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Handwashing substitute for degerming
Handwashing Substitute for Degerming William C. Beck, MD, FACS, Sayre, Pennsylvania
Handwashing serves two purposes: the removal of gross soil and degerming. The importance of the latter was dramatically demonstrated by SemmelWeiss in Vienna and by Oliver Wendell Holmes in the United States. ,Yet today, in our gleaming ultramodern hospitals it is difficult if not impossible to follow their life-saving precepts conveniently. Architects design handwashing facilities in patient quarters for the use and convenience of the patient. Thus, the nurse or, physician must employ the patient’s soap and towel or walk to some distant nursing station, not touching anything en route lest it become contaminated and thus a potential source for further microbial dissemination. The use of a foam for degerming was repeatedly discussed by Maibach and Dineen in their monograph on skin bacteriology [I]. Recently, Steere and Mallison [2] in discussing handwashing procedures bemoaned the unavailability of such an alcohol foam. In a study in our institution using a foam in the surgical hand scrub containing hexachloraphene, we agreed with their comment [3]. Now we not only have such a material available, but we have it in a dispenser that can be conveniently mounted on a wall or bed or intensive care unit carriage. The foam issimply massaged onto the hands in a handwashing motion until the foam has dried. (Figure 1, right.) If the motion is carried out so that the foam is dispersed under the fingernail, even that area becomes relatively germ-free. The dosage of the foam is soon learned and should be enough so that the fingers feel moist for about 60 seconds. The formulation of the foam is designed to prevent the usual ultradry sensation normally felt after a handwash with its principal active ingredient ethyl alcohol. Repeated use leaves the skin normally moist and comfortable. We have heard no complaints from the nurses who have used it after every patient facility exposure and thus repeatedly during the day. Nursing aides who use the foam after bedmaking or other housekeeping functions find it handy. Fingertip cultures on a blood-agar medium before and after use of the foam attest to its degerming quality. (Figure 1, left.) From the Donald Guthrie Foundation for Medical Research, Sayre, Pennsylvania. Reprint requests shouuld be addressed to William C. Beck, MD, Guthrie Clinic, Sayre, Pennsylvania 18840.
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Figure 1. Right, the approximate amount used in a handwash&j motion. /t is important in this niotion that the foam is pushed beneath exposed fingernails and Into the periungual creases. Left, fingertip culture before (/en) and after (right) use. (Only the colonies should be considered: the small white dots are artifacts. )
The dispensers are affixed to any smooth, clean surface by simple pressure. The surface for mounting can be cleaned with an alcohol sponge or, indeed, by the foam itself on a cotton ball. The metal container is simply inserted into the ring-holder after removing the protecting cap. We find the dispenser best activated by pushing the thumb against the dispenser and moving the plunger gently forward so that the foam will be deposited against the palmar surface of the fingers. Each dispenser holds about 100 to 200 handwashes. The. foam is a degermer and not a soil remover. Handwashing must still be employed to remove blood and other soilage. An additional suggested use could have even greater hygienic benefit. Since the toilet tissue for postdefecational hygiene is sold for its softness rather than for its barrier effect, and since subsequent handwashing must be delayed until after clothing adjustment, contamination of clothing appears to be inevitable. It can be controlled, however, by mounting a dispenser of the alcohol foam above the tissue dispenser. This permits hand degerming before contamination of the clothing can occur. This might have a hygienic implication, but when carried out by persons suffering from bacterial diarrhea, it could have a most beneficial result in preventing disease spread. References 1. Dineen P, Hildick-Smith G: Antiseptic care of the hands, chapt 21. Skin Bacteria and Their Role in Infection (Maibach HI,
Hildick-Smith G, ed). New York, McGraw-Hill, 1965. 2. Steere A, Mallison G: Handwashing practices for the prevention of nosocomial infections. Ann Intern Med83: 683, 1975. 3. Len JJ, Deshmukh NJ: Septisol antiseptic foam vs. handwashiig in patient care. Guthrie C/in Bull 44: 19, 1974.
The American Journal of Surgery
Handwashing serves two purposes: the removal of gross soil and degerming. The importance of the latter was dramatically demonstrated by SemmelWeiss in Vienna and by Oliver Wendell Holmes in the United States. ,Yet today, in our gleaming ultramodern hospitals it is difficult if not impossible to follow their life-saving precepts conveniently. Architects design handwashing facilities in patient quarters for the use and convenience of the patient. Thus, the nurse or, physician must employ the patient’s soap and towel or walk to some distant nursing station, not touching anything en route lest it become contaminated and thus a potential source for further microbial dissemination. The use of a foam for degerming was repeatedly discussed by Maibach and Dineen in their monograph on skin bacteriology [I]. Recently, Steere and Mallison [2] in discussing handwashing procedures bemoaned the unavailability of such an alcohol foam. In a study in our institution using a foam in the surgical hand scrub containing hexachloraphene, we agreed with their comment [3]. Now we not only have such a material available, but we have it in a dispenser that can be conveniently mounted on a wall or bed or intensive care unit carriage. The foam issimply massaged onto the hands in a handwashing motion until the foam has dried. (Figure 1, right.) If the motion is carried out so that the foam is dispersed under the fingernail, even that area becomes relatively germ-free. The dosage of the foam is soon learned and should be enough so that the fingers feel moist for about 60 seconds. The formulation of the foam is designed to prevent the usual ultradry sensation normally felt after a handwash with its principal active ingredient ethyl alcohol. Repeated use leaves the skin normally moist and comfortable. We have heard no complaints from the nurses who have used it after every patient facility exposure and thus repeatedly during the day. Nursing aides who use the foam after bedmaking or other housekeeping functions find it handy. Fingertip cultures on a blood-agar medium before and after use of the foam attest to its degerming quality. (Figure 1, left.) From the Donald Guthrie Foundation for Medical Research, Sayre, Pennsylvania. Reprint requests shouuld be addressed to William C. Beck, MD, Guthrie Clinic, Sayre, Pennsylvania 18840.
728
Figure 1. Right, the approximate amount used in a handwash&j motion. /t is important in this niotion that the foam is pushed beneath exposed fingernails and Into the periungual creases. Left, fingertip culture before (/en) and after (right) use. (Only the colonies should be considered: the small white dots are artifacts. )
The dispensers are affixed to any smooth, clean surface by simple pressure. The surface for mounting can be cleaned with an alcohol sponge or, indeed, by the foam itself on a cotton ball. The metal container is simply inserted into the ring-holder after removing the protecting cap. We find the dispenser best activated by pushing the thumb against the dispenser and moving the plunger gently forward so that the foam will be deposited against the palmar surface of the fingers. Each dispenser holds about 100 to 200 handwashes. The. foam is a degermer and not a soil remover. Handwashing must still be employed to remove blood and other soilage. An additional suggested use could have even greater hygienic benefit. Since the toilet tissue for postdefecational hygiene is sold for its softness rather than for its barrier effect, and since subsequent handwashing must be delayed until after clothing adjustment, contamination of clothing appears to be inevitable. It can be controlled, however, by mounting a dispenser of the alcohol foam above the tissue dispenser. This permits hand degerming before contamination of the clothing can occur. This might have a hygienic implication, but when carried out by persons suffering from bacterial diarrhea, it could have a most beneficial result in preventing disease spread. References 1. Dineen P, Hildick-Smith G: Antiseptic care of the hands, chapt 21. Skin Bacteria and Their Role in Infection (Maibach HI,
Hildick-Smith G, ed). New York, McGraw-Hill, 1965. 2. Steere A, Mallison G: Handwashing practices for the prevention of nosocomial infections. Ann Intern Med83: 683, 1975. 3. Len JJ, Deshmukh NJ: Septisol antiseptic foam vs. handwashiig in patient care. Guthrie C/in Bull 44: 19, 1974.
The American Journal of Surgery