Comparative efficacy of hand hygiene agents in the reduction of bacteria and viruses

Sickbert-Bennett, Emily E.; Weber, David J.; Gergen-Teague, Maria F.; Sobsey, Mark D.; Samsa, Gregory P.; Rutala, William A.

doi:10.1016/j.ajic.2004.08.005

« Previous Next »AJIC: American Journal of Infection Control
Volume 33, Issue 2 , Pages 67-77, March 2005

Comparative efficacy of hand hygiene agents in the reduction of bacteria and viruses

Emily E. Sickbert-Bennett, MS
- From the Department of Hospital Epidemiology, University of North Carolina Health Care System
- Department of Environmental Sciences and Engineering, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Emily E. Sickbert-Bennett, MS, Hospital Epidemiology, 1001 West Wing, CB 7600, 101 Manning Drive, Chapel Hill, NC 27514
David J. Weber, MD, MPH
- From the Department of Hospital Epidemiology, University of North Carolina Health Care System
- Reprint requests: David J. Weber, MD, MPH, CB 7030, 130 Mason Farm Road, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7030.
Maria F. Gergen-Teague, MT(ASCP)
- From the Department of Hospital Epidemiology, University of North Carolina Health Care System
Mark D. Sobsey, PhD
- Department of Environmental Sciences and Engineering, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Gregory P. Samsa, PhD
- Department of Biostatistics and Bioinformatics, Duke University Medical School, Durham, North Carolina
William A. Rutala, PhD, MPH
- From the Department of Hospital Epidemiology, University of North Carolina Health Care System

Chapel Hill and Durham, North Carolina

Background

Health care-associated infections most commonly result from person-to-person transmission via the hands of health care workers.

Methods

We studied the efficacy of hand hygiene agents (n=14) following 10-second applications to reduce the level of challenge organisms (Serratia marcescens and MS2 bacteriophage) from the hands of healthy volunteers using the ASTM-E-1174-94 test method.

Results

The highest log₁₀ reductions of S marcescens were achieved with agents containing chlorhexidine gluconate (CHG), triclosan, benzethonium chloride, and the controls, tap water alone and nonantimicrobial soap and water (episode 1 of hand hygiene, 1.60-2.01; episode 10, 1.60-3.63). Handwipes but not alcohol-based handrubs were significantly inferior from these agents after a single episode of hand hygiene, but both groups were significantly inferior after 10 episodes. After a single episode of hand hygiene, alcohol/silver iodide, CHG, triclosan, and benzethonium chloride were similar to the controls in reduction of MS2, but, in general, handwipes and alcohol-based handrubs showed significantly lower efficacy. After 10 episodes, only benzethonium chloride (1.33) performed as well as the controls (1.59-1.89) in the reduction of MS2.

Conclusions

Antimicrobial handwashing agents were the most efficacious in bacterial removal, whereas waterless agents showed variable efficacy. Alcohol-based handrubs compared with other products demonstrated better efficacy after a single episode of hand hygiene than after 10 episodes. Effective hand hygiene for high levels of viral contamination with a nonenveloped virus was best achieved by physical removal with a nonantimicrobial soap or tap water alone.