Advertisement

APIC guidelines for handwashing and hand antisepsis in health care settings

      This paper is only available as a PDF. To read, Please Download here.

      References

        • Steere AC
        • Mallison GF
        Handwashing practices for the prevention of nosocomial infections.
        Ann Intern Med. 1975; 83: 683-690
        • Garner JS
        • Favero MS
        CDC guideline for handwashing and hospital environmental control 1985.
        Infect Control. 1986; 7: 231-235
        • Khan MU
        Interruption of shigellosis by handwashing.
        Trans R Soc Trop Med Hyg. 1982; 76: 164-168
        • Black RE
        • Dykes AC
        • Anderson KE
        • et al.
        Handwashing to prevent diarrhea in day care centers.
        Am J Epidemiol. 1981; 113: 445-451
        • Ansari SA
        • Springthorpe VS
        • Sattar SA
        • et al.
        Potential role of hands in the spread of respiratory viral infections: studies with human parainfluenza virus 3 and rhinovirus 14.
        J Clin Microbiol. 1991; 29: 2115-2119
        • Isaacs D
        • Dickson H
        • O'Callaghan C
        • et al.
        Handwashing and cohorting in prevention of hospital acquired infection with respiratory syncytial virus.
        Arch Dis Child. 1991; 66: 227-231
        • Doebbeling BN
        • Stanley GL
        • Sheetz CT
        • et al.
        Comparative efficacy of alternative handwashing agents in reducing nosocomial infections in intensive care units.
        N Engl J Med. 1992; 327: 88-93
        • Rotter ML
        • Koller W
        Surgical hand disinfection: effect of sequential use of two chlorhexidine preparations.
        J Hosp Infect. 1990; 16: 161-166
        • Ehrenkranz NJ
        Bland soap handwash or hand antisepsis?.
        in: The pressing need for clarity. Infect Control Hosp Epidemiol. 13. 1992: 299-301
        • Ehrenkranz NJ
        • Alfonso BC
        Failure of bland soap handwash to prevent hand transfer of patient bacteria to urethral catheters.
        Infect Control Hosp Epidemiol. 1991; 12: 654-662
        • Larson E
        APIC guideline for use of topical antimicrobial agents.
        Am J Infect Control. 1988; 16 (See: Erratum): 253-266
        • Larson E
        APIC guideline for use of topical antimicrobial agents.
        Am J Infect Control. 1991; 19: 59
        • Association of Operating Room Nurses
        Recommended practices: surgical hand scrubs.
        AORN J. 1990; 52: 830-836
        • Food and Drug Administration
        Over-the-counter drugs generally recognized as safe, effective and not misbranded.
        Federal Register. 1978; 43: 1210-1249
        • Food and Drug Administration
        Topical antimicrobial drug products for over-the-counter human use: tentative final monograph for health care antiseptic drug products—proposed rule.
        Federal Register. June 17, 1994; 59: 31441-31452
        • Larson EL
        Persistent carriage of gram-negative bacteria on hands.
        Am J Infect Control. 1981; 9: 112-119
        • Larson E
        Handwashing and skin: physiologic and bacteriologic aspects.
        Infect Control. 1985; 6: 14-23
        • Larson E
        • McGinley KJ
        • Grove GL
        • et al.
        Physiologic, microbiologic, and seasonal effects of handwashing on the skin of health care personnel.
        Am J Infect Control. 1986; 14: 51-59
        • Ehrenkranz NJ
        • Eckert DG
        • Alfonso BC
        • Moskowitz LB
        Proteeae groin skin carriage in ambulatory geriatric outpatients.
        Infect Control Hosp Epidemiol. 1989; 10: 150-154
        • Bruch MK
        • Larson E
        Regulation of topical antimicrobials: history, status and future perspective.
        Infect Control Hosp Epidemiol. 1989; 10: 505-508
        • Bruch MK
        • Larson E
        An early historical perspective on the FDA's regulation of OTC drugs.
        Infect Control Hosp Epidemiol. 1989; 11: 527-528
        • Larson E
        • Rotter ML
        Handwashing: are experimental models a substitute for clinical trials?.
        in: Two viewpoints. 3rd ed. Infect Control Hosp Epidemiol. 11. 1990: 63-66
      1. 3rd ed. The APIC curriculum for infection control practice. vol I. Kendall Hunt, Dubuque, Iowa1983: 552-553
        • Fox MK
        • Langner SB
        • Wells RW
        How good are hand washing practices?.
        Am J Nurs. 1974; 74: 1676-1678
        • Larson E
        • Lusk E
        Evaluating handwashing technique.
        J Adv Nurs. 1985; 10: 547-552
      2. 3rd ed. Control of hospital infections: a practical handbook. Chapman and Hall Medical, London1992: 101-105
      3. Ayliffe GAJ Lowbury EJL Geddes AM Williams JD 3rd ed. Control of hospital infections: a practical handbook. Chapman and Hall Medical, London1992: 119-121
        • Lowbury EJL
        Topical antimicrobials; perspectives and issues.
        in: Maibach H Aly R Skin microbiology: relevance to clinical infection. Springer-Verlag, New York1981: 158-168
        • Reybrouck G
        Handwashing and hand disinfection.
        J Hosp Infect. 1986; 8: 5-23
        • Lilly HA
        • Lowbury EJL
        Transient skin flora.
        J Clin Pathol. 1978; 31: 919-922
        • Lilly HA
        • Lowbury EJL
        • Wilkins MD
        Limits to progressive reduction of resident skin bacteria by disinfection.
        J Clin Pathol. 1979; 32: 382-385
        • Larson E
        • Leyden JJ
        • McGinley KJ
        • et al.
        Physiologic and microbiologic changes in skin related to frequent handwashing.
        Infect Control. 1986; 7: 59-63
        • Meers PD
        • Yeo GA
        Shedding of bacteria and skin squames after handwashing.
        J Hyg (Camb). 1978; 81: 99-105
        • Davies RR
        • Noble WC
        Dispersal of bacteria on desquamated skin.
        Lancet. 1962; 2: 1295-1297
        • Larson E
        • Mayur K
        • Laughon BA
        Influence of two handwashing frequencies on reduction in colonizing flora with three handwashing products used by health care personnel.
        Am J Infect Control. 1989; 17: 83-88
        • Larson EL
        • Eke PI
        • Laughon BE
        Efficacy of alcohol-based hand rinses under frequent-use conditions.
        Antimicrob Agents Chemother. 1986; 30: 542-544
        • Larson EL
        • Eke PI
        • Wilder MP
        • Laughon BE
        Quantity of soap as a variable in handwashing.
        Infect Control. 1987; 8: 371-375
        • Bruch M
        Newer germicides: what they offer.
        in: Maibach H Aly R Skin microbiology: relevance to clinical infection. Springer-Verlag, New York1981: 103-112
        • Aly R
        • Maibach HI
        Factors controlling skin bacterial flora.
        in: Maibach H Aly R Skin microbiology: relevance to clinical infection. Springer-Verlag, New York1981: 29-39
        • Gerberding JL
        • Littell C
        • Tarkington A
        • et al.
        Risk of exposure of surgical personnel to patients' blood during surgery at San Francisco General Hospital.
        N Engl J Med. 1990; 322: 1788-1793
        • Wright JG
        • McGeer AJ
        • Chyatte D
        • Ransohoff DF
        Mechanisms of glove tears and sharp injuries among surgical personnel.
        JAMA. 1991; 266: 1668-1671
        • Garner JS
        CDC Guideline for prevention of surgical wound infections, 1985.
        Am J Infect Control. 1986; 14: 71-80
        • Altemeier WA
        Surgical antiseptics.
        in: Block SS Disinfection, sterilization and preservation. 3rd ed. Lea & Febiger, Philadelphia1983: 493-504
        • Semmelweis I
        The etiology, concept and prophylaxis of childbed fever.
        in: Carter KC University of Wisconsin Press, Madison, Wisconsin1983 (and trans)
        • McFarland LV
        • Mulligan ME
        • Kwok RYY
        • Stamm WE
        Nosocomial acquisition of Clostridium difficile infection.
        N Engl J Med. 1989; 320: 204-210
        • Graham DR
        • Anderson RL
        • Ariel FE
        • et al.
        Epidemic nosocomial meningitis due to Citrobacter diversus in neonates.
        J Infect Dis. 1981; 144: 203-209
        • Eckert DG
        • Ehrenkranz NJ
        • Alfonso BC
        Indications for alcohol or bland soap in removal of aerobic gram-negative skin bacteria: assessment by a novel method.
        Infect Control Hosp Epidemiol. 1989; 10: 306-311
        • Association of Operating Room Nurses
        Recommended practices: product evaluation and selection for perioperative patient care.
        AORN J. 1989; 49: 1097-1100
        • Larson E
        • Talbot GH
        An approach for selection of health care personnel handwashing agents.
        Infect Control. 1986; 7: 419-424
        • Larsen EL
        • Morton HE
        Alcohols.
        in: Block SS Disinfection, sterilization and preservation. 4th ed. Lea & Febiger, Philadelphia1991: 191-203
        • Garrison RF
        Acute poisoning from use of isopropyl alcohol in tepid sponging.
        JAMA. 1953; 152: 317-318
        • Groschel DHM
        • Pruett TL
        Surgical antisepsis.
        in: Block SS Disinfection, sterilization and preservation. 4th ed. Lea & Febiger, Philadelphia1991: 642-654
        • Lowbury EJL
        • Lilly HA
        • Ayliffe GAJ
        Preoperative disinfection of surgeons' hands: use of alcoholic solutions and effects of gloves on skin flora.
        Br Med J. 1974; 4: 369-372
        • Ayliffe GAJ
        Surgical scrub and skin disinfection.
        Infect Control. 1984; 5: 23-27
        • Rotter ML
        Hygienic hand disinfection.
        Infect Control. 1984; 5: 18-22
        • Geelhoed GW
        • Sharpe K
        • Simon GL
        A comparative study of surgical skin preparation methods.
        Surg Gynecol Obstet. 1983; 157: 265-268
        • Larson EL
        • Butz AM
        • Gullette DL
        • Laughon BA
        Alcohol for surgical scrubbing?.
        Infect Control Hosp Epidemiol. 1990; 11: 139-143
        • Butz AM
        • Laughon BE
        • Gullette DL
        • Larson EL
        Alcohol-impregnated wipes as an alternative in hand hygiene.
        Am J Infect Control. 1990; 18: 70-76
        • Larson E
        • Bobo L
        Effective hand degerming in the presence of blood.
        J Emerg Med. 1992; 10: 7-11
        • Lilly HA
        • Lowbury EJL
        • Wilkins MD
        • Zaggy A
        Delayed antimicrobial effects of skin disinfection by alcohol.
        J Hyg (Lond). 1979; 82: 497-500
        • Newman SL
        • Seitz JC
        Intermittent use of an antimicrobial hand gel for reducing soap-induced irritation of health care personnel.
        Am J Infect Control. 1990; 18: 194-200
        • Ayliffe GAJ
        • Coates D
        • Hoffman PN
        Chemical disinfection in hospitals.
        Public Health Laboratories Service, London1984
        • Denton GW
        Chlorhexidine.
        in: Block SS Disinfection, sterilization, and preservation. 4th ed. Lea & Febiger, Philadelphia1991: 274-289
        • Montefiori DC
        • Robinson WE
        • Modliszewski A
        • Mitchell WM
        Effective inactivation of human immunodeficiency virus with chlorhexidine antiseptics containing detergents and alcohol.
        J Hosp Infect. 1990; 15: 279-282
        • Bernstein D
        • Schiff G
        • Echler G
        • et al.
        In vitro virucidal effectiveness of a 0.12%-chlorhexidine gluconate mouthrinse.
        J Dent Res. 1990; 69: 874-876
        • Gongwer LE
        • Hubben K
        • Lenkiewicz RS
        • et al.
        The effects of daily bathing of neonatal rhesus monkeys with an antimicrobial skin cleanser containing chlorhexidine gluconate.
        Toxicol Appl Pharmacol. 1980; 52: 255-261
        • Senior N
        Some observations on the formulation and properties of chlorhexidine.
        J Soc Cosmet Chem. 1973; 24: 259-278
        • O'Neill J
        • Hosmer M
        • Challop R
        • et al.
        Percutaneous absorption potential of chlorhexidine in neonates.
        Curr Ther Res. 1982; 31: 485-489
        • Alder VG
        • Burman D
        • Simpson RA
        • et al.
        Comparison of hexachlorophane and chlorhexidine powders in prevention of neonatal infection.
        Arch Dis Child. 1980; 55: 277-280
        • Morizono T
        • Johnstone BM
        • Hadjar E
        The ototoxicity of antiseptics (preliminary report).
        J Otolaryngol Soc Austr. 1973; 3: 550-553
        • Igarashi Y
        • Suzuki J
        Cochlear ototoxicity of chlorhexidine gluconate in cats.
        Arch Otorhinolaryngol. 1985; 242: 167-176
        • MacRae SM
        • Brown B
        • Edelhauser HF
        The corneal toxicity of presurgical skin antiseptics.
        Am J Ophthalmol. 1984; 97: 221-232
        • Hamed LM
        • Ellis FD
        • Boudreault G
        • et al.
        Hibiclens keratitis.
        Am J Ophthalmol. 1987; 104: 50-56
        • Okano M
        • Nomura M
        • Hata S
        • et al.
        Anaphylactic symptoms due to chlorhexidine gluconate.
        Arch Dermatol. 1989; 125: 50-52
        • Waclawski ER
        • McAlpine LG
        • Thomson NC
        Occupational asthma in nurses caused by chlorhexidine and alcohol aerosols.
        Br Med J. 1989; 298: 929-930
        • Layton GT
        • Stanworth DR
        • Amos HE
        The incidence of IgE and IgG antibodies to chlorhexidine.
        Clin Exp Allergy. 1989; 19: 307-314
        • Maki DG
        • Zilz MA
        • Alvarado CJ
        Evaluation of the antibacterial efficacy of four agents for handwashing.
        Curr Chemother Infect Dis. 1979; 11: 1089-1090
        • Pereira LJ
        • Lee GM
        • Wade KJ
        The effect of surgical handwashing routines on the microbial counts of operating room nurses.
        Am J Infect Control. 1990; 18: 354-364
        • Smylie HG
        • Logie JRC
        • Smith G
        From pHisohex to Hibiscrub.
        Br Med J. 1973; 4: 586-589
        • Lowbury EJL
        • Lilly HA
        The effect of blood on disinfection of surgeons hands.
        Br J Surg. 1974; 61: 19-21
        • Sheikh W
        Comparative antibacterial efficacy of Hibiclens and Betadine in the presence of pus derived from human wounds.
        Curr Ther Res. 1986; 40: 1096-1102
        • Babb JR
        • Davies JG
        • Ayliffe GAJ
        A test procedure for evaluating surgical hand disinfection.
        J Hosp Infect. 1991; 18: 41-49
        • Nicoletti G
        • Boghossian V
        • Borland R
        Hygienic hand disinfection: a comparative study with chlorhexidine detergents and soap.
        J Hosp Infect. 1990; 15: 323-337
        • Newsom SWB
        • Rowland C
        Studies in perioperative skin flora.
        J Hosp Infect. 1988; 11: 21-26
        • Baillie L
        Chlorhexidine resistance among bacteria isolated from urine of catheterized patients.
        J Hosp Infect. 1987; 10: 83-86
        • Hammond SA
        • Morgan JR
        • Russell AD
        Comparative susceptibility of hospital isolates of gram-negative bacteria to antiseptics and disinfectants.
        J Hosp Infect. 1987; 9: 255-264
        • Mizuba S
        • Sheikh W
        Microbiological evaluation of a new 2% aqueous chlorhexidine gluconate patient skin preparation on the axilla and abdomen.
        Curr Ther Res. 1986; 40: 364-368
        • Beeuwkes H
        • de Rooij SH
        The efficacy of a foam containing 0.5% chlorhexidine gluconate for the disinfection of the skin.
        Acta Ther. 1982; 8: 173-181
        • Larson EL
        • Laughon BE
        Comparison of four antiseptic products containing chlorhexidine gluconate.
        Antimicrob Agents Chemother. 1987; 31: 1572-1574
        • Aly R
        • Maibach HI
        A comparison of the antimicrobial effect of 0.5% chlorhexidine (Hibistat) and 70% isopropyl alcohol on hands contaminated with Serratia marcescens.
        Clin Exp Dermatol. 1980; 5: 197-201
        • Ulrich JA
        Clinical study comparing Hibistat (0.5% chlorhexidine gluconate in 70% isopropyl alcohol) and Betadine surgical scrub (7.5% povidone-iodine) for efficacy against experimental contamination of human skin.
        Curr Ther Res. 1982; 31: 27-30
        • Murie JA
        • Macpherson SG
        Chlorhexidine in methanol for the preoperative cleansing of surgeons' hands: a clinical trial.
        Scott Med J. 1980; 25: 309-311
        • Cooper EA
        On the relations of phenols and their derivatives to proteins.
        Biochem J. 1913; 7: 175-185
        • Miller JM
        • Jackson DA
        • Collier CS
        The microbicidal property of Phisohex.
        Mil Med. 1962; 127: 576-579
        • Smith CR
        Disinfectants for tuberculosis hygiene.
        Soap Sanit Chem. 1951; : 130-134
        • Smith CR
        Disinfectants for tuberculosis hygiene.
        Soap Sanit Chem. 1951; : 169
        • Hargiss C
        • Larson E
        The epidemiology of Staphylococcus aureus in a newborn nursery from 1970–1976.
        Pediatrics. 1978; 61: 348-353
        • Smith CR
        Disinfectants for tuberculosis hygiene, part II.
        Soap Sanit Chem. 1951 Oct; : 145-149
        • Korlof B
        • Winsten J
        The complications of Phisohex.
        Scand J Plast Reconstr Surg. 1967; 1: 78-80
        • Kimbrough RD
        Review of the toxicity of hexachlorophene, including its neurotoxicity.
        J Clin Pharmacol. 1973; 13: 439-444
        • Lockhart JD
        Hexachlorophene and the Food and Drug Administration.
        J Clin Pharmacol. 1973; 13: 445-450
        • Powell H
        • Swarner O
        • Gluck L
        • Lampert P
        Hexachlorophene myelinopathy in premature infants.
        J Pediatr. 1973; 82: 976-981
        • Favero MS
        Iodine-champagne in a tin cup.
        Infect Control. 1982; 3 ([Editorial]): 30-32
        • Gottardi W
        Iodine and iodine compounds.
        in: Block SS Disinfection, sterilization and preservation. 4th ed. Lea & Febiger, Philadelphia1991: 152-166
        • Anderson RL
        • Vess RW
        • Carr JH
        • et al.
        Investigation of intrinsic Pseudomonas cepacia contamination in commercially manufactured povidone-iodine.
        Infect Control Hosp Epidemiol. 1991; 12: 297-302
        • Berkelman RL
        • Holland BW
        • Anderson RL
        Increased bactericidal activity of dilute preparations of povidone-iodine solutions.
        J Clin Microbiol. 1982; 15: 635-639
        • Panlilio AL
        • Beck-Saque CM
        • Siegal JD
        • et al.
        Infections and pseudoinfections due to povidone-iodine solution contaminated with Pseudomonas cepacia.
        Clin Infect Dis. 1992; 14: 1078-1083
        • Alvarez ME
        • O'Brien RT
        Mechanisms of inactivation of poliovirus by chlorine dioxide and iodine.
        Appl Environ Microbiol. 1982; 44: 1064-1071
        • Zamora JL
        Chemical and microbiologic characteristics and toxicity of povidone-iodine solutions.
        Am J Surg. 1986; 151: 400-406
        • Zamora JL
        • Price MF
        • Chuang P
        • Gentry LO
        Inhibition of povidone-iodine's antibacterial activity by common organic substances: an experimental study.
        Surgery. 1985; 98: 25-29
        • Connolly RJ
        • Shepherd JJ
        The effect of preoperative surgical scrubbing with povidone iodine on urinary iodine levels.
        Aust NZJ Surg. 1972; 42: 94-95
        • Vorherr H
        • Vorherr UF
        • Mehta P
        • et al.
        Vaginal absorption of povidone-iodine.
        JAMA. 1980; 244: 2528-2629
        • Haley CE
        • Marling-Cason M
        • Smith JW
        • et al.
        Bacteri-cidal activity of antiseptics against methicillin-resistant Staphylococcus aureus.
        J Clin Microbiol. 1985; 21: 991-992
        • Russel AD
        • Furr JR
        The antibacterial activity of a new chloroxylenol preparation containing ethylenediamine tetra-acetic acid.
        J Appl Bacteriol. 1977; 43: 253-260
        • Dankert J
        • Schut IK
        The antibacterial activity of chloroxylenol in combination with ethylene diamine tetraacetic acid.
        J Hyg (Camb). 1976; 76: 11-22
        • Aly R
        • Maibach HI
        Comparative antibacterial efficacy of a 2-minute snrgical scrub with chlorhexidine gluconate, povidone-iodine, and chloroxylenol sponge brushes.
        Am J Infect Control. 1988; 16: 173-177
        • Sheena AZ
        • Stiles ME
        Efficacy of germicidal hand wash agents in hygienic hand disinfection.
        J Food Protect. 1982; 45: 713-720
        • Davies J
        • Babb JR
        • Ayliffe GAJ
        • Wilkins MD
        Disinfection of the skin of the abdomen.
        Br J Surg. 1978; 65: 855-858
        • Marzulli FN
        • Maibach HI
        Antimicrobials: experimental contact sensitization in man.
        J Soc Cosmet Chem. 1973; 24: 399-421
        • O'Connor DO
        • Rubino JR
        Phenolic compounds.
        in: 4th ed. Disinfection sterilization and preservation. Lea & Febiger, Philadelphia1991: 204-224
        • Marzulli FN
        • Bruch M
        Antimicrobial soaps: benefits versus risks.
        in: Maibach H Aly R Skin microbiology: relevance to clinical infection. Springer-Verlag, New York1981: 125-134
        • Bartzokas CA
        • Corkill JE
        • Makin T
        • Pinder DC
        Assessment of the remanent antibacterial effect of a 2% triclosan-detergent preparation on skin.
        J Hyg (Lond). 1983; 91: 521-528
        • Bartzokas CA
        • Corkill JE
        • Makin T
        Evaluation of the skin disinfecting activity and cumulative effect of chlorhexidine and triclosan handwash preparations on hands artificially contaminated with Serratia marcescens.
        Infect Control. 1987; 8: 163-167
        • Webster J
        Handwashing in a neonatal intensive care nursery: product acceptability and effectiveness of chlorhexidine gluconate 4% and triclosan 1%.
        J Hosp Infect. 1992; 21: 137-141
        • Bendig JWA
        Surgical hand disinfection: comparison of 4% chlorhexidine detergent solution and 2% triclosan detergent solution.
        J Hosp Infect. 1990; 15: 143-148
      4. Taylor EW Infection in surgical practice. Oxford University Press, Oxford, England1992: 61-67
        • Larson E
        Handwashing: it's essential—even when you use gloves.
        Am J Nurs. 1989; 89: 934-939
        • Taylor LJ
        An evaluation of handwashing techniques—1.
        Nurs Times. 1978; 74: 54-55
        • McGinley KJ
        • Larson EL
        • Leyden JJ
        Composition and density of microflora in the subungual space of the hand.
        J Clin Microbiol. 1988; 26: 950-953
        • Sprunt K
        • Redman W
        • Leidy G
        Antibacterial effectiveness of routine hand washing.
        Pediatrics. 1973; 52: 264-271
        • Blackmore M
        Hand drying methods.
        Nurs Times. 1987; 83: 71-74
        • Larson EL
        • McGinley KJ
        • Foglia A
        • et al.
        Handwashing practices and resistance and density of bacterial hand flora on two pediatric units in Lima, Peru.
        AJIC Am J Infect Control. 1992; 20: 65-72
        • Robinton ED
        • Mood EW
        A study of bacterial contaminants of cloth and paper towels.
        Am J Public Health. 1968; 58: 1452-1459
        • Ansari SA
        • Springthorpe VS
        • Sattar SA
        • et al.
        Comparison of cloth, paper, and warm air drying in eliminating viruses and bacteria from washed hands.
        Am J Infect Control. 1991; 19: 243-249
        • Matthews JA
        • Newsom SWB
        Hot air electric hand driers compared with paper towels for potential spread of airborne bacteria.
        J Hosp Infect. 1987; 9: 85-88
        • Ojajarvi J
        Effectiveness of hand washing and disinfection methods in removing transient bacteria after patient nursing.
        J Hyg (Lond). 1980; 85: 193-203
        • Ayliffe GAJ
        • Babb JR
        • Davies JG
        • Lilly HA
        Hand disinfection: a comparison of various agents in laboratory and ward studies.
        J Hosp Infect. 1988; 11: 226-243
        • Altemeier WA
        • Burke JF
        • Pruitt BA
        • Sandusky WR
        Manual on control of infection in surgical patients.
        JB Lippincott, Philadelphia1984
        • Galle PC
        • Homesley HD
        • Rhyne AL
        Reassessment of the surgical scrub.
        Surg Gynecol Obstet. 1978; 147: 215-218
        • Dineen P
        An evaluation of the duration of the surgical scrub.
        Surg Gynecol Obstet. 1969; 129: 1181-1184
        • O'Shaughnessy M
        • O'Malley VP
        • Corbett G
        • Given HF
        Optimum duration of surgical scrub time.
        Br J Surg. 1991; 78: 685-686
        • Rehork B
        • Ruden H
        Investigations into the efficacy of different procedures for surgical hand disinfection between consecutive operations.
        J Hosp Infect. 1991; 19: 115-127
        • Hingst V
        • Juditzki I
        • Heeg P
        • Sonntag HG
        Evaluation of the efficacy of surgical hand disinfection following a reduced application time of 3 instead of 5 minutes.
        J Hosp Infect. 1992; 20: 79-86
        • Materson BJ
        Skin preparation.
        in: 8th ed. Care of the surgical patient, vol 2, elective care. Scientific American Books, New York1990: 1-8
        • Cruse PJE
        • Foord R
        A five-year prospective study of 23,649 surgical wounds.
        Arch Surg. 1973; 107: 206-210
        • Cruse P
        • Foord R
        The epidemiology of wound infection: a 10-year prospective study of 62,939 wounds.
        Surg Clin North Am. 1980; 60: 27-40
        • Dodds RDA
        • Guy PJ
        • Peacock AM
        • et al.
        Surgical glove perforation.
        Br J Surg. 1988; 75: 966-968
        • Kaczmarek RG
        • Moore RM
        • McCrohan J
        • et al.
        Glove use by health care workers: results of a tristate investigation.
        Am J Infect Control. 1991; 19: 228-232
        • Lynch P
        • Cummings MJ
        • Roberts PL
        • et al.
        Implementing and evaluating a system of generic isolation precautions: body substance isolation.
        Am J Infect Control. 1990; 18: 1-12
        • Centers for Disease Control
        Recommendations for prevention of HIV transmission in health care settings.
        MMWR. 1987; 36: 3S-18S
        • Kjolen H
        • Andersen BM
        Handwashing and disinfection of heavily contaminated hands—effective or ineffective?.
        J Hosp Infect. 1992; 21: 61-71
        • Lynch P
        • Jackson MM
        • Cummings MJ
        • Stamm WE
        Rethinking the role of isolation practices in the prevention of nosocomial infections.
        Ann Intern Med. 1987; 107: 243-246
        • Korniewicz DM
        • Laughon BE
        • Butz A
        • Larson E
        Integrity of vinyl and latex procedure gloves.
        Nurs Res. 1989; 38: 144-146
        • Paulssen J
        • Eidem T
        • Kristiansen R
        Perforations in surgeons' gloves.
        J Hosp Infect. 1988; 11: 82-85
        • Korniewicz DM
        • Kirwin M
        • Cresci K
        • et al.
        In-use comparison of latex gloves in two high-risk units: surgical intensive care and acquired immunodeficiency syndrome.
        Heart Lung. 1992; 21: 81-84
        • Korniewicz DM
        • Laughon BE
        • Cyr WH
        • et al.
        Leakage of virus through used vinyl and latex examination gloves.
        J Clin Microbiol. 1990; 28: 787-788
        • DeGroot-Kosolcharoen J
        • Jones JM
        Permeability of latex and vinyl gloves to water and blood.
        Am J Infect Control. 1989; 17: 196-201
        • Korniewicz DM
        • Kirwin M
        • Cresci K
        • et al.
        Barrier protection with examination gloves: double versus single.
        AJIC Am J Infect Control. 1994; 22: 12-15
        • Doebbeling BN
        • Pfaller MA
        • Houston AK
        • Wenzel RP
        Removal of nosocomial pathogens from the contaminated glove: implications for glove reuse and handwashing.
        Ann Intern Med. 1988; 109: 394-398
        • Weiss SH
        • Goedert JJ
        • Gartner S
        • et al.
        Risk of human immunodeficiency virus (HIV-1) infection among laboratory workers.
        Science. 1988; 239: 68-71
        • Kotilainen HR
        • Brinker JP
        • Avato JL
        • Gantz NM
        Latex and vinyl examination gloves: quality control procedures and implications for health care workers.
        Arch Intern Med. 1989; 149: 2749-2753
        • Olsen RJ
        • Lynch P
        • Coyle MB
        • et al.
        Examination gloves as barriers to hand contamination in clinical practice.
        JAMA. 1993; 270: 350-353
        • Martin MV
        • Dunn HM
        • Field EA
        • et al.
        A physical and microbiological evaluation of the reuse of non-sterile gloves.
        Br Dent J. 1988; 165: 321-324
        • Occupational Safety and Health Administration
        Occupational exposure to bloodborne pathogens: final rule.
        Federal Register 29. Dec 6, 1991; (CFR Part 1910·1030)
        • Stringer B
        • Smith JA
        • Scharf S
        • et al.
        A study of the use of gloves in a large teaching hospital.
        Am J Infect Control. 1991; 19: 223-236
        • Centers for Disease Control and Prevention
        Handwashing and glove use in a long-term-care facility—Maryland, 1992.
        MMWR. 1993; 42: 672-675
        • Patterson JE
        • Vecchio J
        • Pantelick EL
        • et al.
        Association of contaminated gloves with transmission of Acinetobacter calcoaceticus vat. anitratus in an intensive care unit.
        Am J Med. 1991; 91: 479-483
        • Pottinger J
        • Burns S
        • Manske C
        Bacterial carriage by artificial versus natural nails.
        Am J Infect Control. 1989; 17: 340-344
        • Rubin DM
        Prosthetic fingernails in the OR.
        AORN J. 1988; 47: 944-948
        • Arnold HL
        • Odom RB
        • James WD
        Andrews' diseases of the skin.
        in: 8th ed. WB Saunders, Philadelphia1990: 921-922
        • Scher RK
        • Daniel CR
        Nails: therapy, diagnosis, surgery.
        in: WB Saunders, Philadelphia1990: 220-222
        • Baumgardner CA
        • Maragos CS
        • Walz MJ
        • Larson E
        The effects of nailpolish on microbial growth of fingernails.
        AORN J. 1993; 58: 84-88
        • Jacobson G
        • Thiele JE
        • McCune JH
        • Farrell LD
        Handwashing: ring-wearing and number of microorganisms.
        Nurs Res. 1985; 34: 186-188
        • Hoffman PN
        • et al.
        Microorganisms isolated from skin under wedding rings worn by hospital staff.
        Br Meal J (Clin Res). 1985; 290: 206-207
        • Mitchell KG
        • Rawluk DJR
        Skin reactions related to surgical scrub up: results of a Scottish survey.
        Br J Surg. 1984; 71: 223-224
        • Wheeler KF
        Barrier lotions, along with gloves, can help deter occupational dermatitis.
        Occup Health Safety. 1992; 61: 60-61
        • Hall GS
        • Mackintosh CA
        • Hoffman PN
        The dispersal of bacteria and skin scales from the body after showering and after application of a skin lotion.
        J Hyg (Lond). 1986; 97: 289-298
        • France DR
        Survival of Candida albicans in hand creams.
        N Z J Med. 1968; 67: 552-554
        • Morse LJ
        • Williams HL
        • Grann FP
        • et al.
        Septicemia due to Klebsiella pneumoniae originating from a hand cream dispenser.
        N Engl J Med. 1967; 277: 472-473
        • Morse LJ
        • Schonbeck LE
        Hand lotions—a potential nosocomial hazard.
        N Engl J Med. 1968; 278: 376-378
        • Larson EL
        • Wilder MP
        • Laughon BE
        Microbiologic effects of emollient on gloved hands.
        Am J Infect Control. 1987; 15: 168-171
        • Occupational Safety and Health Administration
        Compliance instructions CPL 2-2.44C.
        in: US Department of Labor, Washington, DCMarch 3, 1992: 20
        • Gerber AC
        • Jorg W
        • Zbinden S
        • et al.
        Severe intraoperatire anaphylaxis to surgical gloves: latex allergy, an unfamiliar condition.
        Anesthesiology. 1989; 71: 800-802
        • Leynadier F
        • Pecquet C
        • Dry J
        Anaphylaxis to latex during surgery.
        Anaesthesia. 1989; 44: 547-550
        • Moneret-Vautrin DA
        • Laxenaire MC
        • Bavoux F
        Allergic shock to latex and ethylene oxide during surgery for spina bifida.
        Anesthesiology. 1990; 73: 556-558
        • Pecquet C
        • Leynadier F
        • Dry J
        Contact urticaria and anaphylaxis to natural latex.
        J Am Acad Dermatol. 1990; 22: 631-633
        • Spaner D
        • Dolovich J
        • Tarlo S
        • et al.
        Hypersensitivity to natural latex.
        J Allergy Clin Immunol. 1989; 83: 1135-1137
        • Berky ZT
        • Luciano J
        • James WD
        Latex glove allergy: a survey of the US Army Dental Corps.
        JAMA. 1992; 268: 2695-2697
        • Bubak ME
        • Reed CE
        • Fransway AF
        • et al.
        Allergic reactions to latex among health care workers.
        Mayo Clin Proc. 1992; 67: 1075-1079
        • Larson E
        • Anderson JK
        • Baxendale L
        • Bobo L
        Effects of a protective foam on scrubbing and gloving.
        AJIC Am J Infect Control. 1993; 21: 297-301
        • Benson L
        • LeBlanc D
        • Bush L
        • White J
        The effects of surfactant systems and moisturizing products on the residual activity of a chlorhexidine gluconate handwash using a pigskin substrate.
        Infect Control Hosp Epidemiol. 1990; 11: 67-70
        • Walsh B
        • Blakemore PH
        • Drabu YJ
        The effect of handcream on the antibacterial activity of chlorhexidine gluconate.
        J Hosp Infect. 1987; 9: 30-33
        • Nakashima AK
        • Highsmith AK
        • Martone WJ
        Survival of Serratia marcescens in benzalkonium chloride and in multiple-dose medication vials: relationship to epidemic septic arthritis.
        J Clin Microbiol. 1987; 25: 1019-1021
        • Frank MJ
        • Schaffner W
        Contaminated aqueous benzalkonium chloride: an unnecessary hospital infection hazard.
        JAMA. 1976; 236: 2418-2419
        • Lee JC
        • Fialkow PJ
        Benzalkonium chloride: source of hospital infection with gram-negative bacteria.
        JAMA. 1961; 177: 708-710
        • Mitchell RG
        • Hayward AC
        Postoperative urinary tract infections caused by contaminated irrigating fluid.
        Lancet. 1966; 1: 793-795
        • Centers for Disease Control
        Contaminated povidoneiodine solution—northeastern U.S..
        MMWR. 1980; 29: 553-555
        • Anderson K
        The contamination of hexachlorophene soap with Pseudomonas pyocyanea.
        Med J Aust. 1962; 2: 463
        • Burdon DW
        • Whitby JL
        Contamination of hospital disinfectants with Pseudomonas species.
        Br Med J. 1967; 2: 153-155
        • Centers for Disease Control
        Contaminated povidoneiodine solution—Texas.
        MMWR. 1989; 38: 133-134
        • Donowitz LG
        Benzalkonium chloride is still in use.
        Infect Control Hosp Epidemiol. 1991; 12: 186-187
        • Bannan EA
        • Judge LF
        Bacteriologic studies relating to handwashing.
        Am J Public Health. 1965; 55: 915-922
        • Heinze JE
        • Yackovich F
        Washing with contaminated bar soap is unlikely to transfer bacteria.
        Epidemiol Infect. 1988; 101: 135-142
        • McBride ME
        Microbial flora of in-use soap products.
        Appl Environ Microbiol. 1984; 48: 338-341
        • Kabara JJ
        • Brady MB
        Contamination of bar soaps under “in-use” conditions.
        J Environ Pathol Toxicol Oncol. 1984; 5: 1-14
        • Knights HT
        • Harvey J
        Hand creams containing hexachlorophene and cross infection with gram negative bacteria.
        N Z Med J. 1964; 63: 653-655
        • Maki DG
        Skin as a source of nosocomial infections: directions for future research.
        Infect Control. 1986; 7: 113-116
        • DeCarvalho M
        • Lopes JMA
        • Pelliteri M
        Frequency and duration of handwashing in a neonatal intensive care unit.
        Pediatr Infect Dis J. 1989; 8: 179-180
        • Larson E
        Compliance with isolation technique.
        Am J Infect Control. 1983; 11: 221-225
        • Quraishi ZA
        • McGuckin M
        • Blais FX
        Duration of handwashing in intensive care units: a descriptive study.
        Am J Infect Control. 1984; 11: 83-87
        • Albert RK
        • Condie F
        Hand-washing patterns in medical intensive care units.
        N Engl J Med. 1981; 304: 1465-1466
        • McLane C
        • Chenelly S
        • Sylwestrak ML
        • Kirchhoff KT
        A nursing practice problem: failure to observe aseptic technique.
        Am J Infect Control. 1983; 11: 178-182
        • Simmons B
        • Bryant J
        • Neiman K
        • et al.
        The role of handwashing in prevention of endemic intensive care unit infections.
        Infect Control Hosp Epidemiol. 1990; 11: 589-594
        • Broughall JM
        • Marshman C
        • Jackson B
        • Bird P
        An automatic monitoring system for measuring handwashing frequency in hospital wards.
        J Hosp Infect. 1984; 5: 447-453
        • Haley RW
        • Bregman DA
        The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit.
        J Infect Dis. 1982; 145: 875-885
        • Pettinger A
        • Nettleman MD
        Epidemiology of isolation precautions.
        Infect Control Hosp Epidemiol. 1991; 12: 303-307
        • Kaplan LM
        • McGuckin M
        Increasing handwashing compliance with more accessible sinks.
        Infect Control. 1986; 7: 408-410
        • Larson E
        • Killien M
        Factors influencing handwashing behavior of patient care personnel.
        Am J Infect Control. 1982; 10: 93-99
        • Zimakoff J
        • Kjelsberg AB
        • Larsen SO
        • Holstein B
        A multicenter questionnaire investigation of attitudes toward hand hygiene, assessed by the staff in fifteen hospitals in Denmark and Norway.
        Am J Infect Control. 1992; 20: 58-64
        • Scott D
        • Barnes A
        • Lister M
        • Arkell P
        An evaluation of the user acceptability of chlorhexidine handwash formulations.
        J Hosp Infect. 1991; 18: 51-55
        • Rotter ML
        • Koller W
        • Neumann R
        The influence of cosmetic additives on the acceptability of alcohol-based hand disinfectants.
        J Hosp Infect. 1991; 18: 57-63
        • Taylor LJ
        An evaluation of handwashing techniques–2.
        Nurs Times. 1978; 74: 108-110
        • Conly JM
        • Hill S
        • Ross J
        • et al.
        Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates.
        Am J Infect Control. 1989; 17: 330-339
        • Dubbert PM
        • Dolce J
        • Richter W
        • et al.
        Increasing ICU staff handwashing: effects of education and group feedback.
        Infect Control Hosp Epidemiol. 1990; 11: 191-193
        • Larson E
        • McGeer A
        • Quraishi A
        • et al.
        Effect of an automated sink on handwashing practices and attitudes in high-risk units.
        Infect Control Hosp Epidemiol. 1991; 12: 422-428
        • Graham M
        Frequency and duration of handwashing in an intensive care unit.
        Am J Infect Control. 1990; 18: 77-80
        • Mayer JA
        • Dubbert PM
        • Miller M
        • et al.
        Increasing handwashing in an intensive care unit.
        Infect Control. 1986; 7: 259-262
        • Wenzel RP
        • Pfaller MA
        Handwashing—efficacy versus acceptance: a brief essay.
        J Hosp Infect. 1991; 18: 65-68
        • Nettleman MD
        • Trilla A
        • Fredrickson M
        • Pfaller M
        Assigning responsibility: using feedback to achieve sustained control of methicillin-resistant Staphylococcus aureus.
        Am J Med. 1991; 91 (3B232S): 3B228S
        • Larson E
        Current handwashing issues.
        Infect Control. 1984; 5 ([Editorial]): 15-17
        • Goldmann D
        • Larson E
        Hand-washing and nosocomial infections.
        N Engl J Med. 1992; 327 ([Editorial]): 120-122
        • Dooms-Goossens A
        • Deveylder H
        • de Alam AG
        • et al.
        Contact sensitivity to nonoxynols as a cause of intolerance to antiseptic preparations.
        J Am Acad Dermatol. 1989; 21: 723-727
        • Fisher AA
        Allergic contact reactions in health care personnel.
        J Allergy Clin Immunol. 1992; 90: 729-738
        • Beezhold D
        • Beck WC
        Surgical glove powders bind latex antigens.
        Arch Surg. 1992; 127: 1354-1357
        • Fisher AA
        Management of allergic contact dermatitis due to rubber gloves in health and hospital personnel.
        Cutis. 1991; 47: 301-302
        • Rich P
        • Belozer ML
        • Norris P
        • Storrs FJ
        Allergic contact dermatitis to two antioxidants in latex gloves: 4,4′-thiobis(6-tert-butyl-meta-cresol) (Lowinox 44S36) and butylhydroxyanisole.
        J Am Acad Dermatol. 1991; 24: 37-43
        • Ojajarvi J
        • Makela P
        • Rantasalo I
        Failure of hand disinfection with frequent hand washing: a need for prolonged field studies.
        J Hyg (Lond). 1977; 79: 107-119
        • Ojajarvi J
        Handwashing in Finland.
        J Hosp Infect. 1991; 18: 35-40
        • Lauharanta J
        • Ojajarvi J
        • Sarna S
        • Makela P
        Prevention of dryness and eczema of the hands of hospital staff by emulsion cleansing instead of washing with soap.
        J Hosp Infect. 1991; 17: 207-215
        • Kolari PJ
        • Ojajarvi J
        • Lauharanta J
        • Makela P
        Cleansing of hands with emulsion—a solution to skin problems of hospital staff?.
        J Hosp Infect. 1989; 13: 377-386
        • Decker LA
        • Gross A
        • Miller FC
        • Read JA
        • Cutright DE
        • Devine J
        A rapid method for the presurgical cleansing of hands.
        Obstet Gynecol. 1978; 51: 115-117
        • Modak S
        • Sampath L
        • Miller HSS
        • Millman I
        Rapid inactivation of infectious pathogens by chlorhexidinecoated gloves.
        Infect Control Hosp Epidemiol. 1992; 13: 463-471