title: In vivo efficacy of an alcohol-based surgical hand disinfectant containing a synergistic combination of ethylhexylglycerin and preservatives.
abstract: Alcohol-based surgical hand disinfectants are widely available in healthcare settings. Some currently marketed alcohol-based products use active concentrations of antimicrobials to achieve the required efficacy, raising the risk for exposure to potentially irritating levels of antimicrobials. This study compares the in vitro and in vivo efficacy of an alcohol-based surgical hand preparation containing 70% ethanol and preservative levels of chlorhexidine gluconate (CHG) and benzalkonium chloride (BZK) in synergistic combination with ethylhexylglycerin (Surgicept) with a surgical hand disinfectant containing 61% ethanol and 1% CHG (Avagard). The in vivo efficacy of Surgicept and Avagard was evaluated in volunteers using the Tentative Final Monograph method of the Food and Drug Administration (FDA), and their prolonged effect against transient pathogens was compared using a pig skin model. Surgicept exceeded the FDA requirements for surgical hand antiseptic with mean log(10) reductions of 2.36, 3.3 and 3.54 in resident flora 1 min after initial application, and showed a persistent effect with mean log(10) reductions of 2.23, 2.73 and 3.3, 6h post application on days 1, 2 and 5, respectively. Surgicept showed a superior prolonged effect against transient bacteria compared with Avagard. Surgicept (70% alcohol and preservative levels of CHG and BZK) may provide similar in vivo efficacy as Avagard (61% ethanol and 1% CHG).
authors.affiliation: Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. smm4@columbia.edu
authors.forename: T A
authors.initials: TA
authors.lastname: Gaonkar
authors.forename: I
authors.initials: I
authors.lastname: Geraldo
authors.forename: M
authors.initials: M
authors.lastname: Shintre
authors.forename: S M
authors.initials: SM
authors.lastname: Modak
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; D000438:Alcohols / Q000008:administration & dosage / Q000009:adverse effects; D000818:Animals; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage* / Q000009:adverse effects / Q000737:chemistry; D001548:Benzalkonium Compounds / Q000008:administration & dosage* / Q000009:adverse effects; D002710:Chlorhexidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D006235:Hand Disinfection / Q000379:methods*; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods; D008875:Middle Aged; D018709:Statistics, Nonparametric; D013552:Swine
chemical_list: D000438:Alcohols; D000891:Anti-Infective Agents, Local; D001548:Benzalkonium Compounds; C010882:chlorhexidine gluconate; D002710:Chlorhexidine