Kjølen H, Andersen B M
Department of Pharmacy, University Hospital, Tromsø, Norway.
J Hosp Infect. 1992 May;21(1):61-71. doi: 10.1016/0195-6701(92)90154-e.
Hands are among the principal vehicles for transfer of nosocomial pathogens in hospitals. Often, outbreaks of infection are thought to be caused by a lack of compliance with handwashing guidelines, rather than due to the inadequacy of the handwashing agents used. In this study the effectiveness of proper handwashing and the use of three different hand disinfectants: ethanol 70% (E), isopropanol 40% (I) and alcoholic chlorhexidine (70%) (AC) was compared using three volunteers whose fingertips were heavily contaminated with a succession of bacteria including: Enterococcus faecalis, Staphylococcus aureus, Escherichia coli and Enterobacter cloacae. After each contamination, thorough handwashing and application of one disinfectant on the hands were performed three times. Fingerprint-samples were taken before and 1 min after application of the disinfectants. Thorough handwashing with an ordinary liquid soap ('Sterisol') did not reduce the confluent growth of bacteria on fingertips for any of the species used (197 examinations). Only AC had a significant effect on fingers heavily contaminated with S. aureus (126 examinations; AC compared with E and I; P less than 0.0002 and P less than 0.0002 respectively), but did not completely eradicate the bacteria. After contamination with Ent. cloacae (118 examinations), none of the three agents were particularly effective, but E and AC seemed to be somewhat more effective than I (P less than 0.0002 and P less than 0.01 respectively). When successive contamination was performed using all bacterial species, AC was the most effective decontaminant. However, Ent. cloacae was still present on the fingertips after 15 repeated courses of handwashing and applications of disinfectants. Bathing of hands in AC for 20s completely eradicated all bacteria from the hands. The study demonstrates that, when heavily contaminated, an ordinary handwashing followed by disinfectants is not enough to eradicate potentially pathogenic bacteria from the hands.
在医院中，手部是医院内病原菌传播的主要载体之一。通常，感染暴发被认为是由于未遵守洗手指南，而非所用洗手剂的不足。在本研究中，使用三名志愿者，其指尖被包括粪肠球菌、金黄色葡萄球菌、大肠杆菌和阴沟肠杆菌在内的一系列细菌严重污染，比较了正确洗手以及使用三种不同手部消毒剂（70%乙醇（E）、40%异丙醇（I）和70%酒精洗必泰（AC））的效果。每次污染后，进行三次彻底洗手并在手上涂抹一种消毒剂。在涂抹消毒剂前和涂抹后1分钟采集指纹样本。用普通液体肥皂（“Sterisol”）彻底洗手，对所用任何一种细菌（197次检查）都未减少指尖上细菌的融合生长。只有AC对被金黄色葡萄球菌严重污染的手指有显著效果（126次检查；AC与E和I相比；P分别小于0.0002和P小于0.0002），但并未完全根除细菌。在被阴沟肠杆菌污染后（118次检查），这三种消毒剂都不是特别有效，但E和AC似乎比I稍有效（P分别小于0.0002和P小于0.01）。当使用所有细菌种类进行连续污染时，AC是最有效的去污剂。然而，在15次重复洗手和涂抹消毒剂后，阴沟肠杆菌仍存在于指尖上。将手浸泡在AC中20秒可完全清除手上的所有细菌。该研究表明，当严重污染时，普通洗手后再使用消毒剂不足以从手上根除潜在病原菌。
