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Comparative Study On Efficacy of Different Alcohol Hand Rubs and Routine Hand Wash in A Health-Care Setting, Alexandria, Egypt
Comparative Study On Efficacy of Different Alcohol Hand Rubs and Routine Hand Wash in A Health-Care Setting, Alexandria, Egypt
5 & 6,2010
ABSTRACT
Background: Antiseptic agents or plain soap and water are mainly used
for hand hygiene in Egypt. The impact of hand hygiene depends not
only on the regularity and thoroughness of the procedures used but also
on the type of hand-washing agent selected. Objectives: To compare the
efficacy of alcohol-based hand rubs versus traditional hand washing
with soap and water in reducing hand contamination during routine
patient care. Material and Methods: The study included 20 volunteered
nurses in 3 intensive care units and the renal dialysis unit, in the
Alexandria University Students' Hospital. A total of 200 samples were
collected by direct finger-print of the dominant hand taken from all
nurses before and after applying hand hygiene procedures. Three hand-
rubs available in the Egyptian market (Brands A, B; alcohol-based
liquid, and C; alcohol-based gel) were used and compared to a locally
prepared hand-rubbing solution (D) and to hand washing with non-
antiseptic soap and water (SW). Results: Hand washing with non-
antiseptic soap and water and all of the four used alcohol-based hand-
rubs showed significant reduction of bacterial counts on the examined
hands. The median percentage reductions were 99%, 94%, 77%, and 87%
with brands A, B, C and D respectively and only 30% reduction with
soap and water (x2: 23.023, p <0.001). Conclusions and
Recommendations: Alcohol-based hand rub is far more efficient than
traditional hand washing, and more convenient and time saving.
Locally prepared hand rub is comparable to readymade ones. It is
recommended as a hand hygiene practice in critical areas, particularly
when sink and running water are inaccessible.
J Egypt Public Health Assoc Vol. 85 No. 5 & 6,2010
Corresponding Author:
Dr. Amira E. Amine
Microbiology Department, High Institute of Public Health,
Alexandria University, Egypt
E-mail: amiraamine@yahoo.com
INTRODUCTION
Hand hygiene, which refers to routine hand wash, antiseptic hand
wash, antiseptic hand rub or surgical hand antisepsis, is universally
acknowledged as a cornerstone of the prevention of health care-associated
infections (HAIs). It is the simplest and most effective measure for
preventing cross-transmission of microorganisms and reducing patient
morbidity and mortality from HAIs.(1, 2)
The impact of hand hygiene depends not only on the regularity and
thoroughness of the procedures used but also on the type of hand-washing
agent selected. For most routine activities, hand washing with plain soap is
sufficient since soap will remove most transient microorganisms.
Nevertheless, compliance with hand washing among health care workers
(HCWs) is only about 40–50%, which is unacceptably low. This constant
finding is disturbing because studies have shown that this level of
compliance will not reduce the risk of transmission of multi-resistant
bacteria in hospitals. In a study conducted in Egypt (2009) to assess
knowledge, attitude and practice of hand washing among Ain Shams
University Hospital HCWs, it was reported that doctors showed a
significantly higher compliance (37.5%) than other groups of HCWs.(3)
Attempts to improve compliance have included increasing the number of
accessible sinks and educating HCWs, but none of these interventions led to
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Statistical Analysis
Data were analyzed by the Statistical Package for Social Sciences (SSPS
version 11.5). Bacterial counts before and after application of one of the
hand hygiene methods were compared using Wilcoxon signed ranks test.
Percentage reduction for all methods was calculated, tested by Kruskal
Wallis, and comparison between methods was done by Mann Whitney test.
Statistical significance was accepted at p ≤ 0.05.
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RESULTS
Bacteria isolated from the fingertips of the nursing staff are shown in
table (1). A total of 124 bacterial agents were isolated. More than half of the
samples (57%) showed mixed pattern of colonization by 2 or more bacterial
isolates, while 43% yielded a single isolate. Coagulase-negative
staphylococci (CoNS) were isolated from 80% of nurses' fingertips, while S.
aureus and Gram-negative bacilli (GNB) were colonizing 8% and 9% of
fingertips samples, respectively (Table 2). Bacterial count before application
of hand hygiene was considered as the baseline and ranged from 10 to 900
CFU/hand, with an average mean of 131.9 (±154.8) CFU/hand.
Frequency of isolation
Bacterial Isolates
No. %
CoNS 80 64.5
S. aureus 8 6.5
Diphtheroids 27 21.8
GNB 9 7.3
Total 124 100.0
CoNS: coagulase negative staphylococci
S. aureus: Staphylococcus aureus
GNB: Gram negative bacilli
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DISCUSSION
Hands are normally colonized by resident and transient bacterial flora,
according to the layer of skin they colonize. Resident flora, the less
pathogenic bacteria is more resistant to remove (e.g., CoNS and
Diphtheroids). Transient flora is more likely to cause disease and is less
resistant to remove. (e.g: S. aureus, GNB). Hands are contaminated by this
flora during contact with patients or environmental flora contaminated by
patients’ environment.(12,13) Their number increases with the duration of
clinical activities, on average by 16 CFU /min. (14)
CoNS are the main type of resident skin flora, they are found on
almost every hand.(15) In our study, CoNS colonized 80% of nurses’ hands.
Nearly similar results were reported by Cimiotti et al. (NY-USA, 2004),
where CoNS were found to colonize 133 (86.3%) and 74 (92.5%) of hands of
the experienced nurses and newly graduate nurses respectively; though
methicillin-resistant CoNS were isolated significantly more often from the
experienced nurses than from the new graduate nurses (95% and 33%
respectively). (16) In another study (Michigan-USA, 2000), out of all isolated
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propanol.(22) This goes with our results as Brand A showed the highest
(99%) percentage reduction, while the brands B and D (locally prepared)
were 94% and 87%, respectively, yet with no statistically significant
differences. It was also demonstrated that hand rubs were also affected by
their types where the gel hand rub (Brand C) had the least efficacy among
hand rubs in reducing bacterial hand contamination (77%).
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REFERENCES
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