Patient Presentation
A resident physician was discussing a premature female infant’s health supervision visit with his attending physician.
The resident felt that he had adequately answered all of the mother’s questions except for one that was “do those antibacterial cleaning wipes actually work?”The attending physician said that although he didn’t have any research studies to point the resident to, he thought that they did not work because of all the variabilities of which product, surface type, drying times, etc.. They then went on to discuss whether or not alcohol-based handrubbing products worked.
The attending physician said that again he couldn’t point to the literature, but knew that there were several studies that supported the use of alcohol-based handrubbing products.
The attending physician also pointed out that the hospital was now providing and promoting the handrubbing products. He said, “Someone who looks at this all the time, must think that they work or they wouldn’t have us use them.”Later in the week, the resident did a PUBMED search and found a research article which compared various antibacterial cleaning wipes for food surface decontamination.
The resident and the attending discussed the article at their next continuity clinic and both agreed that they could improve upon their own cleaning procedures at home and would be better able to talk to parents about the issue.
Discussion
Hand hygiene, and food and other surface decontamination procedures are some of the most important ways to decrease infection transmission.
Over the past several years, new consumer and professional products have been developed to help improve these procedures.
Bacteria survival and transfer between surfaces including hands is influenced by temperature, nature of the surface, moisture level, bacteria type, inoculum, and time since bacterial inoculation.
Learning Point
According to the Hand Hygiene Resource Center, “Two million people each year become ill as a result of a hospital-acquired infection. Proper hand hygiene is critical to the prevention of these infections – which contribute to the death of nearly 90,000 hospital patients per year and $4.5 billion in medical expenses.”The Centers for Disease Control recommended alcohol-based handrubbing products in healthcare settings in 2002.
These recommendations include using these products when hands are not visibly soiled and:
- Before and after having direct contact with patients
- Before putting on and after taking off sterile and non-sterile gloves
- If during patient care, one moves from a contaminated-body site to a clean-body site
- After contact with body fluids or excretions, mucous membranes, non-intact skin, and wound dressings
- After contact with inanimate objects, including medical equipment, in the immediate area of the patient
These recommendations include using plain soap and water or an antibacterial soap and water when:
- Hands are visibly soiled
- Before eating
- After using the restroom
- Exposure to Bacillus anthracis is suspected or proven
One study of the effectiveness of antibacterial products on decontaminating food surfaces inoculated food preparation surfaces with Escherichia coli and Staphylococcus aureus. Four different antibacterial products were evaluated none of which was household bleach. The study found that survival of the bacteria depended on:
- Surface type – with glass > plastic >> wood surfaces, with glass having the highest bacterial survival and wood having the least survival.
- Antibacterial product – wipes > sprays, with wipes having highest bacterial survival
The products ability to decontaminate the surfaces was wood > glass >> plastic with wood having the best decontamination rate and plastic the least
This was presumably because of the uneven surface of the plastic. Wood apparently has some intrinsic antibacterial properties and also the porous nature allows the bacteria to penetrate the wood and not be recoverable on the surface thereby decreasing contamination.
The study also found that the one antibacterial product that did not perform as well as the other products had confusing consumer instructions and the authors felt that this could contribute to an even higher rate of continued contamination when using these products.
Childcare centers and other settings often use bleach as a disinfectant because it is inexpensive and easy to use. The recommendation is to mix 1/4 cup (2 ounces) household bleach in 1 gallon (128 ounces) of water and dispense by a spray bottle. For smaller amounts 1 tablespoon (15 ml) in 1 quart (32 ounces) of water can be used. The solution must be mixed fresh everyday because the chlorine evaporates.
The bleach solution should contact the surface for 2 minutes or longer to provide disinfection.
Questions for Further Discussion
1. Does using alcohol-based handrubbing product increase or decrease the skin condition (i.e. irritation) of health care providers?
2. How can household sponges be appropriately cleaned?
3. How long should hands be washed or rubbed for?
Related Cases
- Disease
- Symptom/Presentation
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Information prescriptions for patients can be found at MedlinePlus for these topics: Germs and Hygiene
and Food Contamination and Poisoning
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
Wilson E. Child Care Home: Disease Prevention. National Network for Child Care. Available from the Internet at http://www.nncc.org/Health/cch.disease.html (rev. 1996, cited 5/14/2007).
Boyce JM, Pettet D. 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. MMWR. October 25, 2002 / 51(RR16);1-44. Available from the Internet at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm (cited 5/14/2007).
Hand Hygiene Resource Center. Available from the Internet at http://www.handhygiene.org/ (rev. 2/2/2007, cited 5/14/2007).
Girou E,
Loyeau S,
Legrand P,
Oppein F,
Brun-Buisson C.
Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial.
BMJ. 2002:17; 325(7360):362.
Larson EL,
Cimiotti J,
Haas J,
Parides M,
Nesin M,
Della-Latta P,
Saiman L.
Effect of antiseptic handwashing vs alcohol sanitizer on health care-associated infections in neonatal intensive care units.
Arch Pediatr Adolesc Med. 2005;159(4):377-83.
Devere E,
Purchase D.
Effectiveness of domestic antibacterial products in decontaminating food contact surfaces.
Food Microbiol. 2007;24(4):425-30.
ACGME Competencies Highlighted by Case
2. Essential and accurate information about the patients’ is gathered.
3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
5. Patients and their families are counseled and educated.
6. Information technology to support patient care decisions and patient education is used.
8. Health care services aimed at preventing health problems or maintaining health are provided.
10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.
12. Evidence from scientific studies related to the patients’ health problems is located, appraised and assimilated.
13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
14. Knowledge of study designs and statistical methods to appraisal clinical studies and other information on diagnostic and therapeutic effectiveness is applied.
15. Information technology to manage information, access on-line medical information and support the healthcare professional’s own education is used.
16. Learning of students and other health care professionals is facilitated.
Author
Donna M. D’Alessandro, MD
Associate Professor of Pediatrics, Children’s Hospital of Iowa
Date
June 25, 2007
Pediatric Education 