爱护佳洗手液手部消毒的应用

随着人们对皮肤屏障功能的逐渐认识,原刷子刷手已被人们认为是不必需的,用含乙醇的无水洗手液揉搓消毒方法被越来越广泛的应用,现将我院采用爱护佳外科无水洗手液外科洗手方法效果作总结.     

不同清洁洗手方法对外科手消毒效果的影响

目的比较不同的清洁洗手方法对外科手消毒效果的影响。方法使用同种手清洁剂和外科手消毒剂,分别采取揉搓清洁洗手(A组)、刷洗清洁洗手(B组)和不进行清洁洗手(C组)3种方法后按同样的方法进行外科手消毒,比较其即刻消毒效果和对手部皮肤的影响。结果 C组外科手消毒后手部菌落数(0.27±0.45)CFU/cm2及手部带菌阳性率(46.7%)明显高于A组和B组,差异有统计学意义(P<0.01),A组和B组之间比较,差异无统计学意义,均有较好的即刻消毒效果,但刷洗法对皮肤损伤较大。结论外科手消毒前推荐使用揉搓清洁洗手方法。     

爱护佳手部皮肤消毒效果监测及评价

目的探讨4%爱护佳皮肤消毒剂消毒效果。方法将参加手术的医护人员按8个时段随机分成涂抹、未涂抹两组,每组50例;均采用4%爱护佳外科洗手液进行皮肤消毒;在消毒后,需再次涂抹0.5%爱护佳快速无水消毒洗手液于手部和前臂,为涂抹组;无需涂抹0.5%爱护佳快速无水消毒洗手液,为未涂抹组;两组均在消毒后即刻及术中1、2、3、4、5、6 h及6 h后分别进行手指采样培养,检测消毒效果。结果两组人员在各时段进行细菌学检测,菌落数均<5 CFU/cm2,手消毒效果均达到国家卫生部《消毒技术规范》标准,涂抹组与未涂抹组在各时段及总时段的培养结果差异无统计学意义(P>0.05)。结论4%爱护佳皮肤消毒剂消毒效果可靠,无需再次涂抹0.5%爱护佳快速无水消毒洗手液,其抗菌作用可持续≥6 h,使用流程简便,并能降低手术成本,提高工作效率。     

免刷手式外科手消毒法的临床应用与研究

目的：观察免刷式外科手消毒法在临床中实际消毒效果。方法：研究医院2013年参加择期手术的医护人员200人次,随机分为对照组和实验组,每组100人次;应用同一种洗手液和消毒液（手洁肤柔抗菌洗手液和消毒凝胶）,将采用免刷手消毒法作为实验组,采用刷洗外科手消毒法作为对照组,对两种外科手消毒法进行分析,并比较两组消毒后的无菌率和操作时间。结果：免刷手式外科手消毒方法消毒效果达到卫生部《消毒技术规范》,且操作时间短,对皮肤损害小,得到医院医护人员的肯定。     

外科免洗手消毒液对手术人员手部皮肤消毒效果与不良反应的调查

目的调查百能外科免洗手消毒液对手术人员手部皮肤消毒的效果、不良反应和依从性。方法采用百能外科免洗手消毒液和0.5%聚维酮碘消毒液分别对100人次手术人员的手部皮肤消毒,监测消毒后即刻、60、120、180 min手部皮肤的细菌菌落数,观察两组消毒后手部皮肤不良反应发生率和依从性。结果两组消毒效果均达到国家标准,百能外科免洗手消毒液对手部皮肤不良反应的发生率(1.0%)显著低于0.5%聚维酮碘消毒液(12.0%),依从性好。结论百能外科免洗手消毒液与0.5%聚维酮碘消毒液均能满足外科手消毒的要求,百能外科免洗手消毒液对手部皮肤不良反应发生率低,使用更安全、舒适,依从性好。     

北京市30所三甲医院外科手消毒剂使用的调查

目的了解北京市大型医院外科手消毒剂的使用情况. 方法用自设问卷调查了北京市30所三甲综合医院手术室护士长,内容包括各医院使用外科手消毒剂的种类;影响手消毒剂选择的因素;手消毒剂的使用方法等. 结果最常用的外科手消毒剂是碘伏,护士长选择消毒剂时主要考虑高效性和对皮肤的影响,刷手5 min和刷手3 min是最常用的消毒方法. 结论建议加强不同消毒剂消毒效果和最佳使用方法方面的比较研究,以保证外科手消毒质量.     

免刷手方法在外科手消毒中的应用

目的 比较免刷手与刷手两种外科手部消毒方法的效果和对皮肤的影响,以提高洗手依从性.方法 研究医院2011年参加手术的医护人员,随机分为对照组和试验组,每组50人,医师、护士各25人;应用同一种外科手洁肤柔免洗手消毒凝胶消毒剂,对照组采用传统的刷手方法进行手部消毒,试验组采用免刷手方法进行手消毒,余均按2009年《医务人员手卫生规范操作》执行,并对手消毒前后对皮肤作细菌和病原菌检测,对同期的600例患者手术切口的感染率进行同步分析.结果 两组手消毒后杀菌率分别为98.12％和97.77％,经检验比较二者差异有统计学意义(P＜0.05);对照组手部消毒时间为(10.28±1.23)min,试验组为(5.65±0.78)min,,试验组与对照组相比手部消毒时间明显缩短,二者差异有统计学意义(P＜0.05);消毒后对照组和试验组的医护人员手部细菌总数明显减少,未测出致病菌,符合消毒技术规范要求;切口感染对照组15例感染率5,0％,试验组12例感染率4.0％,两组比较差异无统计学意义.结论 免刷手与刷手两种手部消毒方法均能达到杀菌要求,消毒效果和手术切口感染率无差异,但免刷手比刷手式手部消毒方法时间缩短,减少了医护人员皮肤的损害,提高了医护人员依从性,值得在临床推广.     

免刷洗与刷洗两种不同外科手消毒效果监测及评价

目的比较免刷洗与刷洗两种不同外科洗手消毒方法效果,提高医护人员洗手依从性。方法随机抽取200名手术人员,将其分为刷手消毒法组100名、免刷手消毒法组100名;消毒后手术前用生物检测法进行手指采样送微生物室培养检测培养,并进行问卷调查,对手消毒效果进行监测及评价。结果免刷洗与刷洗手两组外科洗手人员手指皮肤细菌培养均获得同样的消毒效果,两组对照检测方法结果显示,差异无统计学意义,但手揉搓消毒剂由于含护肤成分和免刷手的消毒方法,对皮肤的损伤比需要刷手的消毒剂更小,两组对照检测方法结果显示,差异有统计学意义(P<0.05)。结论免刷洗手消毒具有一定的优势,既保证外科手消毒效果,又保证了手术人员的皮肤屏障的完整性,提高医护人员洗手依从性,因此免刷洗手是一种高效、安全、快捷的消毒方法,值得临床推广使用。     

洗手与卫生手消毒效果比较

目的 了解普通洗手和使用速干手消毒剂两种不同手卫生处置方法的效果,为医务人员工作中手卫生处置提供便利、可靠的方法.方法 随机选择临床医务人员,手部无血液或其他体液等肉眼可见污染;设洗手组30人,手消毒组30人;洗手组使用洗手液,手消毒组使用速干手消毒剂,均按六步洗手法进行揉搓,手卫生处置前、后用浸有洗脱液的无菌棉拭子采集标本,37℃温箱培养48 h后,进行细菌菌落计数.结果 洗手后细菌菌落数较洗手前下降,差异有统计学意义(P<0.05);手消毒后细菌菌落数较手消毒前下降差异有统计学意义(P<0.05);洗手效果与手消毒效果比较,手消毒效果优于洗手效果差异有统计学意义(P<0.05).结论 洗手和手消毒均能有效减少手部细菌菌落,手消毒效果优于洗手效果.     

3种抗菌型家用洗手液的抑菌效果试验研究

目的对比研究市售含有植物成分、化学成分和含有表面活性剂的3种洗手液的抑菌效果。方法采用滤纸片法对3种洗手液进行抑菌实验,并进行现场皮肤消毒试验。结果通过抑菌试验表明,含植物成分和化学成分的洗手液对大肠杆菌、金黄色葡萄球菌、绿脓杆菌有很好的抑制作用。3种成分的洗手液原液对金黄色葡萄球菌、大肠杆菌、绿脓杆菌作用1 m in,杀菌率菌均可达为99%以上。手消毒现场试验中3种洗手液原液平均消除对数值分别为1.31、2.09、0.53。结论本方法可很好地检验3种洗手液的抑菌效果,且3种洗手液稳定性良好。     

Comparison of two alcohol-based surgical scrub solutions with an iodine-based scrub brush for presurgical antiseptic effectiveness in a community hospital

The antiseptic effectiveness and acceptability of a commercial alcohol-based waterless (ABWL) and an alcohol-based water-aided (ABWA) scrub solution were compared with a brush-based iodine solution (BBIS) under conditions encountered in community hospital operating rooms. This randomized partially blinded study was based on guidelines from the American Society for Testing and Methods. The three scrub solutions were compared for antimicrobial efficacy, using criteria within the Food and Drug Administration's Tentative Final Monograph for Healthcare Antiseptic Products (FDA-TFM), and for participants' acceptance of the products. Volunteer surgical staff that worked daily in the same operating room for the entire duration of the study were enrolled. In total, 1126 surgical scrub procedures were performed over the duration of the study. Only the ABWL met all of the FDA-TFM criteria. The BBIS performed better than both of the alcohol-based solutions at the end of Day 1 (P=0.03), but the ABWL was more efficacious than the ABWA and the BBIS at the end of Days 2 and 5 (P=0.02 and 0.01, respectively). When colony-count reductions were compared over the entire duration of the study, there was no significant difference between the three solutions (P=0.2). The participants found the ABWL easiest to use (P<0.001), with the fewest adverse effects on skin (P=0.007), and it was their preferred product (P<0.001). Although both of the commercially available alcohol-based solutions may be considered as acceptable alternatives to the BBIS for presurgical antisepsis, the ABWL was found to have significantly higher user acceptability.     

Evaluation of an alcohol-based surgical hand disinfectant containing a synergistic combination of farnesol and benzethonium chloride for immediate and persistent activity against resident hand flora of volunteers and with a novel in vitro pig skin model.

OBJECTIVE: To evaluate the immediate, persistent and sustained in vivo activity of an alcohol-based surgical hand disinfectant, consisting of a zinc gel and a preservative system containing a synergistic combination of farnesol and benzethonium chloride (ZBF disinfectant), and to develop a pig skin model for in vitro evaluation of the immediate and persistent efficacy of alcohol-based surgical hand disinfectants against resident hand flora. DESIGN: The in vivo immediate, persistent, and sustained activity of ZBF disinfectant was evaluated using human volunteers and the "glove-juice" method described in the US Food and Drug Administration's Tentative Final Monograph (FDA-TFM) for Healthcare Antiseptic Products. A novel in vitro pig skin model was developed to compare the immediate and persistent activity of alcohol-based surgical hand disinfectants against resident flora using Staphylococcus epidermidis as the test organism. Four alcohol-based surgical hand disinfectants were evaluated using this model. RESULTS: The results for the ZBF disinfectant exceed the FDA-TFM criteria for immediate, persistent, and sustained activity required for surgical hand disinfectants. The reduction factors for the 4 hand disinfectants obtained using the pig skin model show good agreement with the log(10) reductions in concentrations of hand flora obtained using human volunteers to test for immediate and persistent activity. CONCLUSION: The ZBF disinfectant we evaluated met the FDA-TFM criteria for surgical hand disinfectants. The immediate and persistent efficacy of the surgical hand disinfectants evaluated with the novel pig skin model described in this study shows good agreement with the results obtained in vivo.     

Evaluation of the bactericidal effect of five products for surgical hand disinfection according to prEN 12054 and prEN 12791

Surgical hand disinfection (with an alcohol-based hand rub) and surgical handwash (with an antiseptic-based liquid soap) are accepted measures to reduce the risk for surgical site infections. The new European Standards allow a comparison of their antimicrobial efficacy. The bactericidal activity of surgical hand rubs [Sterillium and Softaman, (active ingredient=alcohols)] and handwashes [Derman plus (triclosan), Hibiscrub (chlorhexidine) and Betadine (PVP-iodine)] was tested according to the prEN 12054 suspension test using Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus hirae, and to prEN 12791 for the effect on resident skin flora in comparison with 1-propanol, 60% (v/v). All five products achieved a reduction of test bacteria within 3 min of >10(5)-fold so fulfilling prEN 12054. However, only Hibiscrub, Sterillium and Softa Man met the requirements of prEN 12791, giving a mean reduction of resident micro-organisms (immediate and sustained effect) which was not significantly lower than the reference alcohol (P>0.1; Wilcoxon matched-pairs signed-rank test). Sterillium was significantly more effective than the reference alcohol (immediate and sustained affect). Products for surgical hand disinfection may have equal antimicrobial activity in suspension tests but show large differences under practical conditions. Healthcare workers should not rely on results from suspension tests when deciding on a product for surgical hand disinfection.     

Double-blind, randomized, crossover trial of 3 hand rub formulations: fast-track evaluation of tolerability and acceptability.

OBJECTIVE: To compare healthcare workers' skin tolerance for and acceptance of 3 alcohol-based hand rub formulations. DESIGN: Double-blind, randomized, crossover clinical trial. SETTING: Intensive care unit in a university hospital. PARTICIPANTS: Thirty-eight healthcare workers (HCWs). INTERVENTION: A total of 3 alcohol-based hand rub formulations (hereafter, formulations A, B, and C) were used in random order for 3-5 consecutive working days during regular nursing shifts. Formulations A and B contained the same emollient, and formulations B and C contained the same alcohol at the same concentration. Use of each test formulation was separated by a "washout" period of at least 2 days. A visual assessment of skin integrity by a blinded observer using a standard 6-item scale was conducted before and after the use of each formulation. Univariate and multivariate analyses were used for the assessment of risk factors for skin alteration, and product acceptability was assessed by use of a customized questionnaire after the use of each formulation. RESULTS: Thirty-eight HCWs used each of 3 formulations for a median of 3 days (range, 3-5 days). The mean amount of product used daily (+/-SD) was 54.9+/-23.5 mL (median, 50.9 mL). Both subjective and objective evaluation of skin conditions after use showed lower HCW tolerance for product C. Male sex (odds ratio [OR], 3.17 [95% confidence interval {CI}, 1.1-8.8]), fair or very fair skin (OR, 3.01 [95% CI, 1.1-7.9]), skin alteration before hand rub use (OR, 3.73 [95% CI, 1.7-8.1]), and use of formulation C (OR, 8.79 [95% CI, 2.7-28.4]) were independently associated with skin alteration. CONCLUSIONS: This protocol permits a fast-track comparison of HCWs' skin tolerance for different alcohol-based hand rub formulations that are used in healthcare settings. The emollient in formulation C may account for its inferior performance.     

Dermatological aspects of a successful introduction and continuation of alcohol-based hand rubs for hygienic hand disinfection

With the new Centers for Disease Control and Prevention (CDC) guideline on hand hygiene, hospitals often introduce alcohol-based hand rubs for hand disinfection. Healthcare workers, however, may reject the new products because of skin irritation or other skin-related problems, which they experience after years of handwashing. In order to facilitate a successful introduction and continued use of alcohol-based hand rubs in hospitals, we have reviewed and summarized the major studies on the topic. Occupational hand dermatitis may occur in up to 30% of healthcare workers. It is mainly described as an irritant contact dermatitis caused by detergents. The diagnosis is usually clinical. Allergic reactions are very rare. After using an alcohol-based hand rub for the first time, healthcare workers may have a burning skin sensation that can be explained by pre-irritated skin. In this case the skin barrier has usually been impaired by frequent handwashing or occlusive gloves. This may result in a vicious circle whereby the healthcare worker increases the frequency of handwashing and reduces the frequency of hand disinfection. Prevention of irritant contact dermatitis is possible by selection of a low-irritating hand rub, which contains emollients, the correct use of the hand rub and a clear guideline when to disinfect and wash hands in the clinical setting. Common mistakes in the use of alcohol-based hand rubs are application to pre-irritated skin and washing hands before hand disinfection, which is, in general, not necessary, or after hand disinfection, which results in washing off the emollients. Clear preparation and guidance of healthcare workers before the introduction of alcohol-based hand rubs can help to enhance compliance in hand hygiene. The switch from handwash to alcohol-based hand rub will improve healthcare workers skin if mistakes are avoided and hand rinses are used correctly.     

Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America.

The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission ofpathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.     

An alcohol hand rub containing a synergistic combination of an emollient and preservatives: prolonged activity against transient pathogens

A new alcohol-based hand antiseptic (Octoxy hand rub) containing a synergistic combination of an emollient (Octoxyglycerine) and preservatives was developed and evaluated for immediate and prolonged activity against transient bacteria. The in vitro and in vivo antimicrobial efficacy was compared with other alcohol hand rubs containing preservative/antimicrobial (Prevacare and Avagard). In vitro evaluation was carried out using a tube-dilution method and a pig-skin model. Rapid and prolonged efficacy in vivo was evaluated against Staphylococcus epidermidis on the hands of volunteers. Octoxy hand rub was 100% effective in rapidly killing pathogens including methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium in vitro. In volunteers, all three hand rubs gave a significant reduction in microbial count within 15s. Octoxy hand rub showed significantly higher efficacy against S. aureus and Escherichia coli than Avagard and Prevacare 15 min after application to the pig-skin model, and against S. epidermidis in both the pig-skin model and in volunteers. Use of Octoxy hand rub with broad-spectrum immediate and prolonged antimicrobial activity may be a very effective way of improving hand hygiene without exposing the hands to higher concentrations of antimicrobials.     

Prevention of irritant contact dermatitis among health care workers by using evidence-based hand hygiene practices: a review

Irritant contact dermatitis is often found on the hands of healthcare workers and is generally caused by frequent hand washing, gloves, aggressive disinfectants or detergents. Alcohols have only a marginal irritation potential, although they may cause a burning sensation on pre-irritated skin. A burning sensation when using alcohols therefore, suggests that the skin barrier is already damaged. Two options for hand hygiene are generally available in clinical practice: (1) hand washing with some type of soap and water or (2) hand disinfection with alcohol-based hand rubs. Most clinical situations require the use of an alcohol-based hand rub for decontamination, which is especially useful for reducing the nosocomial transmission of various infectious agents. Washing one's hands should be the exception, to be performed only when they are visibly soiled or contaminated with proteinaceous material, or visibly soiled with blood or other body fluids. The overall compliance rate in hand hygiene is around 50%, which is far too low. In addition, healthcare workers quite often wash their hands with soap and water, when they should use an alcohol-based hand rub. This not only adds to the degree of skin irritation, but is also potentially dangerous for patients, due to the low efficacy of hand washing when compared to hand disinfection with alcohol rubs. Adhering to evidence-based hand hygiene protocols and following international guidelines on hand hygiene practices therefore, can help prevent irritant contact dermatitis among healthcare workers.     

An in-use evaluation of an alcohol-based pre-surgical hand disinfectant.

OBJECTIVE: To determine whether alcohol hand disinfection is an effective alternative to traditional agents for the pre-surgical scrub. DESIGN: A prospective clinical trial of a 70% isopropanol pre-surgical hand disinfectant. SETTING: The operating room suites at two hospital sites in British Columbia. METHODS: Cases were selected to evaluate both short and longer procedures. The hand disinfectant was compared to agents in current use as surgical scrubs (4% chlorhexidine and 7.5% povidone-iodine). Surgical technique and glove use were not modified. Pre- and postoperative fingertip impression and "glove-juice" cultures were used to determine microbial burden, and hands were evaluated for skin integrity. RESULTS: There was no statistical difference between the microbial hand counts following use of the alcohol-based product or the current agents, for cases less than 2 hours' duration. Comparison of longer surgical cases revealed significantly better pre- and postoperative culture results with the alcohol hand rinse, but analysis of matched pairs showed no significant difference in microbial counts. The alcohol hand rinse was equivalent to the operative scrub in terms of skin integrity and user acceptability. CONCLUSION: An alcohol hand rinse was equivalently effective in reducing microbial hand counts as the traditional pre-surgical scrub, both immediately after hand disinfection and at the end of the surgical procedure.