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Effect of quantity of handwashing soap on antimicrobic efficacy
American
92
Abstracts
INFECTION
Journal
of
CONTROL
COMPARATIVE EVAI#ATION OF CHLORHEXIDINE GLfICONATE (HIBICLENS ), POVIDONE DINE (EZ SCRUB ) AND CHLOROXYLENOL (PARA-SOF F ) SPONGE/BRUSHES. R. Aly*, H. Maibacb. University of California, San Francisco, CA.
EFFECT OF QUANTITY ANTIMICROBIC EFFICACY. The Johns Hopkins University Baltimore, MD.
OF
HANDWASHING SOAP ON E. Larson*, P. Eke. 8. Laughon. Schools of Nursing and Medicine.
Thirty-nine subjects were studied using a standard glovejuice protocol to determine the immediate and persistent effects, as well ss irritsncy potent@ of commercially available chfprhexidine gluconate (Hibicleffa ), povidone-iodine (E-Z Scrub ) and chloroxylenol (Pam-Soft ) sponge/brushes in a short (two-minute) surgical scrub procedure. Following pretest and baseline sampling periods, subjects were randomly assigned to one of the three test products to be used under supervision 11 times over a five-day period. Glovejuice samples were obtained after the first treatment on Days 1, 2 and 5. Right hands were sampled immediately after preparation and left hands were gloved and then sampled at either three or six hours after preparation. Assessments for irritation potential were made immediately prior to treatment on Day 1 and at the end of the study on Day 5. The chlorhexidine gluconate sponge/brush achieved significantly greater (p<.Ol) log bacterial count reductions than povidone-iodine and chloroxylenht sponge/brushes at all sampling times. This product maintained reductions greater than SQ% over the six-hour test period of each day. This was not the case for the other test products, which permitted remarkable increases in bacterial counts over baseline under the occlusive conditions of gloved hands. No significant differences in irritation among the three test preparations were found.
The antimicrobic effects of four handwashing products (4% chlorhexidine, two alcohol-based hand rinses, and a nongermicidal liquid soap) were compared in 40 adult volunteers who used three amounts: 1 ml, 3 ml or 5 ml per handwash. Subjects were assigned by block randomization to one of the products and to use one of the three product amounts. Each subject washed hands 15 times consecutively under supervision using a-standardized technique for five consecutive days. Quantitative cultures of aerobic hand flora were performed after the first and fifteenth wash on days I and 5. There were significant differences in logarithms of colony-forming units (CFU) between products (pc1.001) at all sampling times. In addition, there was a dose response effect, with subjects using more antiseptic soap or hand rinse having significantly lower CFU than those using 1 ml (p=.OO5). However, among subjects using nongermicidal soap there was no significant difference in bacterial recovery by amount of soap used We conclude that the amount of soap used is an important variable in determining the antimicrobial electiveness of handwashing when an antiseptic product is used.
PATTERNS OF ANTIBIOTIC USE IN INPATIENTS WITH BACTERIURIA. W.H. Greene*, H. Nadworny, M. Lanmann, S. Ort. Yale University School of Medicine, New Haven, CT and SUNY School of Medicine, Stony Brook, NY.
EXCESS HOSPITALIZATION IN SURGICAL PATIENTS WITH NOSOCOMIAL INFECTION. G.B. Penin*, N.J. Ehrenkranz, D. Poppe. South Florida Consortium for Infection Control, Miami, FL.
We retrospectively reviewed 3 months of adult inpatients (pts) with positive (+) urine cultures (UC) (>104 cfu/ml) to sssess the pattern of treatment (rx) of such pts and whether rx wss appropriate and nontoxic. Appropriate rx wss defined as the use of an antibiotic (Ab) to which the organism wss susceptible; toxic (T) rx wss the use of aminoglycosides, clindamycin or vancomycin despite susceptibility to other agents. One hundred ninety-seven complete records were available. One hundred one (51%) of the pts had community-acquired bacteriuria; 86 (48%) were noso corn&l. Of these, 55 (28%) had been rx-ed before UC results returned. Of the other 142, 74 (52%) were subsequently rx-ed and 68 (48%) were never rx-ed while in the hospital. Of the 55 pts rx-ed empirically, in 43 the Ab chosen was active against the UC organism; in 34 it was also the lesst T. Of the 9 in whom a less T Ab could be chosen, in 4 tbls wss not done - an error rate of 44% (4/g). Of the 12 isolates resistant to the empiric Ab chosen, in 5 no cban~c wae mode - an error rate of 42% (5/12). The error rates were low for pts rx-sd after the UC returned - only 2/74 (3%) were given an inactive Ab; of the 72 rx-ed appropriately, only 3 (4%) were not given the least T Ab. Of the 68 pts never rx-sd, 28 were diecharged prior to return of the UC, 4 had a negative repeat UC; 36 had no apparent reason for non-rx, i.e. 3% of those pts with (+) UC still in the hospital and not empirically on Ab. Monitoring efftcacy of tx by doing UCs during or after rx was seen only 40% and 23% of the time respectively. In summary, empiric rx of bacteriuria often results in suscep tibility and toxicity errors. Many pts with (+) UC not empirically rx-ed remain so without apparent reason. Educational programs should focus on post-empiric rx Ab choices and on how to evaluate a (+) UC for subsequent rx.
b of ho+ The effect of nosocomial infection on extending hss not pit&&on in surgical patients at community has been clearly defined. Given that the Diagnosis &latsd Group (DRG) system restricts the number of reimbaraed days for each specific surgical procedure, we investigated bow sosocomial infections are associated with excess stay over assigned DRG. A random sample of 2,026 clean and clean-contaminated elective operations was retrospectively surveyed. The sample CCNI&ted of abdominal, pelvic and orthopedic operat&s WIBWI!~Y performed at 17 Florida community hcspi&als. Tbe time period was January-December 1985. Medical record a&its were conducted at each of these hospitals by a team of 2 reviewers from the Florida Consortium for Infection Control (FCIC). Standard criteria for infection and consistent review msthods were used based on SENIC methodology. Overutiliaation (pat&t ho&ahsation exceeding DRG) was evaluated using individual patient DRG assignment. The Chi-square test was used for statistical significance. There were 189 nosocomial infectious detected in 167 patients; 74 of the 187 patients exceeded their DRC a&gument. Overall rates of infection by site were: sur#cai wound 1.146, bacteremia 0.4%, lower respiratory 1.3%, &m+oft &sue O.l%, urinary tract 6.1% and other 0.1%. Forty-four ~pereent of the infected patients vs. 13% of the uninfected patients had excess hospitalization days over sssigncd DRG (p< ,001). Days over DRG per operation per $00 patients were: lrmmectomy 81, hi plnnin8 63, t&d hip rapf6esursnt 52, IargsboweI43, hip prosthesis 28, chobsuystsetotny 11, hydttractomy 11, and tran= surethral resection of the prostate 0. !hgc stay over DRG dti no( appear to be atps related. Mesa p&sat qp for rfl ape*+ wm -92. Surgid WOW& &fwtiw osd lowrs rqspiraky $fyt+m were the commoitss~ iufaecioas that wtn diictf~ atttib-rlt;abIe as causes of excess len8th of stay. These preliminary Endings suggest that idmsiIicr&on of and appropriate intervention on pariarr~s with operaa&ats &sly to be compiicated by a~ooom iri i*factbn may ultiaataigam* aa * cost-effective measure.
92
Abstracts
INFECTION
Journal
of
CONTROL
COMPARATIVE EVAI#ATION OF CHLORHEXIDINE GLfICONATE (HIBICLENS ), POVIDONE DINE (EZ SCRUB ) AND CHLOROXYLENOL (PARA-SOF F ) SPONGE/BRUSHES. R. Aly*, H. Maibacb. University of California, San Francisco, CA.
EFFECT OF QUANTITY ANTIMICROBIC EFFICACY. The Johns Hopkins University Baltimore, MD.
OF
HANDWASHING SOAP ON E. Larson*, P. Eke. 8. Laughon. Schools of Nursing and Medicine.
Thirty-nine subjects were studied using a standard glovejuice protocol to determine the immediate and persistent effects, as well ss irritsncy potent@ of commercially available chfprhexidine gluconate (Hibicleffa ), povidone-iodine (E-Z Scrub ) and chloroxylenol (Pam-Soft ) sponge/brushes in a short (two-minute) surgical scrub procedure. Following pretest and baseline sampling periods, subjects were randomly assigned to one of the three test products to be used under supervision 11 times over a five-day period. Glovejuice samples were obtained after the first treatment on Days 1, 2 and 5. Right hands were sampled immediately after preparation and left hands were gloved and then sampled at either three or six hours after preparation. Assessments for irritation potential were made immediately prior to treatment on Day 1 and at the end of the study on Day 5. The chlorhexidine gluconate sponge/brush achieved significantly greater (p<.Ol) log bacterial count reductions than povidone-iodine and chloroxylenht sponge/brushes at all sampling times. This product maintained reductions greater than SQ% over the six-hour test period of each day. This was not the case for the other test products, which permitted remarkable increases in bacterial counts over baseline under the occlusive conditions of gloved hands. No significant differences in irritation among the three test preparations were found.
The antimicrobic effects of four handwashing products (4% chlorhexidine, two alcohol-based hand rinses, and a nongermicidal liquid soap) were compared in 40 adult volunteers who used three amounts: 1 ml, 3 ml or 5 ml per handwash. Subjects were assigned by block randomization to one of the products and to use one of the three product amounts. Each subject washed hands 15 times consecutively under supervision using a-standardized technique for five consecutive days. Quantitative cultures of aerobic hand flora were performed after the first and fifteenth wash on days I and 5. There were significant differences in logarithms of colony-forming units (CFU) between products (pc1.001) at all sampling times. In addition, there was a dose response effect, with subjects using more antiseptic soap or hand rinse having significantly lower CFU than those using 1 ml (p=.OO5). However, among subjects using nongermicidal soap there was no significant difference in bacterial recovery by amount of soap used We conclude that the amount of soap used is an important variable in determining the antimicrobial electiveness of handwashing when an antiseptic product is used.
PATTERNS OF ANTIBIOTIC USE IN INPATIENTS WITH BACTERIURIA. W.H. Greene*, H. Nadworny, M. Lanmann, S. Ort. Yale University School of Medicine, New Haven, CT and SUNY School of Medicine, Stony Brook, NY.
EXCESS HOSPITALIZATION IN SURGICAL PATIENTS WITH NOSOCOMIAL INFECTION. G.B. Penin*, N.J. Ehrenkranz, D. Poppe. South Florida Consortium for Infection Control, Miami, FL.
We retrospectively reviewed 3 months of adult inpatients (pts) with positive (+) urine cultures (UC) (>104 cfu/ml) to sssess the pattern of treatment (rx) of such pts and whether rx wss appropriate and nontoxic. Appropriate rx wss defined as the use of an antibiotic (Ab) to which the organism wss susceptible; toxic (T) rx wss the use of aminoglycosides, clindamycin or vancomycin despite susceptibility to other agents. One hundred ninety-seven complete records were available. One hundred one (51%) of the pts had community-acquired bacteriuria; 86 (48%) were noso corn&l. Of these, 55 (28%) had been rx-ed before UC results returned. Of the other 142, 74 (52%) were subsequently rx-ed and 68 (48%) were never rx-ed while in the hospital. Of the 55 pts rx-ed empirically, in 43 the Ab chosen was active against the UC organism; in 34 it was also the lesst T. Of the 9 in whom a less T Ab could be chosen, in 4 tbls wss not done - an error rate of 44% (4/g). Of the 12 isolates resistant to the empiric Ab chosen, in 5 no cban~c wae mode - an error rate of 42% (5/12). The error rates were low for pts rx-sd after the UC returned - only 2/74 (3%) were given an inactive Ab; of the 72 rx-ed appropriately, only 3 (4%) were not given the least T Ab. Of the 68 pts never rx-sd, 28 were diecharged prior to return of the UC, 4 had a negative repeat UC; 36 had no apparent reason for non-rx, i.e. 3% of those pts with (+) UC still in the hospital and not empirically on Ab. Monitoring efftcacy of tx by doing UCs during or after rx was seen only 40% and 23% of the time respectively. In summary, empiric rx of bacteriuria often results in suscep tibility and toxicity errors. Many pts with (+) UC not empirically rx-ed remain so without apparent reason. Educational programs should focus on post-empiric rx Ab choices and on how to evaluate a (+) UC for subsequent rx.
b of ho+ The effect of nosocomial infection on extending hss not pit&&on in surgical patients at community has been clearly defined. Given that the Diagnosis &latsd Group (DRG) system restricts the number of reimbaraed days for each specific surgical procedure, we investigated bow sosocomial infections are associated with excess stay over assigned DRG. A random sample of 2,026 clean and clean-contaminated elective operations was retrospectively surveyed. The sample CCNI&ted of abdominal, pelvic and orthopedic operat&s WIBWI!~Y performed at 17 Florida community hcspi&als. Tbe time period was January-December 1985. Medical record a&its were conducted at each of these hospitals by a team of 2 reviewers from the Florida Consortium for Infection Control (FCIC). Standard criteria for infection and consistent review msthods were used based on SENIC methodology. Overutiliaation (pat&t ho&ahsation exceeding DRG) was evaluated using individual patient DRG assignment. The Chi-square test was used for statistical significance. There were 189 nosocomial infectious detected in 167 patients; 74 of the 187 patients exceeded their DRC a&gument. Overall rates of infection by site were: sur#cai wound 1.146, bacteremia 0.4%, lower respiratory 1.3%, &m+oft &sue O.l%, urinary tract 6.1% and other 0.1%. Forty-four ~pereent of the infected patients vs. 13% of the uninfected patients had excess hospitalization days over sssigncd DRG (p< ,001). Days over DRG per operation per $00 patients were: lrmmectomy 81, hi plnnin8 63, t&d hip rapf6esursnt 52, IargsboweI43, hip prosthesis 28, chobsuystsetotny 11, hydttractomy 11, and tran= surethral resection of the prostate 0. !hgc stay over DRG dti no( appear to be atps related. Mesa p&sat qp for rfl ape*+ wm -92. Surgid WOW& &fwtiw osd lowrs rqspiraky $fyt+m were the commoitss~ iufaecioas that wtn diictf~ atttib-rlt;abIe as causes of excess len8th of stay. These preliminary Endings suggest that idmsiIicr&on of and appropriate intervention on pariarr~s with operaa&ats &sly to be compiicated by a~ooom iri i*factbn may ultiaataigam* aa * cost-effective measure.