The Impact of the Three Most Common Hand Cleansing Methods on the Bacterial Profile: A Randomized Clinical Trial
El impacto de los tres métodos de limpieza de manos más comunes en el perfil bacteriano: un ensayo clínico aleatorizado
Zean Zefenkey
Abstract
Introduction: The hand harbors different species of bacteria that may play a role in the transmission of infectious diseases. Therefore, this study was conducted to determine the bacterial profile of hands and assess the efficacy of the three most common methods of hand cleansing on the reduction of that bacteria.
Materials and methods: Hand swaps were collected from 150 adults. The identity of bacteria was done by standard microbiological procedures. Each participant applied one of three selected methods of hand cleansing namely, handwashing with water and plain soap, hand rubbing with an alcohol-based sanitizer, and hand wiping with alcohol-free hand sanitizer wipes. A second swap was collected after cleansing to determine the efficacy of each method by calculating the percentage of the reduction of isolated bacteria.
Results: Most isolated bacteria were commensal flora like Coagulase Negative Staphylococcus (92%), and Corynebacterium spp (81.3%). Other pathogenic bacteria were isolated mainly, Staphylococcus aureus (32%), Escherichia coli (10%), Pseudomonas aeruginosa (2.6%), Klebsiella spp (2.6%) and Acinetobacter spp. (2%). The hand rubbing was more efficacy than handwashing without a statistically significant difference (P>0.05), and the hand wiping had lower efficacy than the other two methods with statistically significant difference (P<0.001).
Conclusions: The hand is a serious source of infection due to the variety of bacteria on it. These bacteria can be eliminated either by handwashing with water and plain soap or hand rubbing with an alcohol-based sanitizer. Alcohol-free hand sanitizer wipes should be used just for cleaning without disinfection due to their low efficacy as a sanitizer.
Keywords
Resumen
Introducción: La mano alberga diferentes especies de bacterias que pueden jugar un papel en la transmisión de enfermedades infecciosas. Este estudio se realizó para determinar el perfil bacteriano de las manos y evaluar la eficacia de los tres métodos más comunes de limpieza de manos en la reducción de esa bacteria.
Materiales y métodos: Se recolectaron información de las manos de 150 adultos. La identidad de las bacterias se realizó mediante procedimientos microbiológicos estándar. Cada participante aplicó uno de los tres métodos seleccionados de limpieza de manos, a saber: lavarse las manos con agua y jabón común, frotarse las manos con un desinfectante a base de alcohol y limpiarse las manos con toallitas desinfectantes para manos sin alcohol. Se recogió una segunda muestra después de la limpieza para determinar la eficacia de cada método calculando el porcentaje de reducción de bacterias aisladas.
Resultados: La mayoría de las bacterias aisladas fueron flora comensal como Staphylococcus Coagulasa Negativo (92%) y Corynebacterium spp (81,3%). Se aislaron otras bacterias patógenas principalmente, Staphylococcus aureus (32%), Escherichia coli (10%), Pseudomonas aeruginosa (2,6%), Klebsiella spp (2,6%) y Acinetobacter spp. (2%). Frotar las manos fue más eficaz que lavarse las manos sin una diferencia estadísticamente significativa (P> 0,05), y la limpieza de las manos tuvo una eficacia menor que los otros dos métodos con una diferencia estadísticamente significativa (P <0,001).
Conclusiones: La mano es una fuente grave de infección debido a la variedad de bacterias que contiene. Estas bacterias pueden eliminarse lavándose las manos con agua y jabón común o frotándose las manos con un desinfectante a base de alcohol. Las toallitas desinfectantes para manos sin alcohol deben usarse solo para limpiar sin desinfectar debido a su baja eficacia como desinfectantes.
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References
1. Fredricks DN. Microbial ecology of human skin in health and disease. J Investig Dermatol Symp Proc. 2001;6(3):167-9. doi: 10.1046/j.0022-202x.2001.00039.x.
2. Best M, Neuhauser D. Ignaz Semmelweis and the birth of infection control. Qual Saf Health Care. 2004;13(3):233-4. doi: 10.1136/qhc.13.3.233.
3. Jefferson T, Del Mar C, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review. BMJ. 2009;339:b3675. doi: 10.1136/bmj.b3675.
4. World Health Organization. Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility Level. Available from: https://www.who.int/gpsc/core-components.pdf (accessed July 2021).
5. Hoffmann M, Sendlhofer G, Gombotz V, Pregartner G, Zierler R, Schwarz C, et al. Hand hygiene compliance in intensive care units: An observational study. Int J Nurs Pract. 2020;26(2):e12789. doi: 10.1111/ijn.12789.
6. O'Donoghue M, Ho JMC, Pittet D, Suen LKP. Acceptability and tolerability of alcohol-based hand hygiene products for elderly residents in long-term care: a crossover study. Antimicrob Resist Infect Control. 2019;8:165. doi: 10.1186/s13756-019-0610-7.
7. Bednarek RS, Nassereddin A, Ramsey ML. Skin Antiseptics. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021.
8. Bailey WR, Scott EG. Scott. Diagnostic microbiology: a textbook for the isolation and identification of pathogenic microorganisms. 4th ed. Mosby; 1974.
9. Șindilar E., Chidon-Radivanschi A., Chidon-Radivanschi I., Șindilar EV, Bondoc I. Evaluation of the hygienic status in a milk factory before the work starts. Lucr. Stiinţ Ser Med Vet. 2001;3(2):672-4.
10. Kavitha E, Srikumar R, Muthu G, Sathyapriya T. Bacteriological profile and perception on hand hygiene in school-going Children. J Lab Physicians. 2019;11(4):300-4. doi: 10.4103/JLP.JLP_113_18.
11. Vishwanath R, Selvabai AP, Shanmugam P. Detection of bacterial pathogens in the hands of rural school children across different age groups and emphasizing the importance of hand wash. J Prev Med Hyg. 2019;60(2):E103-E108. doi: 10.15167/2421-4248/jpmh2019.60.2.1186.
12. Hemmadi V, Biswas M. An overview of moonlighting proteins in Staphylococcus aureus infection. Arch Microbiol. 2021;203(2):481-98. doi: 10.1007/s00203-020-02071-y.
13. Bondoc I. European Regulation in the Veterinary Sanitary and Food Safety Area, a Component of the European Policies on the Safety of Food Products and the Protection of Consumer Interests: A 2007 Retrospective. Part One: the Role of European Institutions in Laying Down and Passing Laws Specific to the Veterinary Sanitary and Food Safety Area. Universul Juridic. 2016;Suppl 1:12-5.
14. Navab-Daneshmand T, Friedrich MND, Gächter M, Montealegre MC, Mlambo LS, Nhiwatiwa Tet al. Escherichia coli Contamination across Multiple Environmental Compartments (Soil, Hands, Drinking Water, and Handwashing Water) in Urban Harare: Correlations and Risk Factors. Am J Trop Med Hyg. 2018;98(3):803-13. doi: 10.4269/ajtmh.17-0521.
15. Thi MTT, Wibowo D, Rehm BHA. Pseudomonas aeruginosa Biofilms. Int J Mol Sci. 2020;21(22):8671. doi: 10.3390/ijms21228671.
16. Bengoechea JA, Sa Pessoa J. Klebsiella pneumoniae infection biology: living to counteract host defences. FEMS Microbiol Rev. 2019;43(2):123-44. doi: 10.1093/femsre/fuy043.
17. Harding CM, Hennon SW, Feldman MF. Uncovering the mechanisms of Acinetobacter baumannii virulence. Nat Rev Microbiol. 2018;16(2):91-102. doi: 10.1038/nrmicro.2017.148.
18. Ray SK, Amarchand R, Srikanth J, Majumdar KK. A study on prevalence of bacteria in the hands of children and their perception on hand washing in two schools of Bangalore and Kolkata. Indian J Public Health. 2011;55(4):293-7. doi: 10.4103/0019-557X.92408.
19. Nasution TA, Yunita R, Pasaribu AP, Ardinata FM. Effectiveness Hand Washing and Hand Rub Method in Reducing Total Bacteria Colony from Nurses in Medan. Open Access Maced J Med Sci. 2019;7(20):3380-3. doi: 10.3889/oamjms.2019.427.
20. Boyce JM, Pittet D; Healthcare Infection Control Practices Advisory Committee; HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection
Control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002;51(RR-16):1-45, quiz CE1-4.
21. Foddai AC, Grant IR, Dean M. Efficacy of Instant Hand Sanitizers against Foodborne Pathogens Compared with Hand Washing with Soap and Water in Food Preparation Settings: A Systematic Review. J Food Prot. 2016;79(6):1040-54. doi: 10.4315/0362-028X.JFP-15-492.
22. Abaza AF, Amine AE, Hazzah WA. Comparative study on efficacy of different alcohol hand rubs and routine hand wash in a health-care setting, alexandria, egypt. J Egypt Public Health Assoc. 2010;85(5-6):273-83.
23. Corre J, Lucchini JJ, Mercier GM, Cremieux A. Antibacterial activity of phenethyl alcohol and resulting membrane alterations. Res Microbiol. 1990;141(4):483-97. doi: 10.1016/0923-2508(90)90074-z.
24. Rasmussen CA, Kaufman PL, Kiland JA. Benzalkonium chloride and glaucoma. J Ocul Pharmacol Ther. 2014;30(2-3):163-9. doi: 10.1089/jop.2013.0174.
25. Shadman SA, Sadab IH, Noor MS, Khan MS. Development of a Benzalkonium Chloride Based Antibacterial Paper for Health and Food Applications. ChemEngineering. 2021;5:1. doi: 10.3390/chemengineering5010001.
26. Sickbert-Bennett EE, Weber DJ, Gergen-Teague MF, Sobsey MD, Samsa GP, Rutala WA. Comparative efficacy of hand hygiene agents in the reduction of bacteria and viruses. Am J Infect Control. 2005;33(2):67-77. doi: 10.1016/j.ajic.2004.08.005.
27. Ogilvie BH, Solis-Leal A, Lopez JB, Poole BD, Robison RA, Berges BK. Alcohol-free hand sanitizer and other quaternary ammonium disinfectants quickly and effectively inactivate SARS-CoV-2. J Hosp Infect. 2021;108:142-5. doi: 10.1016/j.jhin.2020.11.023.
Submitted date:
08/30/2021
Reviewed date:
10/17/2021
Accepted date:
10/30/2021
Publication date:
11/02/2021