Skin tolerance and effectiveness of two hand decontamination procedures ineveryday hospital use

Background Hand decontamination is crucial to central nosocomial infections . The utility of hand decontamination is related not only to its antimicrob ial effectiveness, but also to its acceptability by hospital staff. Objectives We aimed to assess skin tolerance and antimicrobial effects of t wo widely accepted hand hygiene measures under in-use conditions. Methods Fifty-two nurses were randomly assigned for an 8-day period to eith er an alcohol-based disinfectant or a hand wash with a non-antiseptic soap. At baseline and at the end of the test period, microbiological hand sample s were obtained both before and after a hand hygiene procedure, and skin to lerance was assessed using clinical scores and measurement of transepiderma l water loss. Results Self-assessment of skin condition and grade of skin damage worsened significantly more in the group using soap than in the group using alcohol ic disinfectant (P = 0 . 004 and P = 0 . 01, respectively). The alcohol-bas ed rinse was significantly more effective than liquid soap in removing tran sient contaminant micro-organisms (P = 0 . 016). Twenty of 50 hand washes w ith non-antiseptic soap apparently resulted in bacterial contamination of t he hands. At the end of the study, the total bacterial count increased with the increasing number of hand washes in the soap group (P = 0 . 003), and with the degree of skin damage (P = 0 . 005) in the antiseptic group. Conclusions In everyday hospital practice, alcohol-based disinfectant is mo re effective and better tolerated than non-antiseptic soap; soap is at risk of spreading contamination; and skin comfort strongly influences the numbe r and the quality of hand hygiene procedures.