NEWS FEATURES
Comparative Efficacy of Hand Hygiene Products in the Reduction of Bacteria and
Viruses from the Hands
(Article summarizes two abstracts presented at APIC 2002 conference.*)
Nosocomial infections are often acquired by the spread of transient microorganisms via
the hands of healthcare workers. Therefore, effective hand hygiene is essential to the
prevention and control of nosocomial infections. However, no previous studies
compare the efficacy of various handwashing products at an exposure time
representative of healthcare workers’ behavior. To compare the efficacy of a wide
spectrum of products (n=13) in reducing both Serratia marcescens, a Gram-negative
bacillus, and MS2 bacteriophage, a surrogate human virus, on the hands, we followed
the ASTM-E-1174-94 Standard Test Method for Evaluation of Health Care Personnel
Handwash Formulations with the wash time modified from 30 seconds to 10 seconds.
A series of 10 contaminations followed by 10-second washes were performed with
samples recovered from each hand following the first, third, fifth, seventh and tenth
washes using the glove juice technique.
Log reductions of S. marcescens at the tenth wash were as follows: 2% chlorohexidine
gluconate (CHG) wash (3.63), 4% CHG wash (3.14), 0.75% CHG wash (3.04), 1%
triclosan wash (2.49), 0.2% benzalkonium chloride wash (1.98), non-antimicrobial wash
(1.60), 61% ethyl alcohol rub (1.35), 61% ethyl alcohol with 1% CHG rub (1.08), 70%
ethyl alcohol with 0.005% silver iodide rub (1.07), 0.5% PCMX with 40% SD alcohol
wipe (0.84), 62% ethyl alcohol foam rub (0.67), 60% ethyl alcohol rub (0.42), and 0.4%
benzalkonium chloride wipe (0.01). In summary, antimicrobial hand wash soaps,
containing agents such as CHG, are the most efficacious in removing transient bacteria
from the hands. The waterless agents, hand rubs and hand wipes, show variable
efficacy but are not as efficacious in bacteria reduction as the antimicrobial hand wash
soaps. Waterless products, if shown to demonstrate sufficient efficacy, should be
reserved for situations when sinks are not available and to improve general hand
hygiene compliance.
The non-enveloped MS2 bacteriophage was not reduced effectively by any of the
alcohol-based products and instead led to a gradual accumulation of organisms on the
hands; the efficacy results measured by log reduction at wash 10 were as follows: 60%
ethyl alcohol (–0.67), 61% ethyl alcohol (–0.59), 62% ethyl alcohol (–0.71), 61% ethyl
alcohol/1% CHG (–0.87), 70% ethyl alcohol/0.005% silver iodide (0.18), 0.5%
PCMX/40% SD Alcohol (–0.23), and 0.4% benzalkonium chloride (–0.46). In fact, for
removal of the MS2 bacteriophage the non-antimicrobial control soap, 1.62 log
reduction at wash 10, was even more efficacious than any of the antimicrobial wash
products at wash 10: 0.75% CHG (0.77), 2% CHG (0.30), 4% CHG (0.37), 0.2%
benzalkonium chloride (1.33). Therefore, non-antimicrobial soaps may be equally or
more effective in reduction of certain microorganisms, especially non-enveloped
viruses, from the hands.
*Sickbert-Bennett EE, Rutala WA, Weber DJ, Gergen-Teague MF, Sobsey MD.
Comparative Efficacy of Handwashing Products in Removal of Bacteria at a
Handwashing Time of 10 Seconds. Abstract. Association of Professionals in Infection
Control and Epidemiology 29th Annual Educational and International Conference.
Nashville, TN, May 19-23, 2002. p 37.
*Sickbert-Bennett EE, Rutala WA, Weber DJ, Gergen-Teague MF, Sobsey MD.
Comparative Efficacy of Handwashing Products in Removal of Viruses. Abstract.
Association of Professionals in Infection Control and Epidemiology 29th Annual
Educational and International Conference. Nashville, TN, May 19-23, 2002, p 37.
REGULATORY/LEGISLATIVE
Proposed Changes to NC Health Rules
The North Carolina Division of Public Health held a public hearing for proposed
changes to six administrative rules. Of special interest to infection control professionals
in the state are the proposed rule changes related to prenatal HIV testing and
chlamydia testing. Proposed changes to the following rules are being considered.
15A NCAC 19A.0202 [Prenatal HIV testing]
15A NCAC 19A.0204 [Chlamydia Testing]
15A NCAC 19A.0401 [Varicella Vaccine; Authority of State Health Director to suspend
rules]
15A NCAC 19A.0901/.0907 [DHHS Bioregistry]
15A NCAC 21A.0815/.0822 [Teen Pregnancy Initiatives]
15A NCAC 21H.0111 [Sickle Cell Treatment]
Copies of those proposed rules changes can be downloaded from
http://www.unc.edu/depts/spice/ncrule.html. The portions of underlined texts are
proposed additions; portions of struckthrough texts are proposed deletions. If the
Commission for Health Services approves them, the effective date of these changes
will be April 1, 2003.
QUESTION OF THE MONTH
Management of Hepatitis B Vaccination Failures
Q:
As the employee health nurse at my facility I am now testing healthcare workers
1-2 months after completion of the 3-dose vaccination series for anti-HBs. My question
is what should I do about persons who do not respond?
A:
OSHA requires, in the Bloodborne Pathogen Rule, that Guidelines from the
Public Health Service (i.e., CDC) must be implemented to protect healthcare workers
from bloodborne pathogens. The updated U.S. Public Health Service Guidelines for the
Management of Occupational Exposures to HBV, HCV, and HIV and
Recommendations for Postexposure Prophylaxis, MMWR, June 29, 2001, Vol 50, No
RR 11 (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm) states that the
following should be done for persons who do not respond to the primary vaccine series
(i.e. anti-HBs <10 mlU/mL). The healthcare workers should either complete a second
3-dose vaccination series and be retested for antibodies or be evaluated to determine if
they are HBsAg-positive. Persons who are found to be HBsAg-positive should be
counseled regarding how to prevent HBV transmission and regarding the need for
medical evaluation. Healthcare workers who fail to demonstrate adequate anti-HBV
after the second series of vaccinations should also be tested for potential chronic
HBsAg positivity.
NEWS AND ANNOUNCEMENTS
New Head of North Carolina Bioterrorism
Colonel James W. Kirkpatrick, MD, MPH will become North Carolina Bioterrorism
Coordinator and the Branch Head of the newly formed Office of Public Health
Preparedness and Response in the Bioterrorism Branch of the Epidemiology Section of
the Division of Public Health. Dr. Kirkpatrick currently serves as Chief Academic
Officer, Dean/Commandant of the US Army Academy of Health Sciences. This
institution is charged with training and educating all reserve and international military
healthcare personnel of all DoD branches and allied countries to ensure optimal health
and readiness of America's military forces and its coalition partners in all medical
aspects and particularly in bioterrorism response. Dr. Kirkpatrick has had a 30 year
distinguished career as a US Army physician. Dr. Kirkpatrick received his Bachelor of
Science Degree from Texas Tech and graduated from the University of Texas
Southwestern Medical School and completed his internship at Fort Lewis, Washington.
He went on to complete his residency at Walter Reed Army Institute of Research and
received his Master's Degree in Public Health from Tulane University. After that, he
graduated from the Armed Forces Staff College and the Army War College. Dr.
Kirkpatrick is board certified in Preventive Medicine.
New Director of CDC
Dr. Julie Gerberding, a former HIV researcher who became a front-line government
spokesperson in the anthrax outbreak, was named director of the Centers for Disease
Control and Prevention (CDC) July 3, 2002. An internal medicine specialist, Gerberding
was working at the University of California at San Francisco San when the AIDS crisis
began and is credited with being one of the first researchers to address the potential
risks to healthcare workers. Then Gerberding was chief of the CDC's division of
healthcare quality promotion. Last September, she agreed to serve several months as
acting deputy director of the National Center for Infectious Diseases. Following the
departure of former CDC director Jeffrey Koplan March 31, Gerberding was named part
of a four-person interim management team.
Staphylococcus aureus Resistant to Vancomycin - USA, 2002 is reported in the
MMWR, July 5, 2002. This report describes the first clinical isolate of S. aureus that is
fully resistant to vancomycin.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5126a1.htm
New Variant CJD: Fact Sheet is available online
http://www.cdc.gov/od/oc/media/pressrel/fs020418.htm
In April 2002, the Food and Drug issued a Public Health Advisory notifying the medical
community of two recent hospital outbreaks of lower respiratory tract colonization and
infection with Burkholderia cepacia attributed to contaminated multi-dose bottles of
albuterol sulfate. In most cases, colonization or infection occurred in the ICU setting,
often in patients receiving mechanical ventilation. The advisory reminds healthcare
professionals of measures that may be important in reducing the risk of contamination
and subsequent outbreaks of infections.
http://www.fda.gov/cder/drug/advisory/albuterol.htm
On April 18, 2002, U.S. Secretary of Labor Elaine L. Chao announced that the first
industry-specific guidelines to reduce ergonomic-related injuries and illnesses will be
developed for nursing homes. Representatives from the field have agreed to work with
the Occupational Safety and Health Administration (OSHA) to develop a draft for public
comment. The draft guidelines are expected to be ready for public comment later this
year. They will be published in the Federal Register for review before becoming final.
Recommendations of the Advisory Council for the Elimination of Tuberculosis were
published in the MMWR May 3, 2002.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5105a1.htm
The Occupational Health and Safety Administration issued a news release on June 12,
2002 prohibiting needle removal of contaminated needles from phlebotomy tube
holders and reuse of tube holders. OSHA's position is stated in the Compliance
directive CPL 2-2.69, November 2001.
http://www.osha.gov/OshDoc/Directive_pdf/CPL_2-2_69.pdf
Guidelines for Preventing Opportunistic Infections Among HIV-Infected Persons - 2002,
Recommendations of the US Public Health Service and the Infectious Diseases Society
of America were published in the MMWR June 14, 2002. They are available online at
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5108a1.htm
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
"Infection Control Part II: The ICP as an Environmentalist" will be held September 28November 1, 2002 at the Holiday Inn in Chapel Hill.
"Infection Control in Long-Term Care Facilities will be held September 9-10, 2002 at
The Friday Center in Chapel Hill.