Transient Flora Research Articles

Molecular methods for detection of pathogenic viruses of respiratory tract—A review

Human respiratory system is harbored by a vast array of transient and normal microbial flora. A number of pathogenic viruses were diagnosed from samples in different occasions from mild to severe infections of respiratory tract. Molecular methods were developed for detection of these viruses during last two decades. Nucleic acid amplification methods were introduced for rapid and accurate diagnosis of pathogenic viruses. Multiplex detection systems were employed to identify a panel of pathogenic viruses, which requires specialized kits and instruments in some cases. This review summarizes different types of molecular approaches which were developed with time and applied for the detection of pathogenic viruses associated with infections of the respiratory system.

An Appeal to Incorporate Hand Hygiene Education into Standard Elementary School Curriculum

BackgroundThe Center for Disease Control and Prevention reports that 160 million school days are lost each year due to infectious illnesses. Hand hygiene is one of the most effective ways to prevent illness that can lead to absenteeism among school-aged children, yet few schools have a formal education program as a preventative strategy.MethodsA Pilot Hand Hygiene experiment was initiated for 90 second grade students at a Virginia Beach Public School. The experiment was designed to bring awareness and to satisfy a scientific module requirement. Students cultured their hands on general purpose agar plates with the assistance of physicians and a microbiologist. The proper hand washing technique was demonstrated. Students were equally divided into two groups: hand washing group and sanitizer group. They were instructed to re-culture hands after intervention. Students observed cultures for five days and documented results.ResultsOverall, student observation of decreased microbial growth was an average of 91% (Figure 1). Education improved compliance, which resulted in a favorable behavioral change on average of 89% (Figure 2). There was a 71% decrease in incidence of illness-related absences 30 days after the hand hygiene intervention (Figure 3). In three out of five classes, hand sanitizer was more effective when compared with hand washing. In addition, a random sample of cultures were incubated in a microbiology lab to identify the common microbes among the second-grade elementary school population. It revealed both resident and transient flora. Post-intervention, there was a rise in coagulase-negative Staphylococci resident flora. This indicated a successful decrease in transient flora, which is most likely to cause illness.ConclusionHand Hygiene education is remarkably beneficial, especially in children who are at greater risk of illness. It is clearly effective in decreasing infectious disease risk, while teaching a life-long skill. For the impact as a preventative strategy to be felt, its implementation into elementary school curriculum is warranted.Disclosures All authors: No reported disclosures.

Effects of olanexidine gluconate on preoperative skin preparation: an experimental study in cynomolgus monkeys.

PurposeTo determine the bactericidal efficacy of a new topical antiseptic for preoperative skin preparation, olanexidine gluconate (development code: OPB-2045G), against transient or resident bacterial flora on the skin of cynomolgus monkeys.MethodologyAfter measuring baseline bacterial counts on test sites marked on the abdomens, we applied olanexidine, chlorhexidine or povidone–iodine. After 10 min (fast-acting effect) and 6 h (long-lasting effect), bacterial counts were measured again and log10 reductions were calculated. In addition, we determined the bactericidal effects on the skin contaminated with blood before or after applying the antiseptics.ResultsIn the non-blood-contaminated condition, the mean log10 reductions of olanexidine at doses of 1–2 % were significantly higher than those of saline (negative control), but did not significantly differ from those of 0.5 % chlorhexidine and 10 % povidone–iodine at either time point. But olanexidine was significantly more effective at both time points than chlorhexidine and povidone–iodine when applied after the site was contaminated with blood. Olanexidine was also significantly more effective than chlorhexidine and as effective as or more effective than povidone-iodine at both time points when skin was contaminated with blood after the antiseptics were applied.ConclusionThe bactericidal effects of olanexidine were comparable to those of commercial antiseptics such as chlorhexidine and povidone–iodine in non-blood-contaminated conditions. More importantly, the effect of olanexidine was hardly affected by blood unlike commercial antiseptics. Thus, it is considered that olanexidine has a favourable property for skin preparation in various types of surgical treatments.

Evaluation of antimicrobial persistent activity of alcohol-based hand antiseptics against bacterial contamination.

The purpose of this study was to evaluate persistent activity of three alcohol-based antiseptics widely used in the clinical routine containing chlorhexidine, triclosan or mecetronium after hand disinfection. Four tests were used to evaluate the antimicrobial activity of antiseptics on: (i) resident microbiota; (ii) nutrient agar plates (NAP) subsequently inoculated with a test organism; and transient microbiota acquired by contact with dry hands (iii), or (iv) a wet inert surface that had been artificially contaminated. Four reference strains (Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis) and an Acinetobacter baumannii strain responsible for a hospital outbreak were used as transient microbiota. Antimicrobial activity was calculated according to the CFUs reduction by reference to non-disinfected control hands. The antiseptics were applied according to European Standard EN1500. Solutions containing chlorhexidine or triclosan showed some persistent effects on transient microbiota on inert humid surfaces and NAP, but not on contaminated dry hands. Solutions containing mecetronium showed no persistent effect on transient flora in any of the trials. All alcohol-based antiseptics tested were more effective against resident flora than soap. No persistent activity was observed for A. baumannii in any of the trials. Chlorhexidine and triclosan are preferred when an antiseptic with persistent activity is desired, but a moist environment appears to be necessary for that antibacterial activity. Accordingly, relevant conclusions regarding the persistent activity of antiseptics for clinical practice and protection against bacterial contamination cannot be derived from this study for the alcoholic solutions tested.

Human Sebaceous <i>Cis</i>-6-Hexadecenoic Acid: Possible Application of an Innate Antimicrobial Substance to Cosmetic Products for Mucous Membrane

The antimicrobial properties of cis-6-hexadecenoic acid (C16:1Δ6), a component of the innate human metabolome, were studied and its application to cosmetic products was investigated in detail. A variety of the resident and transient microbial flora of the skin, oral cavity, and intestine was applied to an investigation of the antimicrobial activity of C16:1Δ6. C16:1Δ6 showed selective antibacterial activity against human microbial pathogens such as Clostridium perfringens (one of the most common causes of food poisoning) and Streptococcus mutans (one of the tooth-decaying bacteria), as well as Staphylococcus aureus. C16:1Δ6 seemed to possess a “species-selective” antibacterial activity against bacteria belonging to the genera Staphylococcus and Clostridium. We performed a preliminary assessment of the application of C16:1Δ6 as an antimicrobial component in a liquid lip gloss by performing preservation efficacy and home-use tests. We noted that the amount of p-hydroxybenzoate was needed in an oily cosmetic, especially liquid lip gloss, could be reduced by replacing p-hydroxybenzoate with C16:1Δ6. We suggest that C16:1Δ6 may find application as a stable antimicrobial substance gentle enough for use in consumer products by its selective antimicrobial characteristics.

Evaluation of Transient Microbial Flora on Biometric System as a Potential Source of Infection in Tertiary Care Hospitals

In developing countries, along with the Health Care Providers, Inanimate objects plays a critical role in microbial transmission so also the ability of the microorganism to survive on inanimate objects to cause Hospital Acquired Infections. The purpose of this Study was to evaluate transient microbial flora on Biometric System as a potential Source of infection in hospital settings.

Recent developments for Staphylococcus aureus vaccines: clinical and basic science challenges.

Bacterial vaccines have made dramatic impacts upon morbidity and mortality caused by a number of common pathogens, but a vaccine to prevent Staphylococcus aureus infections has proven to be illusive. With successful bacterial vaccines, the organisms are all part of the transient flora, whereas, S. aureus is part of the normal human flora. This means that S. aureus has had a prolonged time to adapt to the host milieu and its defences. The failure of several staphylococcal antigens to protect humans from infection in vaccine clinical trials using active or passive immunisation has stimulated a re-examination of the fundamental assumptions about staphylococcal immunity in humans vs. animals, especially rodents. This has spurred an active debate about the appropriate models for vaccine development and an examination of our current understanding of the protective immunity in humans. A major factor in the development of previous bacterial vaccines was a biomarker that predicted human protection, e.g., antibodies to tetanus toxoid or to pneumococcal polysaccharide. While antibodies against a number of staphylococcal antigens have proven to be an excellent biomarker for protection in rodents, these have not been translated to human infections. Thus, while much work remains, there is a growing consensus that T-cell immunity plays an important role in protecting humans. Moreover, the presence of anti-staphylococcal toxin antibodies correlates with reduced disease severity in humans. The most important recent advances concerning potential biomarkers, and the role of pre-existing immune status of vaccines in vaccine-associated mortality are considered in this review.

The effect of the chlohexidine bath on preventing catheter-related bloodstream infection in ICU

Objective To study the effect of 2% CHG skin disinfection solution in bath on preventing venous catheter-related bloodstream infection(CRBSI)of ICU. Methods From Jan 2011 to Dec 2012, patients with central venous catheter in ICU were given two stages studies before(using soap and warm water daily) and after interventions(using 2% CHG daily). The skin around the inserting catheter sampled respectively, to monitor the bacteria before and after inserting catheter 48 hours. Results CHG Bath for cleaning the skin surface was statically significant compared with the one using soap.Intervention group with center venous catheter in total 2 076 days, CRBSI infection with 2 cases while the control one with 1 583 days, CRBSI infection with 8 cases.The results show CHG bath significantly reduced the incidence of CRBSI. Conclusions CHG bath could significantly reduce the incidence of CRBSI and decrease and inhabit the growth of the transient skin flora .The CHG bath intervention is effective in decreasing the risk CRBSI. Key words: CHG bath; CVC; Catheter-related bloodstream infection; ICU

Antibacterial activity of a sterile antimicrobial polyisoprene surgical glove against transient flora following a 2-hours simulated use.

BackgroundA surgical glove will protect surgeons and patients only if the glove’s integrity remains intact. However, several studies have demonstrated that undetected micro-perforations of surgical gloves are common. Because of the possibility of surgical glove puncture, an antimicrobial surgical glove was developed. The aim of this laboratory based experimental study was to assess the antibacterial efficacy of the interior chlorhexidine-gluconate (CHG)-coat of an antimicrobial synthetic polyisoprene surgical glove by using a standardized microbiological challenge.MethodsSixteen healthy adult participants donned one antimicrobial surgical glove and one non-antimicrobial surgical glove randomly allocated to their dominant and non-dominant hand following a crossover design. During a 2-h wear time, participants performed standardized finger and hand movements. Thereafter, the interior surface of excised fingers of the removed gloves was challenged with 8.00 log10 cfu/mL S. aureus (ATCC 6538) or K. pneumoniae (ATCC 4352), respectively. The main outcome measure was the viable mean log10 cfu counts of the two glove groups after 5 min contact with the interior glove’s surface.ResultsWhen comparing an antimicrobial glove against an untreated reference glove after 2-h simulated use wear-time, a mean reduction factor of 6.24 log10 (S. aureus) and 6.22 log10 (K. pneumoniae) was achieved after 5 min contact.ConclusionThese results demonstrate that wearing antibacterial gloves on hands does not negatively impact their antibacterial activity after 2-h of wear. This may have a potential benefit for patient safety in case of glove puncture during surgical procedures.

Prevalence of Staphylococcus aureus and methicillin resistant Staphylococcus aureus (MRSA) in the oral cavity

ObjectiveTo assess the prevalence of Staphylococcus aureus and methicillin resistant Staphylococcus aureus (MRSA) in plaque and tongue samples from systemically healthy subjects with periodontal health, gingivitis or chronic periodontitis. MethodsAfter screening 720 potentially eligible subjects, 154 systemically healthy participants were ultimately enrolled in the current study. Subgingival samples were taken from the first molars and the tongue and analyzed for the presence of S. aureus and MRSA by polymerase chain reaction (PCR), using primers and conditions previously described in the literature. In addition, samples were taken from deep periodontal pockets of chronic periodontitis patients. Statistical analysis was performed by applying non-parametric tests (Kruskal–Wallis for clinical parameters, and z-test with Bonferroni corrections for distributions of assessed parameters). All comparisons were set at the 0.05 significance level. ResultsS. aureus was detected in 18% of all participants and in 10% of the samples tested. No significant differences were found in its distribution among the three investigated groups (z-test for proportions with Bonferroni corrections, p>0.05). The mecA gene was not present in any of the S. aureus found. ConclusionsS. aureus can be found in the oral environment regardless of the periodontal conditions and therefore should be considered as a member of the transient flora not participating in periodontal pathology. Subgingival sites and tongue surfaces seem to be an unusual habitat of MRSA.

A step-wise approach towards introduction of an alcohol based hand rub, and implementation of front line ownership- using a, rural, tertiary care hospital in central India as a model.

BackgroundAppropriate hand hygiene is a gold standard to combat healthcare associated infections (HAIs). The World Health Organization (WHO) has recommended alcohol based hand rub (ABHR) as the most effective tool to maintain hand hygiene. In resource poor settings commercially available ABHR is not “economically accessible”. The objectives of this study were to assess the acceptability of, and to build confidence for an in-house prepared (based on WHO guidelines) alcohol based hand rub among healthcare workers (HCWs) using a rural, tertiary care hospital in central India as an example.MethodsA series of activities were developed and conducted based on the Precede-Proceed model, the Trans Theoretical model of behaviour change, Front line ownership and Social marketing. A modified WHO-ABHR formulation, the ‘test product’ and ‘WHO product evaluation form’ were used for self assessment of acceptability of the ‘test product’. Confidence building activities, as finger tip culture, visual portrayal method and handmade posters, were used in high-risk wards for HAIs, to build confidence for the ‘test product’ in removing transient flora from the hands. A locally developed feedback from was used to evaluate the impact of the activities conducted.ResultsOverall 183 HCWs were enrolled for the assessment of the ‘test product’ (130- doctors and 53 nurses). Out of these 83% (108/130) doctors and 94% (50/53) nurses were satisfied with the ‘test product’. The confidence building activity was conducted with 116 participants (49 doctors). After single use of the ‘test product’, overall a significant reduction was observed for the CFUs on the blood agar plates (0.77 Log10, p < 0.001). A complete reduction (100%) in colony forming units on incubated blood agar plates was seen for 13% (15/116) participants. Eighty two percent (95/116) participants expressed their confidence in the ‘test product’.ConclusionThe self reported acceptance level for the ‘test product’ was high. The use of finger tip culture coupled with the visual portrayal was perceived as a convincing and highly effective way to develop confidence in HCWs. Thus, is the foremost step towards successful introduction of ABHR and can be seen as a model for similar settings.

Hand hygiene in reducing transient flora on the hands of healthcare workers: an educational intervention.

Hand hygiene has now been recognised as one of the most effective intervention to control the transmission of infections in a hospital and education is an important tool to ensure its implementation. In order to convince the users and as a part of education, it is important to generate evidence on the role of hand hygiene in reducing the bacterial flora on their hands. The present study was undertaken in a tertiary care hospital to demonstrate the presence of bacterial flora on the hands of healthcare workers (HCW) in different categories, to teach them proper hand hygiene technique using alcohol-based hand rub and determine the outcome for reduction of bacteria. A total sample size of 60 subjects including resident doctors, medical students, nurses and hospital attendants were included in the study after obtaining informed consent. Each person was educated on the technique of hand hygiene with alcohol-based hand rub and hand impressions were cultured before and after hand hygiene. All the subjects were also given a questionnaire to assess their perception on hand hygiene. The WHO posters on proper hand hygiene were displayed in the appropriate areas of the hospital in addition, as an educational tool. Majority (42 out of 60) of the HCWs had bacterial count up to 100 colonies or more on both hands before the application of hand rub while working in the hospital. After use of alcohol hand rub with a proper hand hygiene technique, it was found that the percentage reduction was 95-99% among doctors and nurses, 70% among hospital attendants and 50% among sanitary attendants. Staphylococcus aureus was present on the hands of eight persons of which three were methicillin-resistant Staphylococcus aureus. The study demonstrates that transient bacteria are present on the hands of HCWs but majority could be removed by proper hand hygiene, which needs continuous education to be effective. It also shows that active education by demonstrating the proper hand hygiene technique and direct observation of the practices, though demanding, are ideal to understand the attitudes and practices of HCWs and helps in planning implementation strategies.

Antibacterial Activity of Liquid Hand Washes Against Daily Encounter Bacteria

Hands are out in the open to a lot of substances which comprises of dirt touching during personal hygiene, raw and contaminated materials. Bacteria are deposited on skin from external source causing variety of infections. Cleaning hands with antibacterial hand washes stops the spread of bacteria or loose transient flora preventing cross infections. 195 samples were used for determination of MIC and MBC of different antibacterial hand washes with inoculations of a variety of bacteria. Phenol was used as control to measure up its activity with liquid soaps. In the list of liquid soaps, safeguard was found with highest efficacy in terms of its minimum inhibitory concentration against Staphylococcus aureus and Escherichia coli while Johnson and Johnson baby liquid soap had maximum activity against various microorganisms. In order as Johnson and Johnson > Dettol >Safeguard >Lifebuoy >Lux. Staphylococcus aureus had growing resistance against various liquid soaps as Safeguard Johnson and Johnson > Lifebuoy > Lux > Dettol. The MBC values were found to be two to three times greater than its MIC values. The results prove that liquid soaps have a greater effect on inhibition and removal of bacterial population than plain soaps.

Hand contamination during routine care in medical wards: the role of hand hygiene compliance

The hands of healthcare workers (HCWs) are the most common vehicle for the transmission of micro-organisms from patient to patient and within the healthcare environment. The aim of this study was to evaluate the impact of a multimodal campaign on the type and amount of resident and transient flora and the presence of potential risk factors for hand contamination during routine care. A before-after (PRE and POST periods) interventional study was carried out in medical wards of a tertiary care hospital. Eighty-nine samples were analysed. Samples were cultured immediately before patient contact using a glove-juice method. Data collected included socio-demographic and risk factors for hand contamination. Flora was measured as log10 c.f.u. ml(-1) and evaluated by comparing median values in the PRE and POST periods. Transient flora was isolated from the hands of 67.4 and 46.1 % of HCWs in the PRE and POST periods, respectively (P<0.001). Enterobacteriaceae, Pseudomonas spp. and meticillin-sensitive Staphylococcus aureus were the predominant contaminants. Resident flora was isolated from 92.1 % of HCWs in the PRE period and from 70.8 % in the POST period (P<0.001). The meticillin-resistant coagulase-negative staphylococci log10 c.f.u. count ml(-1) decreased from 1.96 ± 1.2 to 0.89 ± 1.2 (mean ± s d; P<0.001), and the global flora count decreased from 2.77 ± 1.1 to 1.56 ± 1.4 (P<0.001). In the POST period, the wearing of fewer rings (P<0.001), shorter fingernail length (P = 0.008), a shorter time since recent hand hygiene (HH) (P = 0.007) and an increased use of alcohol-based hand rub instead of soap (P<0.001) were documented. The HH multimodal strategy reduced the number of risk factors and the level of HCW hand contamination.

Infections in Notes

Introduction of NOTES was welcomed with great enthusiasm. Several experimental and human studies proved feasibility and safety of NOTES procedures (1). In some applications it might be a valid option, however it seems it will not devaluate most of well established laparoscopic and open procedures (2). In terms of surgical safety, one of the serious unknowns of NOTES are surgical infections. There is little known about the prophylactics, epidemiology and potential treatment of infections after NOTES procedures. The number of studies assessing this issue is limited. Some data can be extrapolated from other non-NOTES procedures performed through the same access sites. Both open and laparoscopic surgeries start with incision of the skin, which is quite simple to decontaminate. NOTES starts with mucosal incision inside the vagina, stomach or large bowel and all mucosa host numerous populations of microorganisms (stable and transient flora), which can contaminate peritoneal cavity or even translocate to blood (3). From the microbiological point of view surgical procedures are always related to transmission of flora to their non-physiological sites. Therefore antibiotic prophylaxis with or without other preventive measures seems to be essential in all cases. Surgical accesses are microbiologically very similar, and vary in possible magnitude of microbial transmission. Additionally since there is no open wound and external drainage is limited, surgical site infections in NOTES are to be much harder to diagnose and treat. Endoscopic equipment

Fungal Infections in Cholangitis: Implementation of Diagnostic and Therapeutic Algorithm

Purpose: Infections of the biliary tract with Candida and other fungal species have frequently been reported in the recent years. The aim of this multicenter study was to establish an algorithm for clinical diagnostics and treatment of biliary candidiasis. Methods: Ninety-four patients were included in the study (ClinicalTrials.gov Identifier: NCT01109550). Bile samples for microbiological analysis were obtained by endoscopic retrograde cholangiography (ERC). If appropriate, endoscopic bile duct biopsies were taken for evaluation of invasive fungal infection. Buccal smears and stool samples were collected to identify the individual transient flora. The obtained information was integrated into a diagnostic algorithm (Figure 1).Figure 1: Suggested diagnostic and therapeutic algorithm for biliary candidiasis.Results: In 26 of the 94 patients, we found Candida species in the bile (27.7%). Risk factors for biliary candidiasis were recent long-term antibiotic therapy (>7 days) and age (p<0.05). Forty-two percent of the Candida subspecies were differentiated as complicated with assumed resistance against azole antifungals (C. glabrata, tropicalis, dubliensis). One invasive mycosis was identified histologically without mycological proof in the in bile. Eight patients were treated with antimycotic drugs according to our suggested treatment algorithm; two patients with progressive cancer, two with biliary cast syndrome after cardiopulmonary resuscitation, one with M. Ormond, and three with sepsis of unknown focus. Positive oral (buccal) and enteral (stool) fungal cultures did not correlate with biliary candidiasis (p=0.066 and p=0.158). Furthermore, no significant association of prior endoscopic sphincterotomy (p=0.360) or prior ERCP (p=0.341) and biliary candidiasis were found. No positive fungal blood culture samples were obtained. Conclusion: Candida and its subspecies are frequently seen in the bile of patients with biliary obstruction. Our data indicate that the suggested diagnostic algorithm for biliary candidiasis is feasible in daily clinical routine. The question whether transpapillary biopsies are necessary to diagnose biliary candidiasis is not answered yet. This research was supported by an industry grant from Merck Investigator-initiated Studies Program.

Skin flora: implications for nursing

Many patients receiving inpatient care or admitted as day cases undergo invasive procedures that place them at potential risk of healthcare-associated infection. Human skin is populated with microorganisms most of which are harmless, however some have pathogenic potential. This article outlines the protective function of intact skin and describes its resident and transient microbial flora. The role and limitations of antiseptics in reducing the risk of infection are discussed.

Evaluation of Two Different Hand Hygiene Procedures during Routine Patient Care

In this study, the antimicrobial efficacy of hand washing (HW) and hand washing plus rubbing with an alcohol-based solution (HWR) on numbers of total and transient flora colonies on the hands of healthcare workers (HCWs) during routine patient care was assessed. Samples were collected, using a standard bag broth technique, from the hands of 154 HCWs, before and immediately after carrying out a hand hygiene procedure. The numbers of total and transient flora colonies per plate were counted and transient pathogens were identified. A significant statistical difference between ward speciality was detected with respect to the isolation rate of transient flora. Transient hand flora were recovered from 25.3% of HCWs before carrying out the hand hygiene procedure. With respect to the disappearance and prevention of regrowth of transient flora after hand hygiene, the HWR technique was significantly more effective than HW. In conclusion, a disinfectant should be added to the hand washing process to achieve optimum protection against nosocomial infections in routine hospital practice.

Microbial flora on the hands of healthcare workers

The aims of this study were to study the process of microbial contamination of healthcare workers’ (HCWs) hands during routine patient care and simultaneously to evaluate the state of antibiotic susceptibility of microorganisms isolated from the hands of HCWs. Samples were collected from the hands of 154 HCWs working at Gaziantep University Hospital. A standard bag broth technique was employed. In addition to conventional methods, VITEK 2 automated system and API ID 32C kits were used for identification of the isolated microorganisms. Antimicrobial susceptibility of bacterial agents was performed by disc diffusion method. For antifungal susceptibility, ATB Fungus 2 kit was used. Of 154 specimens, 148 (96.1%) showed microbial growth and 160 microorganisms were isolated as single or multiple members of the resident flora. Transient flora including one or more microorganisms (n = 47) were recovered from the hands of 39 (25.3%) HCWs. All gram-positive bacteria were detected to be sensitive to vancomycin, teicoplanin and linezolid, however 30.1% of the coagulase-negative staphylococci and 40% ofStaphylococcus aureus isolates were resistant to methicillin. Multiple drug resistance was determined in Acinetobacter and Pseudomonas isolates. It can be concluded that transient flora members isolated from hands of HCWs can be causative agents of serious nosocomial infections due to their high and multiple antimicrobial resistance patterns. Key words: Healthcare workers, resident flora, transient flora, antimicrobial susceptibility.

The Hygienic Effectiveness of 2 Different Skin Cleansing Procedures

This study was designed to assess the ability of 2 skin cleaning procedures to remove transient microbial flora from the skin. The study is a direct comparison of 2 washing procedures: soap and water washing versus cleansing with a no-rinse cleanser. The trial was performed at the research facilities of the Department of Clinical Bacteriology at the University of Göteborg. Forty-five healthy adult volunteers were recruited to participate in the study. A solution of test bacteria, either Escherichia coli or Staphylococcus aureus, was applied to both forearms of the test subject. After a 15-minute incubation period, one arm was cleaned using soap and water and the other arm was cleaned with no-rinse cleanser. Both the arms were dried with a disposable cloth. The amount of residual bacteria on the skin was assessed using contact agar plates. Both methods of cleaning resulted in 4-to 5-fold log reductions in bacterial count. The number of residual bacteria after both procedures ranged from 1 to 4 colony-forming units/cm after washing. The amount of residual bacteria was comparable for both washing procedures. Both washing procedures resulted in a low level of residual bacteria on the skin. No-rinse cleansers can be safely used as an alternative to soap and water washing of fragile skin.