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Failure of Bland Soap Handwash to Prevent Hand Transfer of Patient Bacteria to Urethral Catheters

Published online by Cambridge University Press:  21 June 2016

N. Joel Ehrenkranz  and
Blanca C. Alfonso
N. Joel Ehrenkranz*
Affiliation:
Florida Consortium for Infection Control, South Miami, Florida
Blanca C. Alfonso
Affiliation:
Florida Consortium for Infection Control, South Miami, Florida
*
5901 SW 74th St., Suite 300, South Miami, FL 33143
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Abstract

Objective:

The study was designed to compare the efficacies of bland soap handwash and isopropyl alcohol hand rinse in preventing transfer of aerobic gram-negative bacilli to urinary catheters via transient hand colonization acquired from direct patient contact. Glove juice recovery of gram-negative bacteria was considered transient colonization; catheter recovery was considered transfer colonization.

Design:

The contact source for gram-negative bacteria was a single “high burden” groin skin carrier ( ≥ 104/ml cup scrub fluid). Using a two-period cross-over design, 6 healthcare workers had 2 15-second contacts for each hand followed by either soap handwash or alcohol hand rinse (12 experiments with each treatment). Between 4 to 5 minutes after contact, each hand manipulated a catheter; the catheter was then cultured and the hand was glove juice tested.

Results:

Soap handwash failed to prevent gram-negative bacteria transfer to the catheter in 11 of 12 (92%) experiments; alcohol hand rinse in 2 of 12 (17%) (p< .001). Soap handwash failed to prevent transient colonization in 12 of 12 (100%) experiments; alcohol in 5 of 12 (42%) (risk ratio 2.4,95% confidence interval 1.2-4.7). Single gram-negative bacteria species carried at source levels ≥ 5.5 × 103/ml (heavy contamination) established transient colonization in 23 of 30 (77%) exposures following soap handwash; single gram-negative bacteria species carried at levels ≤ 3.5 × 103/ml established colonization in 1 of 22 (5%) similar exposures (p<.001).

Conclusions:

Bland soap handwash was generally ineffective in preventing hand transfer of gram-negative bacteria to catheters following brief contact with a heavy-contamination patient source; alcohol hand rinse was generally effective.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 12 , Issue 11 , November 1991 , pp. 654 - 662
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1991

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References

1. Garibaldi, RA, Brodine, S, Matsumija, S. Infections among patients in nursing homes--policies, prevalence and problems. N Engl J Med. 1981;305:731–735.10.1056/NEJM198109243051304CrossRefGoogle ScholarPubMed
2. Maki, DG, Hennekens, CH, Bennett, JV. Prevention of catheter associated urinary tract infection-an additional measure. JAMA. 1972;221:1270–1271.CrossRefGoogle ScholarPubMed
3. Schaberg, DR, Weinstein, RA, Stamm, WE. Epidemics of nosocomial urinary tract infection caused by multiply-resistant gram negative bacilli: epidemiology and control. J Infect Dis. 1976;133:363–366.CrossRefGoogle ScholarPubMed
4. Warren, JW, Tenney, JH, Hoopes, JM, Muncie, HL. A prospective microbiological study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis. 1982;146:719–723.CrossRefGoogle ScholarPubMed
5. Eckert, DG, Ehrenkranz, NJ, Alfonso, BC, Moskowitz, LB. Proteeae groin skin carriage among nursing home residents-resistance to antiseptics. Infect Control Hosp Epidemiol. 1989;10:155–160.CrossRefGoogle ScholarPubMed
6. Eckert, DG, Ehrenkranz, NJ, Alfonso, BC. Indications for alcohol or bland soap in removal of aerobic gram-negative skin bacteria: assessment by a novel method. Infect Control Hosp Epidemiol. 1989;10:306–311.CrossRefGoogle ScholarPubMed
7. Wong, ES. Guideline for Prevention of Catheter-Associated Urinary Tract Infections: 1981. Washington DC: US Department of Health and Human Services, Public Health Service; 1981.CrossRefGoogle Scholar
8. Allen, JR. The newborn nursery. In: Bennett, JV, Brachman, PS. eds. Hospital Infection. 2nd ed. Boston, Mass: Little, Brown and Co.; 1986:307.Google Scholar
9. DuPont, HL, Ribner, BS. Infectious gastroenteritis. In: Bennett m Brachman, PS, eds. Hospital Infections. 2nd ed. Boston, Mass: Little, Brown and Co.; 1986:497.Google Scholar
10. Simmons, B, Bryant, J, Neiman, K, Spencer, L, Arheart, K. The role of handwashing in preventing endemic intensive care unit infections. Infect Control Hosp Epidemiol. 1990;11:589–594.10.2307/30148433CrossRefGoogle ScholarPubMed
11. D'Amato, RF. McLaughlin, JC. Ferraro, Ml. Rapid manual and mechanized/automated methods for detection and identification of bacteria and yeasts. In: Lennett, EH, Balows, A. Hauser, WJ, Shadomy, HJ, eds. Manual of Clinical Microbiology. 4th ed. Washington, DC: American Society for Microbiology; 1985:52–65.Google Scholar
12. Pocock, SJ. Clinical Trials-A Practical Approach. New York, NY: John Wiley and Sons; 1983:110.Google Scholar
13. Steel, RGD, Torrie, JH. Principles and Procedures of Statistics. New York, NY: McGraw-Hill Book Company, Inc.; 1960:156–157.Google Scholar
14. Fleiss, JL. Statistical Methods for Rates and Proportions. 2nd ed. New York, NY: John Wiley and Sons, Inc.; 1981:104–105.Google Scholar
15. Rothman, KJ. Modern Epidemiology. Boston, Mass: Little, Brown and Co.; 1986.Google Scholar
16. Kass, EH, Schneiderman, IJ. Entry of bacteria into the urinary tract of patients with inlying catheters. N Engl J Med. 1970;282:33–35.Google Scholar
17. Steere, AC, Mallison, GE Handwashing and Semmelweiss. Ann Intern Med. 1976;85:398.Google Scholar
18. Larson, E, Rotter, ML. Handwashing: are experimental models a substitute for clinical trials? Two viewpoints. Infect Control Hosp Epidemiol. 1990;11:63–66.CrossRefGoogle ScholarPubMed
19. Ayliffe, GAS, Babb, JR, Davies, JG, Lilly, HA. Hand disinfection: a comparison of various agents in laboratory and ward studies. J Hosp Znfect. 1988;11:226–243.10.1016/0195-6701(88)90101-6CrossRefGoogle ScholarPubMed
20. Rotter, M. Are models useful for testing hand antisepsis? J Hosp Infect. 1988;11(suppl A):236–243.CrossRefGoogle Scholar
21. Stamm, WE. Nosocomial urinary tract intections. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. 2nd ed. Boston, Mass: Little, Brown and Co.; 1986:375–384.Google Scholar
22. Garner, JS, Simmons, BP. CDC guideline for isolation precautions in hospitals. Znfect Control. 1983;4(suppl):252–253.Google ScholarPubMed
23. Weinstein, RA. Resistant bacteria and infection control in the nursing home and hospital. Bull NY Acad Med. 1987;63:337–344.Google ScholarPubMed
24. Marples, RR, Towers, AG. A laboratory model for the investigation of contact transfer of microorganisms. J Hyg Camb. 1979;82:237–248.CrossRefGoogle Scholar
25. Maki, DG, Hennekens, CG, Phillips, CW, Shaw, WY, Bennett, JV. Nosocomial urinary tract infection with Serratia marcescens: an epidemiological study. J Infect Dis. 1973;128:579–587.10.1093/infdis/128.5.579CrossRefGoogle Scholar
26. Bradley, C, Babb, J, Davies, J, Ayliffe, G. Taking precautions. Nursing Times. 1986;March 5:70–73.Google Scholar
27. Doebbeling, BN, Pfaller, MA, Houston, BS, Wenzel, RI? Removal of nosocomial pathogens from the contaminated glove. Ann Intern Med. 1988;109:394–398.10.7326/0003-4819-109-5-394CrossRefGoogle ScholarPubMed
28. Maki, DG, McCormick, RD, Zilz, MA, Stolz, SM, Alvarado, CJ. An MRSA outbreak in a SICU during Universal Precautions. Presented at the 30th Interscience Conference on Antimicrobial Agents and Chemotherapy, October 21-24, 1991, Atlanta, Georgia. Abstract #473.Google Scholar
29. Garibaldi, RA. Infections in nursing homes. In: Bennett, JV, Brachman, PS, eds. Hospital Infection. 2nd ed. Boston, Mass: Little, Brown and Co.; 1986:345–355.Google Scholar