title: Influence of rings on the efficacy of hand sanitization and residual bacterial contamination.
abstract: BACKGROUND
  Previous studies, conducted before widespread use of scrubless, alcohol-based hand sanitizers, demonstrated increased residual bacterial counts after hand hygiene on hands with jewelry.
  
  
  OBJECTIVE
  To compare the impact of finger rings on the effectiveness of scrubless and water-aided alcohol-based hand sanitization methods with that of povidone-iodine scrub.
  
  
  METHODS
  Randomized, controlled study.Setting. University hospital.Participants. Sixty volunteer subjects from a pool of perioperative staff and medical students.
  
  
  METHODS
  After recruitment, participants wore a ring on one hand and no ring on the other hand. They were randomly assigned to perform hand hygiene with a povidone-iodine scrub, an alcohol wash, or a waterless alcohol-chlorhexidine lotion (n=20 subjects per method). After subjects completed hand hygiene, gloves were placed on their hands by means of sterile methods, and a "glove juice" technique was used to obtain samples for culture. The number of colony-forming units in each culture was counted, and the data were compared.
  
  
  RESULTS
  There was no significant difference in the number of bacteria between hands with and hands without rings for the groups that used alcohol wash or alcohol-chlorhexidine lotion. However, for the povidone-iodine group, the number of bacteria on hands with rings was greater than the number on hands without rings (P<.05). The hands of participants who used waterless alcohol-chlorhexidine had the lowest bacterial count, regardless of the presence of rings (P<.01).
  
  
  CONCLUSIONS
  The presence of rings does not negatively impact the effectiveness of alcohol-based hand sanitizers. Use of waterless alcohol-chlorhexidine lotion resulted in the lowest bacterial count.
authors.affiliation: Department of Orthopaedic Surgery, Loma Linda University, 11406 Loma Linda Drive, Loma Linda, CA 92354, USA. wongwora@usc.edu.
authors.forename: Montri D
authors.initials: MD
authors.lastname: Wongworawat
authors.forename: Sidney G
authors.initials: SG
authors.lastname: Jones
mesh_terms: D000438:Alcohols / Q000008:administration & dosage*; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D002710:Chlorhexidine / Q000008:administration & dosage*; D015169:Colony Count, Microbial; D004203:Disinfection / Q000379:methods; D004338:Drug Combinations; D005385:Fingers; D006225:Hand / Q000382:microbiology*; D006235:Hand Disinfection / Q000379:methods*; D006801:Humans; D011206:Povidone-Iodine / Q000008:administration & dosage*; D013514:Surgical Procedures, Operative / Q000592:standards; D016896:Treatment Outcome
chemical_list: D000438:Alcohols; D000891:Anti-Infective Agents, Local; D004338:Drug Combinations; D011206:Povidone-Iodine; D002710:Chlorhexidine