Infection Control Programme, WHO Collaborating Centre on Patient Safety, Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Department of Microbiology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
Infection Control Programme, WHO Collaborating Centre on Patient Safety, Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
J Hosp Infect. 2020 Apr;104(4):430-434. doi: 10.1016/j.jhin.2020.02.008. Epub 2020 Feb 14.
Hand hygiene is crucial in infection prevention and control. It is unclear whether sprayed alcohol-based hand rub (ABHR) is non-inferior to the World Health Organization (WHO)-recommended method of handrubbing with poured ABHR.
To test whether sprayed ABHR can be an alternative (non-inferior) method for effective hand hygiene with/without handrubbing.
A laboratory experiment was conducted with ABHR (isopropanol 60% v/v) according to European Norm 1500. Hand hygiene was performed by: (1) handrubbing with ABHR poured on to the palm of the hand; (2) handrubbing with sprayed ABHR; and (3) applying sprayed ABHR to hands without handrubbing. Hands were contaminated with Escherichia coli ATCC 10536, followed by hand hygiene and microbiological sampling. A generalized linear mixed model with a random intercept per subject was used to analyse the reduction in bacterial count following hand hygiene.
In total, 19 healthcare workers participated in the study. Handrubbing with sprayed ABHR was non-inferior [margin log 0.6 colony-forming units (cfu)/mL] to the WHO-recommended method of handrubbing with poured ABHR; bacterial count reductions were log 3.66 cfu/mL [95% confidence interval (CI) 1.68-5.64] and log 3.46 cfu/mL (95% CI 1.27-5.65), respectively. Conversely, non-inferiority was not found for sprayed ABHR without handrubbing [bacterial count reduction log 2.76 cfu/mL (95% CI 1.65-3.87)].
Handrubbing with sprayed ABHR was non-inferior to handrubbing with ABHR poured on to the palm of the hand to reduce bacterial counts on hands under experimental conditions. Handrubbing with sprayed ABHR may be an acceptable alternative hand hygiene method pending assessment in other settings and for other pathogens.
手部卫生对于感染预防和控制至关重要。目前尚不清楚喷雾酒精基手部搓揉液（ABHR）是否不如世界卫生组织（WHO）推荐的倒入手掌心的 ABHR 手搓揉方法有效。
测试喷雾 ABHR 是否可作为一种替代（非劣效）方法，用于有效进行有/无手搓揉的手部卫生。
根据欧洲标准 1500 进行了一项 ABHR（60%异丙醇 v/v）的实验室实验。手部卫生通过以下三种方式进行：（1）将 ABHR 倒入手掌心进行手搓揉；（2）用喷雾 ABHR 进行手搓揉；和（3）将喷雾 ABHR 涂于手部而不进行手搓揉。手部用大肠杆菌 ATCC 10536 进行污染，随后进行手部卫生和微生物采样。使用具有每个受试者随机截距的广义线性混合模型分析手卫生后细菌计数的减少情况。
共有 19 名医护人员参与了这项研究。用喷雾 ABHR 进行手搓揉与 WHO 推荐的倒入手掌心的 ABHR 手搓揉方法相比非劣效[相差 0.6 对数菌落形成单位（cfu）/mL]；细菌计数减少分别为 log 3.66 cfu/mL（95%置信区间 [CI] 1.68-5.64）和 log 3.46 cfu/mL（95% CI 1.27-5.65）。相反，对于无手搓揉的喷雾 ABHR，非劣效性未得到证实[细菌计数减少 log 2.76 cfu/mL（95% CI 1.65-3.87）]。
在实验条件下，用喷雾 ABHR 进行手搓揉与将 ABHR 倒入手掌心的手搓揉相比，可减少手部细菌计数。在其他环境中和针对其他病原体进行评估之前，用喷雾 ABHR 进行手搓揉可能是一种可接受的替代手部卫生方法。
