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Infect Control Hosp Epidemiol 2009;30:939–944
© 2009 by The Society for Healthcare Epidemiology of America. All rights reserved.
0899-823X/2009/3010-0002$15.00
DOI: 10.1086/605322
Original Article
Hand Hygiene with Soap and Water Is Superior to Alcohol Rub and Antiseptic Wipes for Removal of Clostridium difficile
使用肥皂和水施行手卫生去除艰难梭菌优于酒精擦手液
Matthew T. Oughton, MD, FRCPC;
Vivian G. Loo, MD, FRCPC;
Nandini Dendukuri, PhD;
Susan Fenn, MLT, RT;
Michael D. Libman, MD, FRCPC
From the Department of Medicine, Division of Infectious Diseases, Sir Mortimer B. Davis–Jewish General Hospital (M.T.O.); the Division of Infectious Diseases, Department of Medicine (V.G.L., M.D.L.), and the Department of Microbiology (V.G.L., M.D.L.), McGill University Health Centre (N.D., S.F.); and the Department of Epidemiology and Biostatistics (N.D.), McGill University, Montreal, Quebec, Canada.
Objective.To evaluate common hand hygiene methods for efficacy in removing Clostridium difficile.
Design.Randomized crossover comparison among 10 volunteers with hands experimentally contaminated by nontoxigenic C. difficile.
Methods.Interventions included warm water with plain soap, cold water with plain soap, warm water with antibacterial soap, antiseptic hand wipes, alcohol‐based handrub, and a control involving no intervention. All interventions were evaluated for mean reduction in colony‐forming units (CFUs) under 2 contamination protocols: “whole hand” and “palmar surface.” Results were analyzed according to a Bayesian approach, by using hierarchical models adjusted for multiple observations.
Results.Under the whole‐hand protocol, the greatest adjusted mean reductions were achieved by warm water with plain soap (2.14log10 CFU/mL [95% credible interval (CrI), 1.74–2.54log10 CFU/mL]), cold water with plain soap (1.88log10 CFU/mL [95% CrI, 1.48–2.28log10 CFU/mL), and warm water with antibacterial soap (1.51log10 CFU/mL [95% CrI, 1.12–1.91log10 CFU/mL]), followed by antiseptic hand wipes (0.57log10 CFU/mL [95% CrI, 0.17–0.96log10 CFU/mL]). Alcohol‐based handrub (0.06log10 CFU/mL [95% CrI, −0.34 to 0.45log10 CFU/mL]) was equivalent to no intervention. Under the palmar surface protocol, warm water with plain soap, cold water with plain soap, and warm water with antibacterial soap again yielded the greatest mean reductions, followed by antiseptic hand wipes (26.6, 26.6, 26.6, and 21.9 CFUs per plate, respectively), when compared with alcohol‐based handrub. Hypothenar (odds ratio, 10.98 [95% CrI, 1.96–37.65]) and thenar (odds ratio, 6.99 [95% CrI, 1.25–23.41]) surfaces were more likely than fingertips to remain heavily contaminated after handwashing.
Conclusions.Handwashing with soap and water showed the greatest efficacy in removing C. difficile and should be performed preferentially over the use of alcohol‐based handrubs when contact with C. difficile is suspected or likely.
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发表于 2009-9-21 10:47
发表于 2009-9-21 12:30