Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-12-01T02:36:03.589Z Has data issue: false hasContentIssue false
  • English
  • Français

Handwashing and Skin Physiologic and Bacteriologic Aspects

Published online by Cambridge University Press:  02 January 2015

Elaine Larson
Elaine Larson*
Affiliation:
University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
*
Room 429 NEB/S2, University of Pennsylvania School of Nursing, Philadelphia, PA 19104
Get access Rights & Permissions [Opens in a new window]

Abstract

Handwashing practices are often based on tradition and belief. To develop sound rationale for handwashing practices, the physiologic and bacteriologic effects of handwashing must be examined. The purposes of this article are to review the three major microenvironments of the skin with their bacterial flora, to discuss physiologic and bacteriologic characteristics of the skin with particular reference to handwashing, and to describe current handwashing recommendations and practices.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 6 , Issue 1 , January 1985 , pp. 14 - 23
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1985 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Yates, JR: Mechanisms of water uptake by skin, in Eiden, HR (ed): Biophysical Properties of the Skin. New York, John Wiley, 1971.Google Scholar
2. Marples, MJ: Ecology of the Human Skin. Springfield, IL, Charles C. Thomas, 1965.Google Scholar
3. Montagna, W, Praakkal, PF: The Structure and Function of Skin, ed 3. New York, Academic Press, 1974.Google Scholar
4. Evans, R, Cowdry, EV, Neilson, PE: Aging of human skin. Anatomical Research 1943; 86:545–560.10.1002/ar.1090860406Google Scholar
5. Kirk, JE: Handwashing. Quantitative studies on skin lipid removal by soaps and detergents based on 1500 experiments. Acta Derm Venereol 1966; (Suppl):1–183.Google Scholar
6. Leveque, JL, deRigal, J, Agache, PC, et al: Influence of aging in the in vivo extensibility of human skin at low stress. Arch Dermatol Res 1980; 269:127–135.10.1007/BF00406532Google Scholar
7. Evans, CA, Smith, WM, Johnston, EA, et al: Bacterial flora of the normal human skin. J Invest Dermatol 1950; 15:305–324.10.1038/jid.1950.105Google Scholar
8. Kligman, AM: The bacteriology of normal skin, in Maibach, H, Hildick-Smith, G (eds): Skin Bacteria and Their Role in Infection. New York, Springer-Verlag, 1965.Google Scholar
9. Leyden, JJ, McGinley, K, Webster, G: Cutaneous microbiology, in Goldsmith, LH (ed): Biochemistry and Physiology of the Skin. Oxford, Oxford University Press, 1983.Google Scholar
10. Ricketts, CR, Squire, JR, Topley, E: Human skin lipids with particular reference to the self-sterilizing power of the skin. Clin Sci 1951; 10:89–111.Google Scholar
11. Mali, JWH: The transport of water through the human epidermis. J Invest Dermatol 1956; 27:451–469.10.1038/jid.1956.118Google Scholar
12. Greene, RS, Downing, DT, Pochi, PE, et al: Anatomical variation in amounts and composition of human skin surface lipid. J Invest Dermatol 1970; 54:240–247.10.1111/1523-1747.ep12280318Google Scholar
13. Downing, DT, Stewart, ME, Strauss, JS: Estimation of sebum production rates in man by measurement of the squalene content of skin biopsies. J Invest Dermatol 1981; 77:358–360.10.1111/1523-1747.ep12493260Google Scholar
14. Jones, JK, Spencer, MC, Sanchez, SA: The estimation of rate of secretion of sebum in man. J Invest Dermatol 1951; 17:213–226.10.1038/jid.1951.84Google Scholar
15. McGinley, KJ, Webster, GF, Ruggieri, MR, et al: Regional variations in density of Propionibacteria: correlation of P. acnes populations with sebaceous secretions. J Clin Microbiol 1980; 12:672–675.10.1128/jcm.12.5.672-675.1980Google Scholar
16. Leyden, JJ, McGinley, KJ, Mills, OH, et al: Propionibacterium levels in patients with and without acne vulgaris. J Invest Dermatol 1975; 65:382–384.10.1111/1523-1747.ep12607634Google Scholar
17. Gowland, G, Ward, RM, Holland, KT, et al: Cellular immunity to Propionibacterium acnes in the normal population and patients with acne vulgaris. Br J Dermatol 1978; 99:43–49.10.1111/j.1365-2133.1978.tb01959.xGoogle Scholar
18. Webster, GF, Leyden, JJ, Nilsson, AR: Complement activation in acne vulgaris: consumption of complement by comedones. Infec Immun 1979; 261:183–186.10.1128/iai.26.1.183-186.1979Google Scholar
19. Webster, GF, Leyden, JJ, Tsai, CC, et al: Polymorphonuclear leukocyte lysosomal release in response to Propionibacterium acnes in vitro and its enhancement by sera from inflammatory acne patients. J Invest Dermatol 1980; 74:398–401.10.1111/1523-1747.ep12544494Google Scholar
20. Millington, PF, Wilkinson, R: Skin. New York, Cambridge University Press, 1983.Google Scholar
21. Foreman, MI, Clanachan, I, Kelley, IP: Diffusion barriers in skin—A new method of comparison. Br J Dermatol 1983; 108:549–553.10.1111/j.1365-2133.1983.tb01055.xGoogle Scholar
22. Thomson, ML: A comparison between the numbsers and distribution of functioning eccrine sweat glands in Europeans and Africans. J Physiol 1954; 123:225–233.10.1113/jphysiol.1954.sp005045Google Scholar
23. Mackinnon, PCB: Variations with age in the number of active palmar digital sweat glands. J Neurol Neurosurg Psychiatry 1954; 17:124–126.10.1136/jnnp.17.2.124Google Scholar
24. Kuno, Y: The Physiology Human Perspiration. London, Churchill. 1934.Google Scholar
25. Kral, JA, Zenisek, A, Kopechka, J: Crossed locomotor and sudomotor innervation. Internationale Zeitschrift Fuer Angewandte Physiologic Einschiesslìch Arbeitsphysiologie 1969; 27:165–170.Google Scholar
26. Somerville, DA: The microbiology of the cutaneous diphtheroids. Br J Dermatol 1972; 86 (Suppl 8): 16–20.10.1111/j.1365-2133.1972.tb15409.xGoogle Scholar
27. Somerville, DA: A taxonomic scheme for aerobic diphtheroids from human skin. J Med Microbiol 1973; 6:215–224.10.1099/00222615-6-2-215Google Scholar
28. Locksley, RM: The lowly diphtheroid: Nondiphtheria corynebacterial infections in humans. Medical staff conference. University of California, San Francisco. West J Med 1982; 127:45–52.Google Scholar
29. Riley, PS, Hollis, DG, Utter, GB, et al: Characterization and identification of 95 diphtheroid (group JK) cultures isolated from clinical specimens. J Clin Microbiol 1979; 9:418–424.10.1128/jcm.9.3.418-424.1979Google Scholar
30. Jackman, PJH: Classification of Corynebacterium species from axillary skin by numerical analysis of electrophoretic protein patterns. J Med Microbiol 1982; 15:485–492.10.1099/00222615-15-4-485Google Scholar
31. Pitcher, DC: Rapid identification of cell wall components as a guide to the classification of aerobic corvneform bacteria from human skin. J Med Microbiol 1977; 10:439–442.10.1099/00222615-10-4-439Google Scholar
32. Leyden, JJ, McGinley, KJ, Holzle, E, et al: The microbiology of the human axilla and its relationship to axillary odor. J Invest Dermatol 1981; 77:413–416.10.1111/1523-1747.ep12494624Google Scholar
33. Marples, RR, Williamson, P: Effects of systemic demethylchlortetracyrline on human cutaneous microflora. Appl Environ Microbiol 1969; 18:228–234.10.1128/am.18.2.228-234.1969Google Scholar
34. Stamm, WE, Thompkins, LS, Wagner, KF, et al: Infection due to Corynebacterium species in marrow transplant patients. Ann Intern Med 1979; 91:167–173.10.7326/0003-4819-91-2-167Google Scholar
35. Lipsky, BA, Goldberger, AC, Tompkins, LS, et al: Infections caused by non-diphtheria corynebacteria. Rev Infect Dis 1982; 4:1220–1235.10.1093/clinids/4.6.1220Google Scholar
36. Hande, KR, Witebsky, FG, Brown, MS, et al: Sepsis with a new species of Corynebacterium . Ann Intern Med 1976; 85:423–426.10.7326/0003-4819-85-4-423Google Scholar
37. Tompkins, LS, Juffali, F, Stamm, WE: Use of selective broth enrichment to determine the prevalence of multiply resistant JK corvnebacteria on skin. J Clin Microbiol 1982; 15:350–351.10.1128/jcm.15.2.350-351.1982Google Scholar
38. Gill, VJ, Manning, C, Lamson, M, et al: Antibiotic-resistant group JK bacteria in hospitals. J Clin Microbiol 1981; 13:472–477.10.1128/jcm.13.3.472-477.1981Google Scholar
39. Appelbaum, PC, Dossett, JH: Arthritis caused by unidentified gram-positive rods in a child with acute lymphocytic leukemia. J Clin Microbiol 1982: 15:525–527.10.1128/jcm.15.3.525-527.1982Google Scholar
40. Cookson, WDC, Harris, ARC, Diphtheroid endocarditis after electrolysis. Br Med J 1981; 282:1513–1514.10.1136/bmj.282.6275.1513Google Scholar
41. Murray, BE, Krachmer, AW, Moellering, RC: Diphtheroid prosthetic valve endocarditis. Am J Med 1980; 69:838–848.10.1016/S0002-9343(80)80009-XGoogle Scholar
42. Gerry, JL, Greenough, WB: Diphtheroid endocarditis: Report of nine cases and review of literature. Johns Hopkins Medical Journal 1976; 139:61–68.Google Scholar
43. Gronemeyer, PS, Weissfeld, AS, Sonnenwirth, AC: Corynebacterium group JK bacterial infection in a patient with an epicardial pacemaker. Am J Clin Pathol 1980; 74:838–842.10.1093/ajcp/74.6.838Google Scholar
44. Young, VM, Meyers, WF, Moody, MR, et al: The emergence of coryneform bacteria as a cause of nosocomial infection in compromised hosts. Am J Med 1981; 70:646–650.10.1016/0002-9343(81)90589-1Google Scholar
45. Jadeja, L, Fainstein, V, LeBlanc, B, et al: Comparative in vitro activities of teichomycin and other antibiotics against JK diphtheroids. Antimicrob Agents Chemother 1983; 24:145–146.10.1128/AAC.24.2.145Google Scholar
46. Maclowry, JD: Clinical microbiology of bacteremia: An overview. Am J Med (Infectious Disease Symposium):2–5, 1983.10.1016/0002-9343(83)90066-9Google Scholar
47. Pearson, TA, Braine, HG, Rathbun, HK: Corynebacterium sepsis in oncology patients. JAMA 1977; 238:1737–1740.10.1001/jama.1977.03280170031021Google Scholar
48. Casewell, M, Phillips, I: Hands as route of transmission for Klebsiella species. Br Med J 1977; 2:1315–1317.10.1136/bmj.2.6098.1315Google Scholar
49. Hoffman, MA, Finberg, L: Pseudomonas infections in infants associated with high humidity environment. J Pediatr 1955; 46:628–630.10.1016/S0022-3476(55)80166-7Google Scholar
50. McBride, ME, Duncan, WC, Knox, JM: Physiologic and environmental control of gram-negative bacteria on skin. Br J Dermatol 1975; 93:191–199.10.1111/j.1365-2133.1975.tb06740.xGoogle Scholar
51. Larson, EL: Persistent carriage of gram-negative bacteria on hands. Am J Infect Control 1981; 9:112–119.10.1016/S0196-6553(81)80091-0Google Scholar
52. Price, PB: The bacteriology of normal skin. J Infect Dis 1938; 63:301–318.10.1093/infdis/63.3.301Google Scholar
53. Kligman, AM, Shelley, WB: An investigation of the biology of the human sebaceous gland. J Invest Dermatol 1958; 30:99–124.10.1038/jid.1958.23Google Scholar
54. Blank, IH, Dawes, RL: The water content of the stratum corneum: IV. The importance of water in promoting bacterial multiplication on cornihed epithelium. J Invest Dermatol 1958; 31:141–144.10.1038/jid.1958.95Google Scholar
55. Bettley, FR: The influence of soap on the permeability of the epidermis. Br J Dermatol 1961; 73:448–454.10.1111/j.1365-2133.1961.tb14998.xGoogle Scholar
56. Ojajarvi, J, Makela, P, Rantasalo, I: Failure of hand disinfection with frequent hand washing: A need for prolonged field studies. JHyg 1977; 79:107–119.Google Scholar
57. Kligman, AM: The biology of the stratum corneum, in Montagna, W, Lobbitz, WC (eds): The Epidermis. New York, Academic Press, 1964, pp 387–433.10.1016/B978-1-4832-3293-5.50027-9Google Scholar
58. Klauder, JV, Gross, BAL: Actual causes of certain occupation dermatosis. Archives of Dermatology and Syphilis 1951; 63:1–23.10.1001/archderm.1951.01570010004001Google Scholar
59. Martin-Scott, I, Ramsay, AG: Soap and the skin with an investigation into the properties of a neutral soap. Br Med J 1956; 1:1525–1528.10.1136/bmj.1.4982.1525Google Scholar
60. Gale, D, Broderick, EG, Lamb, BJ, et al: Re-evaluation of scrub technique for preoperative disinfection of the surgeon's hands. Ann Surg 1962; 155:107–118.10.1097/00000658-196201000-00013Google Scholar
61. Berman, R, Knight, R: Evaluation of hand antisepsis. Arch Environ Health 1969; 18:781–783.10.1080/00039896.1969.10665487Google Scholar
62. Kominos, SD, Copeland, CE, Grosiak, B: Mode of transmission of Pseudomonas aeruginosa in a burn unit and an intensive care unit in a general hospital. Appi Environ Microbiol 1972; 23:309–312.Google Scholar
63. Evans, CA, Stevens, RJ: Differential quantitation of surface and subsurface bacteria of normal skin by the combined use of cotton swab and the scrub methods. JClin Microbiol 1976; 3:576–581.10.1128/jcm.3.6.576-581.1976Google Scholar
64. McBride, ME, Montes, LF, Fahlberg, WJ, et al: Microbial flora of nurses'hands. I. Quantitative differences in bacterial populations between nurses and other occupational groups. Intern J Dermatol 1972; 11:49–53.10.1111/j.1365-4362.1972.tb01721.xGoogle Scholar
65. Aly, R, Maibach, HI: Effect of antimicrobial soap containing Chlorhexidine on the microbial flora of skin. Appi Environ Microbiol 1976; 31:931–935.10.1128/aem.31.6.931-935.1976Google Scholar
66. Shaw, CM, Smith, JA, McBride, ME, et al: An evaluation of techniques for sampling skin flora. J Invest Dermatol 1970; 54:160–163.10.1111/1523-1747.ep12257936Google Scholar
67. Salzman, TC, Clark, JJ, Klemm, J: Hand contamination of personnel as a mechanism of cross-infection in nosocomial infections with antibiotic-resistant Escherichia Coli and Klebsiella-Aerobacter . Antimicrob Agents Chemother 1967, 1968; pp 97–100.Google Scholar
68. Lowbury, EJL, Lilly, HA: Disinfecdon of the hands of surgeons and nurses. Br Med J 1960; 2:1445–1450.10.1136/bmj.1.5184.1445Google Scholar
69. Michaud, RN, McGrath, MB, Goss, WA: Improved experimental model for measuring skin degerming activity on the human hand. Antimicrob Agents Chemother 1972; 2:8–15.10.1128/AAC.2.1.8Google Scholar
70. Knittle, MA, Eitzman, DV, Baer, H: Role of hand contamination of personnel in the epidemiology of gram-negative nosocomial infections. Pediatr 1975; 86:433–437.10.1016/S0022-3476(75)80980-2Google Scholar
71. Updegraff, DM: A culture method of quantitatively studying the microorganisms of the skin. JInvest Dermatol 1964; 43:129–137.10.1038/jid.1964.130Google Scholar
72. Hann, J: The source of the ‘resident’ flora. Hand 1972; 5:247–252.10.1016/0072-968X(73)90037-5Google Scholar
73. Larson, EL: Effects of handwashing frequency, agent used, and clinical unit on bacterial colonization of the hands. Am J Infect Control 1984; 12:76–82.10.1016/0196-6553(84)90020-8Google Scholar
74. Noble, WE, Somerville, D: Microbiology of Human Skin. Philadelphia, WB Saunders, 1981.Google Scholar
75. Meers, PD Yeo, GA: Shedding of bacteria and skin squames after handwashing. J Hyg 1978; 81:99–105.10.1017/S0022172400053808Google Scholar
76. Jarvis, JD, Wynne, CD Enwright, L, et al: Handwashing and antiseptic-containing soaps in hospital. J Clin Pathol 1979; 32:732–737.10.1136/jcp.32.7.732Google Scholar
77. Brandberg, A, Andersson 1: Whole body disinfection by shower-bath with Chlorhexidine soap, in Royal Society of Medicine International Congress and Symposium, Problems in the Control of Hospital Infection. Series No. 23. London, Academic Press, 1980.Google Scholar
78. Hermann, F, Prose, PH, Sulzberger, MB: Studies on sweating. V. Studies of quantities and distribution of thermogenic seat delivery to the skin. J Invest Dermatol 1952; 18:71–86.Google Scholar
79. Allen, AM, Taplin, D, Twigg, L: Cutaneous streptococcal infections in Vietnam. Arch Dermatol 1971; 104:271–274.10.1001/archderm.1971.04000210045008Google Scholar
80. Aly, R, Maibach, HI: Factors controlling skin bacterial flora, in Maibach, H, Aly, R (eds): Skin Microbiology: Relevance to Clinical Infection. New York, Springer-Verlag, 1981.Google Scholar
81. McBride, ME, Duncan, WC, Bodey, GP, et al: Microbial-skin flora of selected cancer patients and hospital personnel. J Clin Microbiol 1976; 3:14–20.10.1128/jcm.3.1.14-20.1976Google Scholar
82. Aly, R, Maibach, HI, Shinefield, HR, et al: Survival of pathogenic organisms on human skin. Dermatologica 1972; 58:205–211.Google Scholar
83. Amonette, RR, Rosenberg, EW: Infection in the toe webs by gram-negative bacteria. Arch Dermatol 1973; 107:71–73.10.1001/archderm.1973.01620160043012Google Scholar
84. Marples, RR: The effect of hydration on the bacterial flora of the skin, in Maibach, H, Hildick-Smith, G (eds): Skin Bacteria and Their Role in Infection. New York, Springer-Verlag, 1965.Google Scholar
85. Milyani, RM, Selwyn, S: Quantitative studies on competitive activities of skin bacteria growing on solid media. J Med Microbiol 1977; 11:379–386.10.1099/00222615-11-4-379Google Scholar
86. Centers for Disease Control: Isolation Techniques for Use in Hospitals. Washington, DC, Government Printing Office, 1970, p 9.Google Scholar
87. American Hospital Association: Infection Control in the Hospital, ed 3. Chicago, American Hospital Association, 1974, p 111.Google Scholar
88. Soule, BM (ed): The APIC Curriculum for Infection Control Practice. Dubuque, IA, Kendall/Hunt, 1983, vol I, pp 552–560.Google Scholar
89. Ojajarvi, J : Effectiveness of handwashing and disinfection methods in removing transient bacteria after patient nursing. J Hyg 1980; 85:193–203.10.1017/S0022172400063221Google Scholar
90. Fox, MK, Langner, SB, Wells, RW: How good are handwashing practices? Am J Nurs 1974; 74:1676–1678.Google Scholar
91. Taylor, LJ: An evaluation of handwashing techniques-1. Nursing Times 1978; 74:54–55.Google Scholar
92. Preston, GA, Larson, EL, Stamm, WE: The effect of private isolation rooms on patient care practices, colonization and infection in an intensive care unit. Am J Med 1980; 70:641–645.10.1016/0002-9343(81)90588-XGoogle Scholar
93. McLane, C, Chenelly, S, Sylvestrak, ML, et al: A nursing practice problem: Failure to observe aseptic technique. Am J Infect Control 1983; 11:178–182.10.1016/0196-6553(83)90078-0Google Scholar
94. Albert, RK, Condie, F: Handwashing patterns in medical intensive-care units. N Engl J Med 1981; 304:1465–1466.10.1056/NEJM198106113042404Google Scholar
95. Larson, E, Killien, M: Factors influencing handwashing behavior of patient care personnel. Am J Infect Control 1982; 10:93–99.10.1016/0196-6553(82)90019-0Google Scholar
96. Hart, CA, Gibson, MF, Buckles, AM: Variation in skin and environmental survival of hospital gentamicin-resistant enterobacteria. J Hyg 1981; 87:277–284.10.1017/S0022172400069497Google Scholar
97. Marples, RR, Towers, AG: A laboratory model for the investigation of contact transfer of micro-organisms. J Hyg 1979; 82:237–248.10.1017/S0022172400025651Google Scholar
98. Lowbury, EJL, Lilly, HA: Use of 4% Chlorhexidine detergent solution (Hibiscrub) and other methods of skin disinfection. Br Med J 1973; 1:510–515.10.1136/bmj.1.5852.510Google Scholar
99. Steere, AC, Mallison, GF: Handwashing practices for the prevention of nosocomial infections. Ann Intern Med 1975; 83:683–690.10.7326/0003-4819-83-5-683Google Scholar
100. Ojajarvi, J: The importance of soap selection for routine hand hygiene in hospital. JHyg 1981; 86:275–283.Google Scholar
101. Lowbury, EJL: Skin disinfection. J Clin Pathol 1961; 14:85.10.1136/jcp.14.1.85Google Scholar
102. Subcommittee on aseptic methods in operating theatres of the committee on hospital infection: Aseptic methods in the operating suite. Lancet 1968; 1:706–709.Google Scholar
103. Feldman, H: Learning transfer from programmed instruction to clinical performance. Nurs Res 1969; 18:51–54.10.1097/00006199-196901000-00010Google Scholar
104. Taylor, LJ: An evaluation of handwashing techniques-2. Nursing Times 1978; 74:108–110.Google Scholar
105. Lowbry, EJL, Lilly, HA: The effect of blood on disinfection of surgeons' hands. Br J Surg 1974; 61:19–21.10.1002/bjs.1800610106Google Scholar
106. Sheena, AZ, Stiles, ME: Efficacy of germicidal hand wash agents in hygienic hand disinfection. Journal of Food Protection 1982; 45:713–720.10.4315/0362-028X-45.8.713Google Scholar
107. Rosenberg, A, Alatary, SD Peterson, AF: Safety and efficacy of the antiseptic Chlorhexidine gluconate. Surg Gynecol Obstetr 1976; 143:789–792.Google Scholar
108. Eitzen, HE, Ritter, MA, French, ML, et al: A microbiological in-use comparison of surgical handwashing agents. J Bone Joint Surg 1979; 61A:403–406.Google Scholar
109. Centers for Disease Control: Methods of prevention and control of nosocomial infections, in National Nosocomial Infection Survey Report. Atlanta, 1977, pp 15–17.Google Scholar
110. Dineen, P: Handwashing degerming: A comparison of povidone-iodine and Chlorhexidine. Clin Pharmacol Ther 1978; 23:63–67.10.1002/cpt197823163Google Scholar
111. Aly, R, Maibach, HI: A comparison of the antimicrobial effect of 0.5% Chlorhexidine (Hibistat) and 70% isopropyl alcohol on hands contaminated with Serratia marcescens . Clin Exp Dermatol 1980; 5:197–201.10.1111/j.1365-2230.1980.tb01688.xGoogle Scholar
112. Ulrich, JA: Clinical study comparing Hibistat (0.5% Chlorhexidine gluconate in 70% isopropyl alcohol) and betadine surgical scrub (7.5% povidone-iodine) for efficacy against experimental contamination of human skin. Current Therapeutic Research 1982; 31:27–30.Google Scholar
113. Ayliffe, FAJ, Babb, JR, Quoraishi, AH: A test for ‘hygienic’ hand disinfection. J Clin Pathol 1978; 31:923–928.10.1136/jcp.31.10.923Google Scholar
114. Maki, DG, Zilz, MA, Alvarado, CJ: Evaluation of the antibacterial efficacy of our agents for handwashing. Presented at Second International Nosocomial Infection Conference, Atlanta, GA, August 5-8, 1980.Google Scholar
115. Rotter, M, Koller, W, Wewalka, G: Efficacy of Chlorhexidine, iodine, and alcohol containing preparations in disinfection of hands. Presented at Second International Nosocomial Infection Conference, Atlanta, GA, August 5-8, 1980.Google Scholar
116. Kaul, AF, Jewett, JF: Agents and techniques for disinfection of the skin. Surg Gynecol Obstetr 1981; 152:677–685.Google Scholar
117. Centers for Disease Control: Guideline for hospital environmental control. Infect Control 1982; 3:52–57.10.1017/S019594170005712XGoogle Scholar
118. Bannan, EA, Judge, LF: Bacteriological studies related to handwashing. I. The inability of soap bars to transmit bacteria. Am J Public Health 1965; 55:915–922.10.2105/AJPH.55.6.915Google Scholar
119. Spaulding, EH: Handwashing as an adjunct to infection control: An evaluation. Asepsis, 1981; 2:2.Google Scholar
120. Vorherr, H, Vorherr, UH, Mehta, P, et al: Antimicrobial potency of hibiclens, betadine, and phisohex on bacteria of vagina and perigenital skin. Surgical Forum 1980; 31:438–440.Google Scholar
121. Oneill, J, Hosmer, M, Challop, R, et al: Percutaneous absorption potential of Chlorhexidine in neonates. Current Therapeutic Research 1982; 31:485–489.Google Scholar
122. Vorherr, H, Ulrich, JA, Messer, RH, et al: Antimicrobial effect of Chlorhexidine on bacteria of groin, perineum and vagina. J Reprod Med 1980; 24:153–157.Google Scholar
123. Vorherr, H, Vorherr, UF, Mehta, P, et al: Vaginal absorption of povidone-iodine. JAMA 1980; 244:2628–2629.Google Scholar
124. Barry, MA, Goularte, TA, Lichtenberg, D, et al: OR Scrub: Should it be used in operating rooms and intensive care units? Poster, Tenth Annual Educational Conference, Association for Practitioners in Infection Control, San Diego, 1983.Google Scholar
125. Edberg, SC: Handwashing as an adjunct to infection control: An evaluation. Asepsis 1981; 2:3.Google Scholar
126. Larson, E, Larson, E: Influence of a role model on handwashing behavior, abstracted. Am J Infect Control 1983; 11:146.Google Scholar