Definitions concerns to hand hygiene

Handwashing with detergents or antiseptic soaps and water, alcohol-based soap solutions and surgical antisepsis.

Washing with common soap and water or detergent in order to remove the newly acquired flora and remove dirt.

Washing of hands with water and antiseptic (soap or detergent) of broad microbial spectrum, in order to remove and destroy the resident flora and maintain residual effect.

Hygiene that is performed with topical solutions, alcoholic gels, antiseptic gels specially prepared for the asepsis of the hands without the use of water, soap and towels

Handwashing before surgical procedures with antiseptics

They are solutions with bactericidal power that can be used on the skin, the most used are:

Iodopovidone: (iodine-polyvinylpyrrolidone) antiseptic proven to perform adequate asepsis and disinfection, particularly when used in soapy formula for antiseptic hand hygiene and pre-surgical bath. (not recommended in neonates because of the high iodine content) Its importance is that it provides effective antisepsis for the activity against Gram (+) and Gram (-) bacteria, as well as against mycobacteria, fungi and viruses. Fast intermediate action, low residual activity. It should be kept in opaque containers and protected from light, to preserve its activity.

Chlorhexidine 4% -gluconate: antiseptic that quickly eliminates (30 sec.) Gram (+) and Gram (-) bacteria, also effective against viruses (HIV, HERPES, CMV and INFLUENZA) with a residual action between 3 and 6 hours. It is effective in the presence of blood and other organic materials; producing disruption of the microbial wall. With greater acceptability for its cosmetic characteristics and low toxicity.

It can be used in neonates and is recommended in the decolonization of patients and presurgical bathing.

It must be kept in its original container, at room temperature and protected from light; It should not be used as a disinfectant for inert surfaces.

The association of alcohols with 0.5% Gluconate C. seems to combine the rapid action of alcohol and the persistence of Gluconate C. transforming it into a desirable combination.

Triclosan: a broad spectrum phenolite compound that generates disruption of the microbial wall with effectiveness on Gram (+) and most Gram (-). It has an intermediate activity and is minimally affected by organic matter. Its concentration at 0.3 to 2% have been tested as adequate. They can be associated with soaps or soapy solutions. They are not recommended for presurgical hygiene.

Alcohol 70%: its bacterial effect is related to protein denaturation. Excellent bactericidal power over Gram (+) and Gram (-), TBC bacillus, some fungi and viruses (Respiratory Syncytial, Hepatitis B and HIV).

Rarely toxic and applied to the skin is one of the safest; with rapid action and reduction of microbial flora count. They are not good cleaners so if the hand is visibly dirty it should not be used.

There are two types of alcohols in the trade: Ethyl and isopropyl alcohol, being considered that the concentration is more important than the type of alcohol in its antiseptic effect They are obtained at 70 or 90%, the lowest concentration being the most effective. It is volatile and flammable, and must be stored at temperatures not exceeding 21 C.

They can also be associated with emollients to minimize the effect of dry skin.

Iodized alcohol: combination of iodine with 70% alcohol, and should be used in 2% concentrations, it is used as the antiseptic of choice in the preparation of the preoperative area.

Alcohol-based solutions: alcoholic solutions with or without antiseptics that do not require water. Forms of presentation: Gel, liquid soap and foam.

Usually constituted by ethyl alcohol and iso propyl alcohol in a concentration of 60 to 70%, they are viscous, with a balanced pH containing emollient agents that decrease skin dryness. They reach a good antiseptic level: they eliminate transient flora and have a residual effect.

They favor the adherence because they generate less changes in the flora of the skin and are more operative: they reduce the time of hand hygiene (26% to 16% time of the work schedule of the infirmary).

They are flammable., They need to be kept tightly sealed, in a clean and fresh place. The most commonly used are the gels for your practicality and comfort.

Some recently published data seem to show greater efficacy compared to usual antiseptic hygiene: BMJ vol 325 August 2002 (randomized work) describes a greater reduction in the colonization of the hands before and after the use of alcohol gel in a neonatal therapy unit. Another more recent work showed the reduction of nosocomial infection in UTIN with the combined use of alcohol gel and gloves in the assistance of newborn of extreme low weight. (Arch Dis Child Fetal Neonatal Ed. 2004,).

They are not recommended when hands are contaminated with biological materials or fluids.

General considerations:
The use of soapy solutions or alcohol gels is preferred. Their selection must have the best efficacy with low skin irritability to achieve maximum acceptance.
The use of bar soaps or scratches is not recommended (it is easily contaminated with residual moisture).
Soapy solutions should:

Keep in original containers.
Contain in closed and disposable containers. Do not fill them out.
Keep at the right temperature and those who need it in opaque containers.
They do not self-sterilize and on the contrary they can become contaminated, the latter is more related to improper use of the dispenser or its refilling.
Alcohol gels evaporate easily, decreasing their effectiveness, so they must be contained in airtight containers. Remember that they are flammable.