2006 Infection Control Guide
Hand Hygiene
Glossary of Terms
Hand hygiene products are placed in three categories:
· Hand cleaning
(does not kill organisms just washes them off leaving less of a
concentration on the skin)
· Hand antisepsis
(actively kills organisms either on contact or over a period of time)
· Surgical scrubbing
(provides a higher level of handwashing)
Alcohol-based hand rub - An alcohol-containing
preparation designed for application to the hands to reduce the number
of microorganisms on the hands. In the U.S., such preparations usually
contain 60 percent to 95 percent ethanol or isopropanol. Alcohol-based
products are more effective for standard handwashing or hand antisepsis
by HCWs than soap or antimicrobial soaps. Alcohols have excellent in
vitro germicidal activity against gram-positive and gram-negative
vegetative bacteria, including multidrug-resistant pathogens (e.g., MRSA
and VRE), Mycobacterium tuberculosis, and various fungi.
The efficacy of alcohol-based
hand-hygiene products is affected by several factors, including the type
of alcohol used, concentration of alcohol, contact time, volume of
alcohol used, and whether the hands are wet when the alcohol is applied.
Alcohol-based hand rubs intended for use in hospitals are available as
low viscosity rinses, gels, and foams. Alcohols are not appropriate for
use when hands are visibly dirty or contaminated with proteinaceous
materials.
Antimicrobial soap - Soap (detergent) containing an antiseptic
agent.
Antiseptic agent - Antiseptics are antimicrobial
substances that are applied to the skin to reduce the number of
microbial flora. Examples include alcohols, chlorhexidine, chlorine,
hexachlorophene, iodophors, chloroxylenol (PCMX), quaternary ammonium
compounds, and triclosan.
Antiseptic handwash - Washing hands with water
and soap or other detergents containing an antiseptic agent.
Antiseptic hand rub - Applying an antiseptic hand
rub product to all surfaces of the hands to reduce the number of
microorganisms present.
Chlorhexidine gluconate (CHG) - Chlorhexidine’s
immediate antimicrobial activity occurs more slowly than that of
alcohols. Chlorhexidine has good activity against gram-positive
bacteria, somewhat less activity against gram-negative bacteria and
fungi. It has substantial residual activity. CHG has been incorporated
into a number of hand-hygiene preparations. Addition of low
concentrations (0.5%-1.0%) of chlorhexidine to alcohol-based
preparations results in greater residual activity than alcohol alone.
Chloroxylenol - Also known as
parachlorometaxylenol (PCMX), is used as an active agent in
antimicrobial soaps. It has good in vitro activity against gram-positive
organisms and fair activity against gram-negative bacteria, mycobacteria,
and certain viruses.
Cumulative effect - A progressive decrease in the
numbers of microorganisms recovered following repeated applications of a
test material.
Decontaminate hands - Reducing bacterial counts
on hands by performing antiseptic hand rub or antiseptic handwash.
Detergents - Compounds that possess a cleaning
action.
Hand antisepsis - Refers to either antiseptic
handwash or antiseptic hand rub.
Hand hygiene - A general term that applies to
handwashing, antiseptic handwash, antiseptic hand rub, or surgical hand
antisepsis.
Handwashing - Washing hands with plain
(non-antimicrobial) soap and water.
Iodine and Iodophors - have bactericidal activity
against gram-positive, gram-negative, and certain spore-forming bacteria
and are active against mycobacteria, viruses, and fungi. Povidone-iodine
5%-10% has been tentatively classified by FDA TFM as a Category I agent
(i.e., a safe and effective agent for use as an antiseptic handwash and
an HCW handwash.) Usually used as a surgical scrub (7.5%) and for
cleaning skin prior to surgery.
Persistent activty - Prolonged or extended antimicrobial activity
that prevents or inhibits the proliferation or survival of
microorganisms after product application. In the past, this
property has also been called
"residual activity".
Plain (non-antimicrobial) soap - Detergents that
do not contain antimicrobial agents, or contain very low concentrations
of antimicrobial agents that are effective solely as preservatives.
Their cleaning activity can be attributed to their detergent properties,
which result in removal of dirt, soil, and various organic substances
from the hands. In several studies, handwashing with plain soap failed
to remove pathogens from the hands of hospital personnel.
Substantivity - An attribute of some active
ingredients that adhere to the stratum corneum, remaining on the skin
after rinsing or drying, to provide an inhibitory effect on the growth
of bacteria remaining on the skin.
Surgical hand antisepsis - Antiseptic handwash or
antiseptic hand rub performed preoperatively by surgical personnel to
eliminate transient bacteria and reduce resident hand flora. Antiseptic
detergent preparations often have persistent antimicrobial activity.
TFM: Tentative Final Monograph - The FDA
Tentative Final Monograph for Healthcare Antiseptic Drug Products
outlines certain ingredients and concentrations that have been proven to
be safe and effective for use in topical antiseptic product development.
A few examples of ingredients on this list are povidone-iodine (PVP-I)
and alcohol.
Triclosan - Concentrations of 0.2%-2% Triclosan
have antimicrobial activity. Like chlorhexidine, triclosan has
persistent activity on the skin.
Waterless antiseptic agent - An antiseptic agent
that does not require use of exogenous water. After applying such an
agent, the hands are rubbed together until the agent has dried.
This glossary was compiled from various sources including the CDC
Guidelines for Hand Hygiene in Health-Care Settings and the Hand Hygiene
Resource Center, with the help of Linda Spaulding, InCo and Associates
LLC. See our
Hand Hygiene Tool Box
for product and resouse info. HPN |
