title: Creating a manual for proper hand hygiene and its clinical effects.
abstract: OBJECTIVE
  To prevent cross-infections, we created a manual for the treatment of infectious wounds that clarifies when to wash one's hands and when to wear gloves.
  
  
  METHODS
  Six patients with widespread infectious wounds caused by methicillin-resistant Staphylococcus aureus (MRSA) were treated. The bacterial count on the hands of the staff was calculated. We then compared the number of patients with MRSA isolated, and typed the MRSA isolates using pulsed-field gel electrophoresis (PFGE).
  
  
  RESULTS
  The pathogenic bacterial count among hospital staff before treatment/before hand hygiene was 8.2 x 10 colony-forming units (cfu)/hand, which were not detected before treatment/after hand hygiene. The pathogenic bacterial count on the hands before hand hygiene/after treatment climbed to 9.1 x 10(5) cfu/hand, and after treatment/after hand hygiene decreased to 0.38 cfu/hand. The number of patients with MRSA isolates before this protocol was 15/402 (3.7%), but that level significantly decreased to 5/411 (1.2%) after implementation of the manual. There were 13 strains of type F by PFGE before the manual was adopted, but five strains of MRSA isolated after the present manual was enforced were all observed to have different migration patterns.
  
  
  CONCLUSIONS
  A hand hygiene manual is effective for decreasing the rate of cross-infection.
authors.affiliation: Third Department of Surgery, Toho University School of Medeicine, 2-17-6 Ohashi, Tokyo 153-8515, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Kusachi
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Sumiyama
authors.forename: Youichi
authors.initials: Y
authors.lastname: Arima
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Hidenori
authors.initials: H
authors.lastname: Tanaka
authors.forename: Youichi
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Jiro
authors.initials: J
authors.lastname: Nagao
authors.forename: Yosihisa
authors.initials: Y
authors.lastname: Saida
authors.forename: Manabu
authors.initials: M
authors.lastname: Watanabe
authors.forename: Junko
authors.initials: J
authors.lastname: Sato
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000517:prevention & control*; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D017575:Gloves, Protective; D006235:Hand Disinfection / Q000379:methods / Q000592:standards; D006801:Humans; D006920:Hygiene; D008297:Male; D008370:Manuals as Topic; D016106:Methicillin Resistance; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control*; D014946:Wound Infection / Q000382:microbiology*
chemical_list: D000891:Anti-Infective Agents, Local