Evolving the EN 1500 test method for alcohol-based hand rub closer to clinical reality by reducing the organic load on hands and enabling product to be applied to dry hands.

Background: The methods currently used in Europe and North America to evaluate the bactericidal efficacy of hand hygiene products have some limitations (e.g. selection of test organism, method of contamination), and none of the methods allow prediction of actual clinical efficacy.

Inactivation of SARS-CoV-2 by commercially available alcohol-based hand sanitizers.

Alcohol-based hand sanitizers are being recommended as an infection prevention measure for COVID-19. Recently published data indicates that ethanol effectively inactivates the SARS-CoV-2 virus, but there is a lack of data for formulated hand sanitizer products currently used in U.S.

Randomized controlled trial evaluating the antimicrobial efficacy of chlorhexidine gluconate and para-chloro-meta-xylenol handwash formulations in real-world doses.

Chlorhexidine gluconate-based soaps have become the gold standard for handwashing in critical care settings and para-chloro-meta-xylenol is an effective alternative antibacterial active ingredient. This study benchmarked 2 novel foaming handwashes, compared to a bland soap for antimicrobial effectiveness using the health care personnel handwash method at realistic soap doses (0.9 mL and 2.

How long is enough? Identification of product dry-time as a primary driver of alcohol-based hand rub efficacy.

Background: The World Health Organization has called for the development of improved methodologies to evaluate alcohol-based handrub (ABHR) efficacy, including evaluation at "short application times and volumes that reflect actual use in healthcare facilities". The objective of this study was to investigate variables influencing ABHR efficacy, under test conditions reflective of clinical use.

Methods: The test product (60% /V 2-propanol) was evaluated according to a modified EN 1500 methodology, where application volumes of 1 mL, 2 mL, and 3 mL were rubbed until dry.

Quantifying the Effects of Water Temperature, Soap Volume, Lather Time, and Antimicrobial Soap as Variables in the Removal of Escherichia coli ATCC 11229 from Hands.

The literature on hand washing, while extensive, often contains conflicting data, and key variables are only superficially studied or not studied at all. Some hand washing recommendations are made without scientific support, and agreement between recommendations is limited. The influence of key variables such as soap volume, lather time, water temperature, and product formulation on hand washing efficacy was investigated in the present study.

Frequency of Use of Alcohol-Based Hand Rubs by Nurses: A Systematic Review.

BACKGROUND Recently, the US Food and Drug Administration requested that a "maximal use" trial be conducted to ensure the safety of frequent use of alcohol-based hand rubs (ABHRs) by healthcare workers. OBJECTIVE To establish how frequently volunteers should be exposed to ABHR during a maximal use trial. DESIGN Retrospective review of literature and analysis of 2 recent studies that utilized hand hygiene electronic compliance monitoring (ECM) systems.

Comparison of 3 in vivo methods for assessment of alcohol-based hand rubs.

Background: Alcohol-based hand rubs (ABHRs) are the primary method of hand hygiene in health-care settings. ICPs increasingly are assessing ABHR product efficacy data as improved products and test methods are developed. As a result, ICPs need better tools and recommendations for how to assess and compare ABHRs.

Efficacy of alcohol gel for removal of methicillin-resistant Staphylococcus aureus from hands of colonized patients.

Of 82 patients with methicillin-resistant Staphylococcus aureus (MRSA) colonization, 67 (82%) had positive hand cultures for MRSA. A single application of alcohol gel (2 mL) consistently reduced the burden of MRSA on hands. However, incomplete removal of MRSA was common, particularly in those with a high baseline level of recovery.

Comparison of hand hygiene monitoring using the 5 Moments for Hand Hygiene method versus a wash in-wash out method.

Background: One strategy to promote improved hand hygiene is to monitor health care workers' adherence to recommended practices and give feedback. For feasibility of monitoring, many health care facilities assess hand hygiene practices on room entry and exit (wash in-wash out). It is not known if the wash in-wash out method is comparable with a more comprehensive approach, such as the World Health Organization's My 5 Moments for Hand Hygiene method.

Comparative efficacy of alcohol-based surgical scrubs: the importance of formulation.

Alcohol-based surgical scrubs (ABSSs) are used to prevent surgical site infections. Chlorhexidine gluconate (CHG) often is added to enhance persistent germicidal activity. The aim of this study was to determine the influence of ABSS product formulation on efficacy.

The relative influences of product volume, delivery format and alcohol concentration on dry-time and efficacy of alcohol-based hand rubs.

Background: Alcohol-based hand rubs (ABHR) range in alcohol concentration from 60-95% and are available in a variety of delivery formats, such as rinses, gels, and foams. Recent studies suggest that some ABHR foams dry too slowly, thereby encouraging the use of inadequate volumes. This study investigates the influence of product volume, delivery format, and alcohol concentration on dry-time and antimicrobial efficacy of ABHR foams, gels and rinses.

Electronic recognition of hand hygiene technique and duration.

We captured 3-dimensional accelerometry data from the wrists of 116 healthcare professionals as they performed hand hygiene (HH). We then used these data to train a k-nearest-neighbors classifier to recognize specific aspects of HH technique (ie, fingertip scrub) and measure the duration of HH events.

Measuring residual activity of topical antimicrobials: is the residual activity of chlorhexidine an artefact of laboratory methods?

Residual activity of chlorhexidine gluconate (CHG) was evaluated by pretreating hands with CHG and then touching Staphylococcus aureus dried on to stainless steel discs. By this method, no reduction in bacteria was observed up to 15 min, suggesting that residual CHG does not offer protection against contamination with transient micro-organisms in clinical practice.

Efficacy of commonly used disinfectants for inactivation of human noroviruses and their surrogates.

Human noroviruses (HuNoVs) are the most common cause of acute viral gastroenteritis worldwide and are a leading cause of foodborne disease. Their environmental persistence and purported resistance to disinfection undoubtedly contribute to their success as foodborne disease agents. The purpose of this study was to compare the efficacy of three commonly used disinfectant active ingredients against representative HuNoV strains and cultivable surrogates.

Effectiveness of hand hygiene for removal of Clostridium difficile spores from hands.

This study determined whether surrogate organisms can predict activity against Clostridium difficile spores and compared the efficacy of hand hygiene preparations against C. difficile. Our data suggest that surrogate organisms were not predictive of C.

Efficacy of novel alcohol-based hand rub products at typical in-use volumes.

In vivo efficacies of 2 alcohol-based hand rub (ABHR) products (gel and foam) were evaluated at a volume of 1.1 mL. Both met US Food and Drug Administration log(10) reduction requirements after a single application and 10 consecutive applications.

Hand hygiene regimens for the reduction of risk in food service environments.

Pathogenic strains of Escherichia coli and human norovirus are the main etiologic agents of foodborne illness resulting from inadequate hand hygiene practices by food service workers. This study was conducted to evaluate the antibacterial and antiviral efficacy of various hand hygiene product regimens under different soil conditions representative of those in food service settings and assess the impact of product formulation on this efficacy. On hands contaminated with chicken broth containing E.

Comparative efficacy of commercially available alcohol-based hand rubs and World Health Organization-recommended hand rubs: formulation matters.

Background: Use of alcohol-based hand rubs (ABHRs) effectively reduces transmission of pathogenic microorganisms. However, the impact of alcohol concentration and format on product efficacy is currently being debated.

Methods: Two novel ABHR formulations containing 70% ethanol were evaluated according to American Society for Testing and Materials E1174 (Health Care Personnel Handwash [HCPHW]) and European Norm (EN) 1500 global standards.

Evaluation and remediation of bulk soap dispensers for biofilm.

Recent studies evaluating bulk soap in public restroom soap dispensers have demonstrated up to 25% of open refillable bulk-soap dispensers were contaminated with ~ 6 log(10)(CFU ml(-1)) heterotrophic bacteria. In this study, plastic counter-mounted, plastic wall-mounted and stainless steel wall-mounted dispensers were analyzed for suspended and biofilm bacteria using total cell and viable plate counts. Independent of dispenser type or construction material, the bulk soap was contaminated with 4-7 log(10)(CFU ml(-1)) bacteria, while 4-6 log(10)(CFU cm(-2)) biofilm bacteria were isolated from the inside surfaces of the dispensers (n = 6).

Quest for a realistic in vivo test method for antimicrobial hand-rub agents: introduction of a low-volume hand contamination procedure.

A novel method has been developed for the evaluation of alcohol-based hand rubs (ABHR) that employs a hand contamination procedure that more closely simulates the in-use conditions of ABHR. Hands of human subjects were contaminated with 0.2 ml of a concentrated suspension of Serratia marcescens (ATCC 14756) to achieve baseline contamination between 8 and 9 log₁₀ CFU/hand while allowing product to be applied to dry hands with minimal soil load.

Bacterial hand contamination and transfer after use of contaminated bulk-soap-refillable dispensers.

Bulk-soap-refillable dispensers are prone to extrinsic bacterial contamination, and recent studies demonstrated that approximately one in four dispensers in public restrooms are contaminated. The purpose of this study was to quantify bacterial hand contamination and transfer after use of contaminated soap under controlled laboratory and in-use conditions in a community setting. Under laboratory conditions using liquid soap experimentally contaminated with 7.

Comparison of the Activity of Alcohol-Based Handrubs Against Human Noroviruses Using the Fingerpad Method and Quantitative Real-Time PCR.

Noroviruses (NoV) are the most common cause of acute nonbacterial gastroenteritis in the United States, and human hands play an important role in their transmission. Little is known about the efficacy of hand hygiene agents against these highly infectious pathogens. We investigated the activity of seven commercially available hand hygiene products against human noroviruses by in vivo fingerpad tests.