Literature Review: Effectiveness of hand-cleaning agents for removing methicillin-resistant Staphylococcus Aureus from contaminated hands.
Literature Review
Guillhermetti M, Hernandes SED, Fukushigue Y, et al. Effectiveness of hand-cleaning agents for removing methicillin-resistant Staphylococcus Aureus from contaminated hands. Infect Control Hosp Epidemiol 2001; 22:105-108.
McNeil SA, Foster CL, Hedderwick SA, and Kauffman CA. Effect of hand cleansing with antimicrobial soap or alcohol-based gel on microbial colonization of artificial fingernails worn by health care workers. Clinical Infectious Diseases 2001; 32:367-372.
When health care workers clean their hands, how much potentially infectious bacteria remains? In these two articles, researchers address this question in a very different fashion. Researchers in Brazil questioned whether the hand-cleansing agent could make a difference in the transmission of methicillin-resistant Staphylococcus Aureus (MRSA) via the hands of health care workers. In this study at the State University of Maringa, MRSA was artificially applied to the fingertips of five health care workers.
The first series involved light contamination (103 colony-forming units per fingertip), and the second test involved heavy contamination (106 colony-forming units per fingertip). As a control, one health care worker was contaminated but did not use hand-cleansing agents. In both cases, the ethyl alcohol 70% and the 10% povidone-iodine detergent (which contained 1% active iodine) killed 99% to 100% of the MRSA. The chlorhexidine gluconate detergent and plain liquid soap were significantly less effective.
Yet even when an effective agent is used, artificial fingernails may harbor pathogens and reduce the impact of hand cleansing, according to a study from the Ann Arbor Veterans Healthcare System and University of Michigan Medical School in Ann Arbor.
Researchers cultured the nails of 21 health care workers with salon-applied, permanent polished acrylic artificial nails and of 20 control subjects who did not wear artificial nails. The samples were taken at unscheduled times during regular work activities. The volunteers then cleaned their hands either with an antimicrobial soap containing para-chloro-meta-xylenol or an alcohol-based gel that contained 60% ethyl alcohol, and additional samples were taken.
Before cleaning with soap, a pathogen was isolated from 86% of health care workers wearing artificial nails, compared with 35% of control health care workers. The same pattern occurred among health care workers cleaning with gel, as 68% of those with artificial nails, and 28% without the nails had a pathogen isolated. The alcohol gel was more effective than the antimicrobial soap in removing pathogens. However, only one of five in the control group had pathogens after cleaning with gel, while more than 50% of those with artificial nails still had pathogens remaining.
The authors speculated that health care workers with artificial fingernails may wash less vigorously in order to protect their manicures. "However, it is also possible that organisms persist on artificial nails because of properties intrinsic to the acrylic material of the nail," they added.
Supporting the position of the Association of Operating Room Nurses, the authors suggest that artificial nails should not be worn in the operating room.
"Hospital infection control committees should seriously consider the development of policies to restrict the use of artificial nails by HCWs [health care workers] who work in other high-risk areas, such as intensive care units," they state. "In the absence of policies to restricting the use of artificial nails, HCWs who choose to wear them should be educated about the tendency of artificial nails to harbor harmful bacteria and the difficulty in eliminating these bacteria with hand cleansing. The importance of conscientious hand cleansing should be stressed and proper techniques emphasized."
The study also showed that routine hand washing with antimicrobial soap did not eliminate pathogens on health care workers’ nails, whether they were artificial or natural. The authors noted that most health care workers in the study washed for a very brief amount of time. "Thus, we cannot exclude the possibility that the failure of antimicrobial soap to eliminate microorganisms was due to inadequate hand cleansing technique by our volunteers and not to ineffectiveness of the antimicrobial soap.
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