Is hand washing really needed in an intensive care unit?
OBJECTIVE
To determine whether a rigorous antiseptic hand washing of bare hands with 4% chlorhexidine and alcohol reduced fingertip microbial colonization as compared with the use of boxed, clean, nonsterile latex gloves. In addition, to investigate if aseptic donning technique and/or a prior hand washing would reduce the level of glove contamination.


METHODS
Prospective, randomized, crossover design, with each subject serving as his/her own control.


METHODS
University intensive care unit.


METHODS
Forty-three intensive care nurses.


METHODS
The fingertips of 20 nurses were cultured before and after a strict antiseptic hand washing and before and after the routine and aseptic donning of sterile gloves. Subsequently, the fingertips of 43 nurses were cultured before and after the casual donning of nonsterile gloves over unwashed hands and before and after a strict antiseptic hand washing. Fingertip cultures were plated directly on agar, incubated for 24 hrs, and counted and recorded as the number of colony-forming units (cfu) for each hand. Different colony types were then subcultured.


RESULTS
Hand washing with antiseptic reduced colonization from 84 to 2 cfu (p < .001). The proportion of cases with > or = 200 cfu/hand was reduced from 30% to 9%. Aseptic or casual donning of sterile gloves, with or without prior antiseptic hand washing, resulted in consistently low glove counts between 0 and 1.25 cfu. Nonsterile gloves casually donned over washed or unwashed bare hands diminished the bioburden to 2.17 and 1.34 cfu, respectively. No qualitative difference was found in the microorganisms recovered from gloved or bare hands.


CONCLUSIONS
Antiseptic hand washing and the use of nonsterile gloves over unwashed hands confer similar reductions in the number of microorganisms. There is no additional benefit with the use of aseptic donning technique, prior antiseptic hand washing, or the use of individually packaged sterile gloves.
Rossoff
L J
LJ
Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, NY 11042, USA.
Borenstein
M
M
Isenberg
H D
HD
D001207:Asepsis / Q000379:methods; D015169:Colony Count, Microbial; D003422:Critical Care / Q000706:statistics & numerical data; D017575:Gloves, Protective / Q000706:statistics & numerical data; D006225:Hand / Q000382:microbiology; D006235:Hand Disinfection / Q000379:methods; D006801:Humans; D011446:Prospective Studies