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Surgical hand disinfection: effect of sequential use of two chlorhexidine preparations
1Hygiene-Institute of the University, Vienna, Austria.
Abstract:
The antimicrobial efficacy of three 'two-phase' surgical hand disinfection procedures was compared, in a volunteer study, to 60% n-propanol, applied for 5 min, which is the reference hand-disinfection procedure used in Austria and West Germany (FRG). The procedures involved sequential use of unmedicated soap or a disinfectant-detergent containing 4% chlorhexidine gluconate (CHX; 'Hibiscrub') followed by a handrub preparation containing 70% w/w isopropanol plus 0.5% CHX ('Hibisol'). The immediate and sustained effects (3 h) of washing with unmedicated soap (3 min) followed by rubbing on 'Hibisol' (4 min) were significantly smaller (log10 reductions of 1.72 and 1.12) than with each of the other procedures. Use of 'Hibiscrub' (3 min) and 'Hibisol' (4 min) produced log10 reductions of 2.50 and 1.71, equalling those of the reference procedure with n-propanol (2.49 and 1.78). When 'Hibisol' was used for 5 min rather than 4 min, a considerable, though not significant, increase in effect was achieved (log10 reductions of 2.90 and 2.07). Replacement of unmedicated soap by 'Hibiscrub' could significantly improve the effectiveness of the hand disinfection procedure commonly used by surgeons in German-speaking countries; namely to wash hands first with soap and then disinfect them with an alcoholic preparation. It may also be of additional advantage as this adds another 'layer' of CHX when 'Hibisol' rather than alcohol alone is used.
Insights
Replacing unmedicated soap with chlorhexidine gluconate (CHX) significantly enhances surgical hand disinfection. Using CHX detergent followed by an alcohol-based handrub provides antimicrobial efficacy comparable to the reference n-propanol procedure.
Area of Science:
- Microbiology
- Infection Control
- Public Health
Background:
- Surgical hand disinfection is critical for preventing healthcare-associated infections.
- Current standard procedures in German-speaking countries often involve soap washing followed by alcohol-based disinfection.
- The efficacy of two-phase hand disinfection protocols needs rigorous evaluation.
Purpose of the Study:
- To compare the antimicrobial efficacy of three two-phase surgical hand disinfection procedures.
- To evaluate the effectiveness of protocols using chlorhexidine gluconate (CHX) and isopropanol-based handrubs.
- To assess sustained antimicrobial effects over a 3-hour period.
Main Methods:
- A volunteer study comparing different hand disinfection protocols.
- Reference procedure: 60% n-propanol for 5 minutes.
- Test procedures: Sequential use of unmedicated soap or 4% CHX detergent ('Hibiscrub'), followed by 70% isopropanol plus 0.5% CHX handrub ('Hibisol') for 4 or 5 minutes.
- Antimicrobial efficacy measured by log10 reduction of bacterial counts immediately and after 3 hours.
Main Results:
- The combination of 'Hibiscrub' (3 min) and 'Hibisol' (4 min) achieved log10 reductions of 2.50 (immediate) and 1.71 (3h), comparable to the n-propanol reference (2.49 and 1.78).
- Using unmedicated soap followed by 'Hibisol' (4 min) resulted in significantly lower efficacy (log10 reductions of 1.72 and 1.12).
- Increasing 'Hibisol' application to 5 minutes showed a trend towards improved efficacy (log10 reductions of 2.90 and 2.07).
Conclusions:
- Replacing unmedicated soap with 4% CHX detergent ('Hibiscrub') significantly improves surgical hand disinfection effectiveness.
- The two-phase procedure using 'Hibiscrub' and 'Hibisol' offers comparable or superior antimicrobial action to the standard n-propanol method.
- This enhanced disinfection protocol may provide an additional benefit due to the residual effect of CHX.