathogens on the surface of stainless steel was significantly reduced after storage at RH 23%, 43%, 68%, and 85%, but not at 100%. When the bacteria formed biofilms on the surface of stainless steel in TSB after 6 days, the results were similar to those of the attached form. However, levels of S. aureus and C. sakazakii biofilms were more slowly reduced after storage at RH 23%, 43%, 68%, and 85% for 5 days than were those of the other pathogens. Formation of biofilms stored at RH 100% for 5 days displayed the highest levels of resistance to inactivation. Treatment with the alcohol sanitizer was very effective at inactivating attached pathogens or biofilms on the surface of stainless steel. Reduction levels of alcohol sanitizer treatment ranged from 1.91 to 4.77 log and from 4.35 to 5.35 log CFU/coupon in E. coli O157:H7 and S. aureus, respectively. From these results, the survival of pathogens contaminating the surfaces of food processing substrates such as stainless steel varied depending on RH and attachment form. Also, alcohol-based sanitizers can be used as a potential method to remove microbial contamination on the surfaces of utensils, cooking equipment, and other related substrates regardless of the microbial attached form.

Comparison of Sanitizing Methods for Reduction of Attached Microorganisms on Various Kitchen Cutting Boards

Escherichia coli O157:H7 infection has been implicated in a number of outbreaks of illness linked to the consumption of foods. Handling raw meat contaminated with E. coli O157:H7 in the kitchen could easily contaminate the surface of cutting boards. Thus, levels of cross-contamination of E. coli O157:H7 from ground beef to cutting boards made of different materials and effects of cleaning methods on reducing E. coli O157:H7 were evaluated. Four types of cutting boards (wood, polyethylene, polypropylene, and acrylic) were selected and contaminated with ground beef inoculated with E. coli O157:H7. Levels of cross-contaminated E. coli O157:H7 on boards were then evaluated. For evaluation of cleaning methods, wiping with dry paper towel, wet paper towel, alcohol paper towel, chlorine paper towel were used to clean the contaminated cutting boards. Initial population of pathogens was 6.09 log CFU/g in ground beef. After 1 h contamination of the inoculated ground beef on the cutting boards, no significant difference were observed in levels of cross-contaminated E. coli O157:H7 depending on the cleaning materials except for the normal polyethylene surface. Order of efficacy in removing E. coli O157: H7 was as follows: alcohol > chlorine > wet > dry paper towel. Cleaning with alcohol sanitizer appeared as the most effective cleaning method for reducing E. coli O157: H7 population on kitchen cutting boards. These results could be used to develop kitchen safety guidelines for preventing foodborne outbreaks.

Pilot Program to Increase Compliance with Hand Hygiene Using a Hand-Held Reporting Device

Methods: The study institution, a multi-site academic medical center with a combined mean daily census of 2,059, requires that contact precautions be implemented for C difficile-infected patients and that staff perform hand hygiene with CHG soap and water after contacting them. Previously, C difficile precautions were indicated by posting a hospital-issued contact precautions sign and displaying stickers on alcohol sanitizer dispensers to remind staff to use CHG after patient contact. In 2010 the infection control team implemented a new isolation category and sign specific to C difficile. Each day for 2 weeks before implementing the new sign, trained observers recorded the presence/absence of CHG and CHG reminder stickers for all C difficile-infected patients. For 4 weeks after sign implementation, observers recorded CHG availability, C difficile sign posting, and hand hygiene/barrier precautions practices of staff entering/exiting rooms of C difficile-infected patients.

Development of a health care personnel handwash with 6-hour persistence

Health care handwashes/sanitizers help prevent the spread of infection. Many are alcohol-based, providing immediate microbial kill. Few contain persistence factors for residual antimicrobial effects. We conducted multiple studies on Viacydin-Containing Alcohol Sanitizer (VCAS) to evaluate antimicrobial properties and skin friendliness. The potential of VCAS to cause use related skin problems was examined by repeated applications over a 3-week period. Excessive handwashing compared effects of VCAS on the skin barrier with that of other handwash products. Antimicrobial range, immediate kill rates, and resistance development were assessed as was the potential for continued antimicrobial activity over an extended period following product use. Our data showed the VCAS formula has broad, rapid antimicrobial efficacy without promoting microbial resistance. VCAS is mild to skin. Antimicrobial persistence testing showed that VCAS remained effective up to 6 hours postapplication. VCAS was superior to or at parity with on-market products, exhibited substantial residual effects and persistence up to 6 hours, and was safe and well tolerated. These results provide strong evidence for the value of VCAS to help prevent and eliminate pathogen contamination of the hands.

Dissemination and Sustainability of a Hospital-Wide Hand Hygiene Program Emphasizing Positive Reinforcement

To increase and sustain hospital-wide compliance with hand hygiene through a long-term ongoing multidimensional improvement program emphasizing behavioral factors. Quasi-experimental short study (August 2000-November 2001) and descriptive time series (April 2003-December 2006). A 450-bed teaching tertiary-care hospital. An initial intervention bundle was introduced in pilot locations that addressed cognitive behavioral factors, which included access to alcohol sanitizer, education, and ongoing audit and feedback. The bundle was subsequently disseminated hospital-wide, along with a novel approach focused on behavior modification through positive reinforcement and annually changing incentives. A total of 36,123 hand hygiene opportunities involving all categories of healthcare workers from 12 inpatient units were observed from October 2000 to October 2006. The rate of compliance with hand hygiene significantly improved after the intervention in 2 cohorts over the first year (from 40% to 64% of opportunities and from 34% to 49% of opportunities;P <.001, compared with the control group). Mean compliance rates ranged from 19% to 41% of 4174 opportunities (at baseline), increased to the highest levels of 73%-84% of 6,420 opportunities 2 years after hospital-wide dissemination, and remained improved at 59%-81% of 4,990 opportunities during year 6 of the program. This interventional cohort study used a behavioral change approach and is one of the earliest and largest institution-wide programs promoting alcohol sanitizer from the United States that has shown significant and sustained improvements in hand hygiene compliance. This creative campaign used ongoing frequent audit and feedback with novel use of immediate positive reinforcement at an acceptable cost to the institution.

재질 표면에 오염된 여러 병원성 세균에 대한 건열살균 및 살균소독제의 저해효과

Pathogens contaminated on the surface of utensils could contribute to the occurrence of outbreaks due to cross-contamination to foods during the food preparation process. Therefore, the efficacy of chemical sanitizers (chlorine-based and alcohol-based commercial sanitizers) and dry-heat (71℃) on inhibiting biofilms of five foodborne pathogens (Escherichia coli O157:H7, Salmonella Typhimurium, Pseudomonas aeruginosa, Listeria monocytogenes, and Staphylococcus aureus) on the surface of stainless steel and polypropylene were investigated in this study. Initial populations of pathogens were 8.8~9.3 and 9.4~10.3 log CFU/coupon on the surface of stainless steel and polypropylene coupon, respectively, and these populations were not significantly reduced when they were treated with water for 5 min at room temperature. Treatments with chlorine sanitizer and dry-heat were not effective on inactivating pathogens on the surfaces of stainless steel and polypropylene. In contrast, treatments with alcohol sanitizer were very effective on inactivating pathogens on the surfaced of stainless steel and polypropylene. Reduction levels ranged from 3.4 to 6.4 log and from 5.5 to 7.4 log CFU/coupon in stainless steel and plastic coupons, respectively. From these results, alcohol-based sanitizer could be used as a potential way for controlling microbial contamination on the surface of utensils, cooking equipment, and other related environments.

Increasing Employee Hand Hygiene Compliance: A Patient Safety Goal

ISSUE: In 2003 healthcare worker hand hygiene became a patient safety goal. In October 2003 the Greenwich Hospital/Yale New Haven Health System Quality Management selected employee compliance with hand hygiene as a quality core measure. Employee compliance with the hand hygiene guidelines was 58% at the start of the initiative . Employees were inconsistent with their hand hygiene practices, had unrealistic perceptions of hand hygiene compliance, failed to recognize the risk to the patient, and were unaware of the hand hygiene policy. In addition a number of barriers to hand hygiene were identified, including sinks blocked by furniture and patient possessions, staff too busy to wash their hands, and the unavailablity of sinks. PROJECT: A Process Improvement Team was formed to address the issues identified, and to improve employee hand hygiene compliance. Improvement strategies included, in-service education with the staff, the distribution of the patient safety goals and the hand hygiene policy and procedure, signage and flyers that emphasized hand hygiene, a newsletter article on hand hygiene, placement of alcohol sanitizer dispensers in areas where sinks were unavailable, as well as in all clinical departments; in all nursing stations, on medication carts, isolation carts, every patient room, and throughout the hospital. Pocket-sized bottles of sanitizer were also available for staff and physicians. A team of hand hygiene monitors trained on observations, documentation and the hand hygiene policy observed employees for compliance with the policy. A compliance scorecard by department and profession was provided to the managers, department heads and the chief of the medical staff. In addition the non-compliant employees received a memo reiterating the hospitals committment to patient safety and the potential consequences of their behavior. RESULTS: In December 2003 the employee hand hygiene compliance was 58% (baseline data). Employee hand hygiene compliance increased from 59% in the 1st Q of fiscal year 2004 to 86% in the 1st Q of fiscal 2005. LESSONS LEARNED: The two most significant factors for increasing hand hygiene compliance among staff was the regular feedback to the individual employee about their hand hygiene practices and the department and nursing unit specific scorecard.

Hand Hygiene Behavior in a Pediatric Emergency Department and a Pediatric Intensive Care Unit: Comparison of Use of 2 Dispenser Systems

Adherence to hand hygiene standards is poor. Approaches and systems to improve hand hygiene practices warrant testing. To compare the frequency of use of manually operated and touch-free dispensers of sanitizer for hand hygiene. Manual and touch-free dispensers of alcohol sanitizer were placed in the emergency department and an intensive care unit of a large pediatric hospital for two 2-month periods for each type of dispenser. Counting devices installed in each dispenser and direct observations were used to determine actual frequency of and indications for hand hygiene. The touch-free dispensers were used significantly more often than were the manual dispensers. The means for the number of episodes of hand hygiene per hour were 4.42 for the touch-free dispensers and 3.33 for the manual dispensers (P=.04); the means for the number of episodes per patient per hour were 2.22 and 1.79, respectively (P=.004); and the means for the number of uses of the dispenser per day were 41.2 and 25.6, respectively (P=.02). However, the overall compliance rate was 38.4% (2136 episodes of hand hygiene per 5568 indications for hand hygiene). The type of dispensing system influenced hand hygiene behavior. Nevertheless, overall hand hygiene compliance remained low. In order for interventions to have a major effect on hand hygiene, multiple factors must be considered.

Antimicrobial efficacy of a benzethonium chloride hand sanitizer, in vitro and in vivo studies

BACKGROUND/OBJECTIVES: Alcohol-based hand sanitizers are just one of the few products employed by healthcare professionals to maintain clean and hygienic hands. However, these same products have some limitations, such as drying hands and being hazardous to handle in large quantities. In addition, alcohol-based hand sanitizers may have limited use in facilities such as rehabilitation, school, and penal institutions. An alternative ingredient to alcohol is benzethonium chloride (BC). The antimicrobial efficacy of a benzethonium chloride hand sanitizer formulation was evaluated by in vitro and in vivo studies. METHODS: Chlorine equivalency analysis, time-kill, and minimum inhibitory concentration (MIC) studies were performed to determine the antimicrobial kinetics and spectrum of the formulation. In vivo testing consisted of a modified general use handwash procedure performed in a 30-member human handwash panel, where 15 members tested an alcohol-based sanitizer and a control and the other 15 members tested the BC formulation, Lonzagard™, against a control. RESULTS: Chlorine equivalency studies showed that the formulation was efficacious in killing 10 repetitive inoculations of S. choleraesuis and S. aureus. MIC studies demonstrated the widespread antimicrobial activity of the formulation against aerobic and anaerobic gram-positive bacteria, gram-negative bacteria, and yeasts. The antimicrobial activity was immediate upon contact as demonstrated by time-kill studies. In vivo studies demonstrated that both the BC and an alcohol-based sanitizer were equally effective in reducing the bacterial populations of Escherichia coli by a log10 value of 1.70 + 0.72 and 2.07 + 0.61, respectively, after the first application. After the fifth application, the log10 reduction values were 2.75 + 1.13 and 2.50 + 0.95. CONCLUSIONS: The data indicated that the BC formulation was equally effective in reducing the number of microbial counts in contaminated hands as the proven alcohol sanitizer in a human clinical trial. Furthermore, chlorine equivalency analysis and MIC and time-kill studies demonstrated a consistent, broad-spectrum, and rapid antimicrobial activity. The study demonstrates the suitability of the formulation for use as a hand sanitizer.

Effect of Antiseptic Handwashing vs Alcohol Sanitizer on Health Care–Associated Infections in Neonatal Intensive Care Units

The Centers for Disease Control and Prevention, Atlanta, Ga, recommend use of waterless alcohol hand products in lieu of traditional handwashing for patient care, but there are few data demonstrating the impact of this recommendation on health care-associated infections. To compare the effect of 2 hand hygiene regimens on infection rates and skin condition and microbial counts of nurses' hands in neonatal intensive care units. Clinical trial using a crossover design in 2 neonatal intensive care units in Manhattan, NY, from March 1, 2001, to January 31, 2003, including 2932 neonatal hospital admissions (51 760 patient days) and 119 nurse participants. Two hand hygiene products were tested: a traditional antiseptic handwash and an alcohol hand sanitizer. Each product was used for 11 consecutive months in each neonatal intensive care unit in random order. After adjusting for study site, birth weight, surgery, and follow-up time, there were no significant differences in neonatal infections between the 2 products; odds ratios for alcohol compared with handwashing were 0.98 (95% confidence interval [CI], 0.77-1.25) for any infection, 0.99 (95% CI, 0.77-1.33) for bloodstream infections, 1.61 (95% CI, 0.57-5.54) for pneumonia, 1.78 (95% CI, 0.94-3.37) for skin and soft tissue infections, and 1.26 (95% CI, 0.42-3.76) for central nervous system infections. The skin condition of participating nurses was significantly improved during the alcohol phase (P = .02 and P = .049 for observer and self-assessments, respectively), but there were no significant differences in mean microbial counts on nurses' hands (3.21 and 3.11 log(10) colony-forming units for handwashing and alcohol, respectively; P = .38). Infection rates and microbial counts on nurses' hands were equivalent during handwashing and alcohol phases, and nurses' skin condition was improved using alcohol. However, assessing the impact on infection rates of a single intervention is challenging because of multiple contributory factors such as patient risk, unit design, and staff behavior. Other practices such as frequency and quality of hand hygiene are likely to be as important as product in reducing risk of cross-transmission.