IS HAND-WASHING REALLY NEEDED IN AN INTENSIVE-CARE UNIT

Objectives: To determine whether a rigorous antiseptic hand washing of bare hands with 4% chlorhexidine and alcohol reduced fingertip microb ial colonization as compared with the use of boxed, clean, nonsterile latex gloves, In addition, to investigate if aseptic donning technique and/or a prior hand washing would reduce the level of glove contamina tion. Design: Prospective, randomized, crossover design, with each sub ject serving as his/her own control, Setting: University intensive car e unit. Subjects: Forty-three intensive care nurses. Interventions: Th e fingertips of 20 nurses were cultured before and after a strict anti septic hand washing and before and after the routine and aseptic donni ng of sterile gloves. Subsequently, the fingertips of 43 nurses were c ultured before and after the casual donning of nonsterile gloves over unwashed hands and before and after a strict antiseptic hand washing. Fingertip cultures were plated directly on agar, incubated for 24 hrs, and counted and recorded as the number of colony-forming units (cfu) for each hand. Different colony types were then subcultured, Measureme nts and Main Results: Hand washing with antiseptic reduced colonizatio n from 84 to 2 cfu (p < .001). The proportion of cases with greater th an or equal to 200 cfu/hand was reduced from 30% to 9%. Aseptic or cas ual donning of sterile gloves, with or without prior antiseptic hand w ashing, resulted in consistently low glove counts between 0 and 1.25 c fu. Nonsterile gloves casually donned over washed or unwashed bare han ds diminished the bioburden to 2.17 and 1.34 cfu, respectively. No qua litative difference was found in the microorganisms recovered from glo ved or bare hands. Conclusions: Antiseptic hand washing and the use of nonsterile gloves over unwashed hands confer similar reductions in th e number of microorganisms. There is no additional benefit with the us e of aseptic donning technique, prior antiseptic hand washing, or the use of individually packaged sterile gloves.