title: Comparative in vitro and in vivo study of nine alcohol-based handrubs.
abstract: BACKGROUND
  Hygienic hand disinfection using alcohol-based handrubs (AHRs) is an alternative method to conventional handwashing in hospital wards. Because a documented choice of such products would consider data from in-care evaluation, we designed a comparative study of 9 AHRs both in vitro and in vivo in actual care conditions.
  
  
  METHODS
  The bactericidal activity of AHRs was first measured in vitro against 4 hospital strains exhibiting multiple antibiotic resistance: Acinetobacter baumannii, Staphylococcus aureus, Pseudomonas aeruginosa, and Enterobacter aerogenes. In a second time, AHRs were tested in an intensive care unit for antibacterial activity against the cutaneous flora of personnel hands and for acceptance by the care personnel.
  
  
  RESULTS
  The 9 AHRs could be classified in 3 groups on the basis of their in vitro activity: products of the first group showed a bactericidal activity higher than 4 log(10) against the 4 strains. Only 1 of these products presented simultaneously an effective antibacterial activity against the cutaneous flora of care personnel hands and a good acceptance by the care personnel.
  
  
  CONCLUSIONS
  The in vitro study allowed the differentiation of the AHRs tested on the basis of bactericidal activity, but evaluation in an in-care situation allowed further discrimination through both antibacterial activity and acceptance. Thus, the combination of in vitro and in vivo evaluations should provide helpful arguments in the choice of AHRs.
authors.affiliation: Department of Microbiology, Centre Hospitalier Universitaire Charles Nicolle, Rouen, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Rochon-Edouard
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Pons
authors.forename: Benoît
authors.initials: B
authors.lastname: Veber
authors.forename: Martine
authors.initials: M
authors.lastname: Larkin
authors.forename: Serge
authors.initials: S
authors.lastname: Vassal
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Lemeland
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D001424:Bacterial Infections / Q000517:prevention & control*; D016022:Case-Control Studies; D000431:Ethanol / Q000494:pharmacology*; D006235:Hand Disinfection / Q000379:methods*; D006801:Humans; D066298:In Vitro Techniques; D007362:Intensive Care Units; D008826:Microbial Sensitivity Tests; D009873:Operating Rooms; D012016:Reference Values; D012680:Sensitivity and Specificity; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D000431:Ethanol