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Press Release - 2002 Guidelines for Hand Hygiene in Healthcare Settings
Hand Hygiene in Healthcare Settings
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Press Release
Date Line: October 25, 2002
Contact: CDC Media Relations
404-639-3286
CDC releases new hand-hygiene guidelines
The Centers for Disease Control and Prevention (CDC) today released new guidelines that advise the use of alcohol-based hand-rubs to protect patients in health care settings. The new hand hygiene guidelines were released in Chicago during the 40th annual meeting of the Infectious Diseases Society of America. "Clean hands are the single most important factor in preventing the spread of dangerous germs and antibiotic resistance in health care settings," said Dr. Julie Gerberding, director of the CDC. "More widespread use of these products that improve adherence to recommended hand hygiene practices will promote patient safety and prevent infections. "CDC estimates that each year nearly 2 million patients in the United States get an infection in hospitals, and about 90,000 of these patients die as a result of their infection.” Infections are also a complication of care in other settings including long-term care facilities, clinics and dialysis centers. Improving hand hygiene will help prevent the spread of germs from one patient to another. Data show that health care personnel may be more inclined to use alcohol-based hand-rubs because they are more convenient to use. Recent studies show that these hand-rubs actually reduce the number of bacteria on the hands more effectively than washing hands with soap and water. "Health care personnel are always on the go which sometimes makes hand washing with soap and water difficult," said Dr. Steve Solomon, acting director of CDC's healthcare quality promotion division. "These hand-rubs should help promote hand hygiene because they are much more accessible than sinks, take less time to use and cause less skin irritation and dryness than many soaps." The new guidelines recommend additional steps that administrators can take to increase adherence to good hand hygiene practices. When deciding what products to purchase, administrators should consult with health care personnel on issues like smell, consistency and the amount of skin irritation the product may cause. If, as expected, hand hygiene products improve hand hygiene practices, preventing even a few additional health care-associated infections per year will lead to savings that will exceed any extra costs for better hand hygiene products. The hand hygiene guidelines were developed by the CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC), in collaboration with the Society for Healthcare Epidemiology of America (SHEA), the Association of Professionals in Infection Control and Epidemiology (APIC), the Infectious Disease Society of America (IDSA). The hand hygiene guidelines are part of an overall CDC strategy to reduce infections in health care settings to promote patient safety. For more information about the hand hygiene campaign go to http://www.cdc.gov/handhygiene. For more information about CDC's seven health care safety challenges go to http://www.cdc.gov/ncidod/hip/challenges.htm
Dateline 10/7/2001
Antibacterial hand antiseptics are marketed to the public as an effective way to “kill germs on one’s hands”. They are not marketed by knowledgeable or responsible manufacturers as a way “to wash one’s hands”. Hand antiseptics are marketed as an addition to washing with soap and water or as a way to kill microorganisms on the hands, if soap and water are not available. Manufacturers of hand antiseptics containing alcohol claim that the sanitizers kill 99.9 percent of germs (microorganisms). This claim is understated. In several randomized, well-controlled, parallel, and blinded, clinical studies antiseptics containing alcohol killed 99.99% of the microorganisms on human skin. The microorganisms killed included both “harmful” and “normal flora” bacteria, viruses and fungi.
How do hand sanitizers work?
Hand antiseptics containing alcohol do not “work” by stripping away the outer layer of oil on the skin. Alcohol containing hand antiseptics destroy the lipid (oil) containing cell membrane of bacteria and fungus and denatures (destroys) proteins and enzymes inside bacteria and fungus. Alcohol kills bacteria and fungus almost instantly upon contact. In addition, alcohol denatures (destroys) the protein or lipoprotein coat of many viruses destroying their ability to infect human cells. A review of several hundred references in the literature on the antimicrobial action of hand antiseptics revealed that hand antiseptics containing alcohol significantly reduce the numbers of microorganism on the skin when properly applied and tested. Only one report was found which did not find a significant reduction in bacteria after using hand antiseptic containing alcohol. That single report, published in 1994, has never been independently confirmed. However, it is possible the alcohol based sanitizer used in the study contained only 40% alcohol. This would explain their puzzling results.
The 99.9 percent claim
Manufacturers of hand antiseptics are required by government regulations (law) to test their products for effectiveness. The test for hand antiseptics effectiveness is called the “Modified AOAC Chlorine (Available) in Disinfectants Germicidal Equivalent Concentration Method (USDA Hand Sanitizer). If a hand antiseptic passes this test it means the antiseptic has equivalent bactericidal activity to chlorine (Chlorox®) disinfectant diluted to 50 parts-per-million (ppm) of available chlorine. By law, the test must be conducted on inanimate surfaces. In additional, manufacturers of hand antiseptics may conduct effectiveness testing on inanimate surfaces for ethical (safety) reasons. It would not be ethical (safe) to test the effectiveness of a hand antiseptics on humans using harmful (pathogenic) bacteria. Manufacturers of hand antiseptics may also conduct effectiveness testing on inanimate surfaces for economic reasons. It is very expensive to conduct clinical studies on human skin. Most manufacturers cannot afford extensive effectiveness studies on human skin. Many preclinical (nonhuman) and clinical (human) studies have shown that the in vitro (on an inanimate surface) bactericidal and fungicidal effectiveness of hand antiseptics containing alcohol correlate very well with the in vivo (on human skin) bactericidal and fungicidal effectiveness.
Current recommendations for hand sanitation
The FDA currently recommends the use of soap and water to wash hands, if available. The FDA also recommends hand antiseptics be used (as an adjunct) in addition to washing hands with soap and water, if available. If soap and water are not available, hand antiseptics should be used to kill germs on the hands. Since we know hand antiseptics containing alcohol are very efficient germ killers, it would seem logical to use a hand antiseptics, if it is available. If you had a choice of using a very effective and safe germ killer on your hands several times a day or nothing at all, which would you choose?
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