title: Comparative efficacy of hand hygiene agents in the reduction of bacteria and viruses.
abstract: BACKGROUND
  Health care-associated infections most commonly result from person-to-person transmission via the hands of health care workers.
  
  
  METHODS
  We studied the efficacy of hand hygiene agents (n = 14) following 10-second applications to reduce the level of challenge organisms (Serratia marcescens and MS2 bacteriophage) from the hands of healthy volunteers using the ASTM-E-1174-94 test method.
  
  
  RESULTS
  The highest log 10 reductions of S marcescens were achieved with agents containing chlorhexidine gluconate (CHG), triclosan, benzethonium chloride, and the controls, tap water alone and nonantimicrobial soap and water (episode 1 of hand hygiene, 1.60-2.01; episode 10, 1.60-3.63). Handwipes but not alcohol-based handrubs were significantly inferior from these agents after a single episode of hand hygiene, but both groups were significantly inferior after 10 episodes. After a single episode of hand hygiene, alcohol/silver iodide, CHG, triclosan, and benzethonium chloride were similar to the controls in reduction of MS2, but, in general, handwipes and alcohol-based handrubs showed significantly lower efficacy. After 10 episodes, only benzethonium chloride (1.33) performed as well as the controls (1.59-1.89) in the reduction of MS2.
  
  
  CONCLUSIONS
  Antimicrobial handwashing agents were the most efficacious in bacterial removal, whereas waterless agents showed variable efficacy. Alcohol-based handrubs compared with other products demonstrated better efficacy after a single episode of hand hygiene than after 10 episodes. Effective hand hygiene for high levels of viral contamination with a nonenveloped virus was best achieved by physical removal with a nonantimicrobial soap or tap water alone.
authors.affiliation: Department of Hospital Epidemiology, University of North Carolina Health Care System, North Carolina, USA. esickber@unch.unc.edu
authors.forename: Emily E
authors.initials: EE
authors.lastname: Sickbert-Bennett
authors.forename: David J
authors.initials: DJ
authors.lastname: Weber
authors.forename: Maria F
authors.initials: MF
authors.lastname: Gergen-Teague
authors.forename: Mark D
authors.initials: MD
authors.lastname: Sobsey
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Samsa
authors.forename: William A
authors.initials: WA
authors.lastname: Rutala
mesh_terms: D000328:Adult; D001558:Benzethonium / Q000008:administration & dosage / Q000494:pharmacology; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology; D003428:Cross Infection / Q000517:prevention & control*; D004202:Disinfectants / Q000008:administration & dosage / Q000494:pharmacology*; D006235:Hand Disinfection; D006801:Humans; D017053:Infection Control / Q000379:methods; D017909:Levivirus / Q000187:drug effects; D008826:Microbial Sensitivity Tests; D012706:Serratia marcescens / Q000187:drug effects; D013501:Surface-Active Agents / Q000008:administration & dosage / Q000494:pharmacology*; D014260:Triclosan / Q000008:administration & dosage / Q000494:pharmacology
chemical_list: D004202:Disinfectants; D013501:Surface-Active Agents; D001558:Benzethonium; D014260:Triclosan; C010882:chlorhexidine gluconate; D002710:Chlorhexidine