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Antimicrobial Resistance & Infection Control
Published in:

Open Access 01-12-2017 | Research

Chlorhexidine is not an essential component in alcohol-based surgical hand preparation: a comparative study of two handrubs based on a modified EN 12791 test protocol

Authors: Thomas-Jörg Hennig, Sebastian Werner, Kathrin Naujox, Andreas Arndt

Published in: Antimicrobial Resistance & Infection Control | Issue 1/2017

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Abstract

Background

Surgical hand preparation is an essential part of modern surgery. Both alcohol-based and antiseptic detergent-based hand preparation are recommended practices, with a trend towards use of alcohol based handrubs. However, discussion has arisen whether chlorhexidine is a required ingredient in highly efficacious alcohol-based formulations, in view of providing sustained antimicrobial efficacy.

Methods

One alcohol-only formulation (product A), containing ethanol and n-propanol, and one formulation containing a chlorhexidine-ethanol combination (product B) were directly compared with each other using a modified test protocol based on European standard EN 12791 (2016) with 25 volunteers. The alcohol-only formulation (product A) was applied for only 90 s, the chlorhexidine-alcohol formulation (product B) for 180 s. Microbial log reduction factors were determined and statistically compared immediately after application and at 6 h under surgical gloves.

Results

The alcohol-only formulation (product A) achieved mean log reduction factors of 1.96 ± 1.06 immediately after application and 1.67 ± 0.71 after 6 h. The chlorhexidine-alcohol combination (product B) achieved mean log reduction factors of 1.42 ± 0.79 and 1.24 ± 0.90 immediately and after 6 h, respectively. The values for product A were significantly greater than those for product B at both measured time points (p ≤ 0.025 immediately after application and p ≤ 0.01 after 6 h).

Conclusions

An optimized alcohol-only formulation tested according to a modified EN 12791 protocol in 25 healthy volunteers outperformed a chlorhexidine-alcohol formulation both immediately after application and at 6 h under surgical gloves, despite a much shorter application time. Thus, optimized alcohol-only formulations do not require chlorhexidine to achieve potent immediate and sustained efficacy. In conclusion, chlorhexidine is not an essential component for alcohol-based surgical hand preparation.
Literature
1.
Gröschel DHM, Pruett TL. Surgical antisepsis. In: Block SS, editor. Disinfection, sterilisation and preservation. 4th ed. London: Lea & Febiger; 1991. p. 642–54.
2.
World Health Organization. WHO guidelines on hand hygiene in health care. Geneva: World Health Organization; 2009.
3.
4.
Graves PB, Twomey CL. Surgical hand antisepsis: an evidence-based review. Periop Nurs Clin. 2006;1:235–49.CrossRef
5.
Tanner J. Surgical hand antisepsis: the evidence. J Perioper Pract. 2008;18(8):330–4. 9PubMed
6.
Boyce JM, Pittet D. Guideline for hand hygiene in health-care settings. Recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. Society for Healthcare Epidemiology of America/Association for Professionals in infection control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002;51(RR-16):1–45. quiz CE1-4PubMed
7.
Association of perioperative Registered Nurses (AORN). Recommended practices for surgical hand antisepsis/hand scrubs. AORN J. 2004;79(2):416–8. 21-6, 29-31CrossRef
8.
Hsieh HF, Chiu HH, Lee FP. Surgical hand scrubs in relation to microbial counts: systematic literature review. J Adv Nurs. 2006;55(1):68–78.CrossRefPubMed
9.
Graf ME, Machado A, Mensor LL, Zampieri D, Campos R, Faham L. Surgical hands antisepsis with alcohol-based preparations: cost-effectiveness, compliance of professionals and ecological benefits in the Brazilian healthcare scenario (in Portuguese). J Bras Econ Saúde. 2014;6(2):71–80.
10.
Parienti JJ, Thibon P, Heller R, et al. Hand-rubbing with an aqueous alcoholic solution vs traditional surgical hand-scrubbing and 30-day surgical site infection rates: a randomized equivalence study. JAMA. 2002;288(6):722–7.CrossRefPubMed
11.
Kampf G, Ostermeyer C, Heeg P. Surgical hand disinfection with a propanol-based hand rub: equivalence of shorter application times. J Hosp Infect. 2005;59(4):304–10.CrossRefPubMed
12.
European Committee for Standardization (CEN). EN 12791:2016. Chemical disinfectants and antiseptics. Surgical hand disinfection. Test method and requirement (phase 2/step2). Brussels: European Committee for Standardization (CEN); 2016.
13.
American Society for Testing and Materials (ASTM). ASTM E1115–11. Standard test method for evaluation of surgical hand scrub formulations West Conshohocken, PA: ASTM International; 2011.
14.
Food and Drug Administration_(FDA). Tentative final monograph for health-care antiseptic drug products; proposed rule. 21 CFR parts 333 and 369. Fed Regist. 1994;59(116):31402–52.
15.
Heeg P, Ostermeyer C, Kampf G. Comparative review of the test design tentative final monograph (TFM) and EN 12791 for surgical hand disinfectants. J Hosp Infect. 2008;70(Suppl 1):22–6.CrossRefPubMed
16.
Beausoleil CM, Paulson DS, Bogert A, Lewis GS. In vivo evaluation of the persistant and residual antimicrobial properties of three hand-scrub and hand-rub regimes in a simulated surgical environment. J Hosp Infect. 2012;81(4):283–7.CrossRefPubMed
17.
Olson LK, Morse DJ, Duley C, Savell BK. Prospective, randomized in vivo comparison of a dual-active waterless antiseptic versus two alcohol-only waterless antiseptics for surgical hand antisepsis. Am J Infect Control. 2012;40(2):155–9.CrossRefPubMed
18.
Kampf G. “Persistent activity”-should the effect of chlorhexidine in the sampling fluid and nutrient broth and on agar plates really be regarded as the effect on hands? Am J Infect Control. 2012;40(6):579.CrossRefPubMed
19.
Kampf G. How valid are the ‘persistent and residual antimicrobial properties’ described by Beausoleil et al.? J Hosp Infect. 2012;82(4):301–2.CrossRefPubMed
20.
European Committee for Standardization (CEN). EN 13727:2012+A2:2015. Chemical disinfectants and antiseptics. Quantitative suspension test for the evaluation of bactericidal activity in the medical area. Test method and requirements (phase 2, step 1). Brussels: European Committee for Standardization (CEN); 2015.
21.
Kampf G, Ostermeyer C. Efficacy of two distinct ethanol-based hand rubs for surgical hand disinfection -- a controlled trial according to prEN 12791. BMC Infect Dis. 2005;5:17.CrossRefPubMedPubMedCentral
22.
Rotter ML. Hand washing, hand disinfection, and skin disinfection. In: Wenzel RP, editor. Prevention and control of nosocomial infections. 3rd ed. Baltimore: Williams &Wilkins; 1997. p. 691–709.
23.
24.
25.
Rotter ML, Kampf G, Suchomel M, Kundi M. Population kinetics of the skin flora on gloved hands following surgical hand disinfection with 3 propanol-based hand rubs: a prospective, randomized, double-blind trial. Infect Control Hosp Epidemiol. 2007;28(3):346–50.CrossRefPubMed
26.
Kampf G, Kramer A, Suchomel M. Lack of sustained efficacy for alcohol-based surgical hand rubs containing ‘residual active ingredients’ according to EN 12791. J Hosp Infect. 2017;95(2):163–8.CrossRefPubMed
27.
Weber WP, Reck S, Neff U, et al. Surgical hand antisepsis with alcohol-based hand rub: comparison of effectiveness after 1.5 And 3 minutes of application. Infect Control Hosp Epidemiol. 2009;30(5):420–6.CrossRefPubMed
28.
Maiwald M. Technique is important for alcohol-based surgical hand antisepsis. Healthc Infect. 2012;17(3):106–7.CrossRef
29.
Burch TM, Stanger B, Mizuguchi KA, Zurakowski D, Reid SD. Is alcohol-based hand disinfection equivalent to surgical scrub before placing a central venous catheter? Anesth Analg. 2012;114(3):622–5.CrossRefPubMed
30.
Maiwald M, Chan ES. The forgotten role of alcohol: a systematic review and meta-analysis of the clinical efficacy and perceived role of chlorhexidine in skin antisepsis. PLoS One. 2012;7(9):e44277.CrossRefPubMedPubMedCentral
31.
Maiwald M, Chan ES. Pitfalls in evidence assessment: the case of chlorhexidine and alcohol in skin antisepsis. J Antimicrob Chemother. 2014;69(8):2017–21.CrossRefPubMed
32.
Kampf G, Shaffer M, Hunte C. Insufficient neutralization in testing a chlorhexidine-containing ethanol-based hand rub can result in a false positive efficacy assessment. BMC Infect Dis. 2005;5(1):48.CrossRefPubMedPubMedCentral
33.
Kampf G. What is left to justify the use of chlorhexidine in hand hygiene? J Hosp Infect. 2008;70(Suppl 1):27–34.CrossRefPubMed
34.
Kampf G, Reichel M, Hollingsworth A, Bashir M. Efficacy of surgical hand scrub products based on chlorhexidine is largely overestimated without neutralizing agents in the sampling fluid. Am J Infect Control. 2013;41(1):e1–5.CrossRefPubMed
35.
Maiwald M, Petney TN, Assam PN, Chan ES. Use of statistics as another factor leading to an overestimation of chlorhexidine's role in skin antisepsis. Infect Control Hosp Epidemiol. 2013;34(8):872–3.CrossRefPubMed
36.
Kampf G, Kramer A. Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clin Microbiol Rev. 2004;17(4):863–93. table of contentsCrossRefPubMedPubMedCentral
37.
Stingeni L, Lapomarda V, Lisi P. Occupational hand dermatitis in hospital environments. Contact Dermatitis. 1995;33(3):172–6.CrossRefPubMed
38.
39.
Kampf G, Ostermeyer C, Heeg P, Paulson D. Evaluation of two methods of determining the efficacies of two alcohol-based hand rubs for surgical hand antisepsis. Appl Environ Microbiol. 2006;72(6):3856–61.CrossRefPubMedPubMedCentral
40.
Rotter M, Kundi M, Suchomel M, et al. Reproducibility and workability of the European test standard EN 12791 regarding the effectiveness of surgical hand antiseptics: a randomized, multicenter trial. Infect Control Hosp Epidemiol. 2006;27(9):935–9.CrossRefPubMed
Metadata
Title
Chlorhexidine is not an essential component in alcohol-based surgical hand preparation: a comparative study of two handrubs based on a modified EN 12791 test protocol
Authors
Thomas-Jörg Hennig
Sebastian Werner
Kathrin Naujox
Andreas Arndt
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Antimicrobial Resistance & Infection Control / Issue 1/2017
Electronic ISSN: 2047-2994
DOI
https://doi.org/10.1186/s13756-017-0258-0

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