Effectiveness of surgical hand antisepsis using chlorhexidine digluconate and parachlorometaxylenol hand scrub: Cross-over trial

Alcohol-Based Chlorhexidine and Potassium Sorbate Rub Strengthens the Effectiveness of Traditional Hand Scrubbing and Improves Long-Lasting Effectiveness-Evaluation of Hand Preparation Protocols According to EN 12791

Despite the advantages of surgical handrub in terms of the ease of application and effectiveness, chlorhexidine (CHG)-based hand scrubbing remains the preferred method for surgical hand preparation. However, it does not systematically meet the non-inferiority requirement of the European norm (EN) 12791 with respect to n-propanol (the reference product) and does not provide the sustained efficacy expected for these long-lasting agents. Commercially available alcohol-based products have also failed to demonstrate sustained efficacy according to EN 12791. Multi-step protocols enhance the efficacy of hand scrubbing, yet their extended disinfection duration might diminish their allure for healthcare professionals. In this study, we show that hand scrubbing with CHG 4% followed by a 1 min rubbing with the novel formulation of ethanol (Et) 70%/CHG 3% plus 0.3% potassium sorbate food additive (PS) meets the non-inferiority requirement and demonstrates sustained efficacy when tested according to EN 12791. The immediate and 3 h effect of this protocol was significantly higher than that of n-propanol and the homologous disinfection protocol without PS (CHG 4% hand scrub plus Et 70%/CHG 3% rub), demonstrating that the inclusion of PS confers a notable residual effect. We speculate that this non-volatile ingredient acts synergistically with CHG. This promising combination represents an alternative method for the development of new disinfection strategies.

Effect on the reduction of bacterial load after surgical hand antisepsis with triclosan 0.5% compared to triclosan 0.5% followed by 70% alcoholic solution

Triclosan 0.5% by scrubbing does not meet the UNE-EN12791 criteria to be used in the surgical hand preparation (SHP). Triclosan 0.5% by scrubbing followed by ethanol 70% hand rubbing is suitable without the additional characteristic of sustained effect. This limited effectiveness implies that triclosan should be avoided in SHP given the restrictions on its use in consumer antiseptic products. The trial was registered at ClinicalTrials.gov (ID: NCT04538365).

The application of normative documents for determination of biocidal activity of disinfectants and antiseptics dedicated for medical area: a narrative review

Disinfectants and antiseptics are important weapons to reduce the number of microorganisms and thus to limit the number of infections. Different methods of antimicrobial activity testing, often not standardised, without appropriate controls and not validated are applied. To address these issues, several European Standards (EN) have been developed, describing the test methods to determine whether chemical disinfectants or antiseptic products have appropriate bactericidal, sporicidal, mycobactericidal or tuberculocidal activity; fungicidal or yeasticidal activity; or virucidal activity. In this narrative review, the 17 EN concerning evaluation of the above-mentioned antimicrobial activity of preparations dedicated to the medical area are briefly reviewed, together with recent publications on this topic. Suspension and carrier tests have been performed in clean and dirty conditions simulating the medical area. In addition, a wide range of applications of these standards has been presented in the research of biocides for hand antisepsis, surfaces disinfection, including airborne disinfection as well as medical device and medical textile disinfection. The role of normative documents in the investigation of antimicrobial activity of disinfectants and antiseptics to limit infections has been underestimated. This narrative review aims to persuade researchers to conduct antimicrobial activity testing in line with validated EN and highlights an existing gap in ongoing research. It also aims to raise awareness of the wide range of biocidal activity tests with standardised methods in medical area. We also pay attention to the recently developed European Pharmacopoeia monography concerning the testing of bactericidal and fungicidal activity of antiseptics classified as medicinal products.

Actualidades en la higiene de manos quirúrgica. Revisión de la literatura

Introducción: La higiene de manos quirúrgica, procedimiento esencial en cirugía; es una técnica que ha evolucionado y se ha ido actualizando tras el surgimiento de evidencia científica. El manual de la Organización Mundial de la Salud (OMS) publicado hace diez años es uno de los documentos que plasman cambios de esta técnica, como dejar de usar el cepillo. Sin embargo, es necesario analizar la evidencia actual con la finalidad de reconocer las nuevas tendencias de acuerdo con los resultados de las investigaciones publicadas. Objetivo: Realizar una revisión actualizada de la literatura sobre la higiene de manos quirúrgica. Desarrollo: El lavado de manos quirúrgico con cepillo es un procedimiento que se realiza en la mayoría de las instituciones hospitalarias de México; pocas han incursionado en la técnica en la que se omite el uso de cepillo. Existen diversos estudios que sustentan que el uso de cepillos debe ser erradicado debido al daño tisular que estos ocasionan. La abrasión dérmica provocada por el uso de cepillos origina que el personal se cepille las superficies de las manos y brazos por menos tiempo que el recomendado y esto a su vez impide un efecto idóneo por parte de los antisépticos. Las sustancias más recomendadas son la clorhexidina y las soluciones a base de alcohol. Conclusiones: La higiene de manos quirúrgica sin cepillo debe ser considerada debido a que disminuye costos hospitalarios, garantiza la efectividad de la descontaminación de manos, ocasiona menos lesiones dérmicas y contribuye a la reducción de las infecciones relacionadas al sitio quirúrgico.