The use of antiseptics for handwashing by medical personnel

Numerous studies have shown that the major reservoir of nosocomial infection in the hospital is the infected or colonised patient and the major mode of spread of organisms between patients is on the hands of medical personnel. A prolonged preoperative scrub with an antiseptic is one of the most time-honoured rituals of surgical asepsis. Hygienic handwashing in the hospital or clinic, to remove transient contaminants acquired from patients or the environment and prevent cross-infection to vulnerable patients, is similarly regarded as one of the most fundamental infection control measures, yet is done infrequently by personnel in most hospitals. Following a typical brief (7.10 second) handwashing with a nonmedicated soap, the number of organisms that can be transmitted from the person's hands may, paradoxically, actually increase. Use of chlorhexidine for handwashing or application of an evaporative alcohol-based lotion has been found to reduce shedding of bacteria-laden skin squames. Routine use of antiseptic-containing handwashing agents is clearly more effective than nonmedicated soaps for microbial removal, can enhance the value of the handwashings that are done and might further confer protection against contaminants acquired between handwashings. In a sequential comparative trial of three handwashing agents in a surgical intensive care unit--a nonmedicated soap, 10% povidone-iodine solution, and 4% aqueous chlorhexidine, each used exclusively for approximately six weeks--the incidence of nosocomial infection was 50% lower during the use of the antiseptic handwashing products than during the use of nonmedicated soap (P less than .001). Novel approaches are needed to improve the frequency of hygienic handwashing.(ABSTRACT TRUNCATED AT 250 WORDS)