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Surgical Hand Disinfection With Alcohols at Various Concentrations: Parallel Experiments Using the New Proposed European Standards Method

Published online by Cambridge University Press:  02 January 2015

Manfred L. Rotter*
Affiliation:
Hygiene-Institute of University, Vienna, Austria
Rosemary A. Simpson
Affiliation:
Healthcare Science Limited, Hitchin, Herts, United Kingdom
Walter Koller
Affiliation:
Hygiene-Institute of University, Vienna, Austria
*
Hygiene-Institute of the University, Kinderspitalgasse 15, A-1095 Vienna, Austria

Abstract

Objectives:

To establish the concentration of isopropanol that exerts the same immediate and sustained effects as n-propanol 60% v/v in surgical scrubbing, and to assess the performance of the test method proposed as the European standard in parallel experiments.

Design:

Isopropanol at concentrations of 70%, 80%, and 90% v/v was tested in comparison with n-propanol 60%, the proposed reference preparation, in the draft method proposed by the European standard. A Latin square design was used with four balanced blocks of five volunteers each in four experimental runs that were spaced by intervals of 1 week each. Volunteers were allotted randomly to one of the four blocks. Independently, the volunteers' right and left hands also were randomized into two groups for the assessment of either immediate or sustained effects.

Setting:

Two laboratories supervised by two investigators, one from Vienna, Austria, and one from London, The United Kingdom.

Method:

The release of skin flora from the fingertips of clean hands was assessed before and after treatment by immediate sampling from one hand and by sampling of the other, gloved hand after 3 hours. The mean log10 reductions (RF) of bacterial release achieved by rubbing the alcoholic preparations for 3 minutes onto the hands were established.

Results:

For both experiments, the immediate effects of isopropanol 70% (RF, 2.0 and 2.1, respectively) were significantly smaller than those of the reference n-propanol 60% (RF, 2.4 and 2.6, respectively). This also was found with the sustained effects (RF, 0.7 and 1.1 vs 1.0 and 1.6, respectively). At 90%, isopropanol equalled the immediate effect of n-propanol 60%, whereas at 80% it proved slightly (although not significantly) less active. There were no significant differences in the results of both investigators. The sustained effects of isopropanol 80% and 90% were both larger than the reference in Vienna but were found smaller by the London investigator; none of the differences were significant. Mean RFs were significantly different between Vienna and London with n-propanol 60% and isopropanol 70%, but not with isopropanol at 80% or 90%.

Conclusions:

At 90%, isopropanol is as effective as n-propanol 60%, which was proposed by the European Committee for Standardization as a reference in testing :products for surgical hand disinfection. It could, therefore, serve as an alternative if the proposed agent is undesirable for any reason. In parallel experiments by two investigators, the proposed test method proved well workable; the results were very similar and the conclusions identical

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

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References

1. European Committee for Standardization (CEN). Chemical Disinfectants and Antiseptics—Test Method and Requirements: Surgical Hand Disinfection. Brussels, Belgium: CEN, Central Secretariat. prEN 12791;1997.Google Scholar
2. European Committee for Standardization (CEN). Chemical Disinfectants and Antiseptics—Test Method and Requirements: Hygienic Hand Rub. Brussels, Belgium: CEN, Central Secretariat. prEN 1500;1996.Google Scholar
3. European Committe for Standardization (CEN). Chemical Disinfectants and Antiseptics—Test Method and Requirements: Hygienic Hand Wash. Brussels, Belgium: CEN, Central Secretariat. EN 1499;1997.Google Scholar
4. Price, PB. Reevaluation of ethyl alcohol as a germicide. Arch Surg 1950;60:492502.Google Scholar
5. Lowbury, EJL, Lilly, HA, Ayliffe, GA. Preoperative disinfection of surgeon's hands: use of alcoholic solutions and effects of gloves on skin flora. BMJ 1974;4:369372.CrossRefGoogle ScholarPubMed
6. Lilly, HA, Lowbury, EJL, Wilkins, D. Detergents compared with each other and with antiseptics as skin “degerming” agents. J Hyg Camb 1979;82:8993.Google Scholar
7. Furuhashi, M, Miyamae, T. Effect of preoperative scrubbing and influence of pinholes appearing in surgical rubber gloves during operation. Bull Tokyo Med Dent Univ 1979;26:7380.Google Scholar
8. Rotter, M, Koller, W, Wewalka, G. Povidone-iodine and chlorhexidine gluconate-containing detergents for disinfection of hands. J Hosp Infect 1980;1:149158.Google Scholar
9. Altemeier, WA. Surgical antisepsis. In: Block, SS, ed. Disinfection, Sterilization and Preservation. 3rd ed. Philadelphia, PA: Lea and Febiger; 1983:493504.Google Scholar
10. Heeg, P, Osswald, W, Schwenzer, N. Wirksamkeitsvergleich von Desinfektions-verf ahren zur chirurgischen Händedesinfektion unter experi-mentellen und klinischen Bedingungen. Hyg Medicine 1986;11:107111.Google Scholar
11. Larson, EL, Butz, AM, Gullette, DL, Laughon, BA. Alcohol for surgical scrubbing? Infect Control Hosp Epidemiol 1990;11:139143.CrossRefGoogle ScholarPubMed
12. Rotter, ML, Koller, W. Surgical hand disinfection: effect of sequential use of two chlorhexidine preparations. J Hosp Infect 1990;16:161166.CrossRefGoogle ScholarPubMed
13. Babb, JR, Davies, JG, Ayliffe, GA. A test procedure for evaluating surgical hand disinfection. J Hosp Infect 1991;18(suppl B):4149.CrossRefGoogle ScholarPubMed
14. Deutsche Gesellschaft für Hygiene und Mikrobiologie. Richtlinien für die Prüfung Chemischer Desinfektionsmittel. 3rd ed. Stuttgart, Germany: G. Fischer; 1972.Google Scholar
15. Deutsche Gesellschaft für Hygiene und Mikrobiologie. Richtlinien für die Prüfung und Bewertung chemischer Desinfektionsverfahren. Zbl Bakt Hyg I Abt Orig B 1981;172:528556.Google Scholar
16. Ayliffe, GAJ, Babb, JR, Quoraishi, AH. A test for “hygienic” hand disinfection. J Clin Pathol 1978;31:923928.Google Scholar
17. Rhyne, AL, Steel, RGD. Tables for a treatment versus control multiple comparis on sign test. Technometrics 1965;7:293306.Google Scholar
18. Wilcoxon, F, Wilcox, RA. Some Rapid Approximate Statistical Procedures. Pearl River, NY: Lederle Laboratories; 1964.Google Scholar
19. Mann, HB, Whitney, DR. On a test of whether one of two random variables is sto chastically larger than the other. Ann Math Stat 1947;18:5060.Google Scholar
20. Rotter, M, Koller, W, Kundi, M, Wewalka, G, Mittermayer, H. Testmethode für die Wertbemessung von Verfahren für die Hygienische Händedesin-fektion. 1. Teil: Besch reibung der Methode. Zbl Bakt Hyg I Abt Orig B 1977;164:498506.Google Scholar
21. Rotter, ML, Koller, W, Wewalka, G, Werner, H-P, Ayliffe, GAJ, Babb, JR. Evaluation of procedures for hygienic hand disinfection: controlled parallel experiments on the Vienna test model. J Hyg Cambr 1986;96:2737.CrossRefGoogle ScholarPubMed