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The World Health Organization Guidelines on Hand Hygiene in Health Care and Their Consensus Recommendations

Published online by Cambridge University Press:  02 January 2015

Didier Pittet*
Affiliation:
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland World Alliance for Patient Safety, World Health Organization, Geneva, Switzerland
Benedetta Allegranzi
Affiliation:
World Alliance for Patient Safety, World Health Organization, Geneva, Switzerland
John Boyce
Affiliation:
Hospital of Saint Raphael, Yale University School of Medicine, New Haven, Connecticut
*
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland ([email protected])

Abstract

The World Health Organization's Guidelines on Hand Hygiene in Health Care have been issued by WHO Patient Safety on 5 May 2009 on the occasion of the launch of the Save Lives: Clean Your Hands initiative. The Guidelines represent the contribution of more than 100 international experts and provide a comprehensive overview of essential aspects of hand hygiene in health care, evidence- and consensus-based recommendations, and lessons learned from testing their Advanced Draft and related implementation tools.

Type
Who Guideline
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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References

1.Pittet, D, Donaldson, L. Clean Care is Safer Care: a worldwide priority. Lancet 2005;366:12461247.CrossRefGoogle Scholar
2.Pittet, D, Donaldson, L. Clean Care is Safer Care: the first global challenge of the WHO World Alliance for Patient Safety. Infect Control Hosp Epidemiol 2005;26:891894.CrossRefGoogle ScholarPubMed
3.World Health Organization. WHO Guidelines for Hand Hygiene in Health Care (Advanced Draft). Geneva, Switzerland: World Health Organization, 2006.Google Scholar
4.Sax, H, Allegranzi, B, Uckay, I, Larson, E, Boyce, J, Pittet, D. ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 2007;67:921.CrossRefGoogle ScholarPubMed
5.Ahmed, QA, Memish, ZA, Allegranzi, B, Pittet, D. Muslim health-care workers and alcohol-based handrubs. Lancet 2006;367:10251027.CrossRefGoogle ScholarPubMed
6.Storr, J, Pittet, D. Re: help or hindrance? Is current infection control advice applicable in low- and middle-income countries? A review of the literature. Am J Infect Control 2008;36:499501.CrossRefGoogle ScholarPubMed
7.World Health Organization. WHO Guidelines on Hand Hygiene in Health Care. Geneva, Switzerland: World Health Organization Press, 2009.Google Scholar
8.Larson, E. A causal link between handwashing and risk of infection? Examination of the evidence. Infect Control 1988;9:2836.Google ScholarPubMed
9.Larson, EL, Morton, HE. Alcohols. In: Block, SS, ed. Disinfection, sterilization and preservation. 4th ed. Philadelphia, PA: Lea and Febiger, 1991:191203.Google Scholar
10.Denton, GW. Chlorhexidine. In: Block, SS, ed. Disinfection, sterilization and preservation. 4th ed. Philadelphia, PA: Lea and Febiger, 1991:274289.Google Scholar
11.Drusin, LM, Sohmer, M, Groshen, SL, Spiritos, MD, Senterfit, LB, Christenson, WN. Nosocomial hepatitis A infection in a paediatric intensive care unit. Arch Dis Child 1987;62:690695.CrossRefGoogle Scholar
12.Doebbeling, BN, Li, N, Wenzel, RP. An outbreak of hepatitis A among health care workers: risk factors for transmission. Am J Public Health 1993;83:16791684.CrossRefGoogle ScholarPubMed
13.Standaert, SM, Hutcheson, RH, Schaffher, W. Nosocomial transmission of Salmonella gastroenteritis to laundry workers in a nursing home. Infect Control Hosp Epidemiol 1994;15:2226.CrossRefGoogle ScholarPubMed
14.Rodriguez, EM, Parrott, C, Rolka, H, Monroe, SS, Dwyer, DM. An outbreak of viral gastroenteritis in a nursing home: importance of excluding ill employees. Infect Control Hosp Epidemiol 1996;17:587592.CrossRefGoogle Scholar
15.Schaffner, W, Lefkowitz, LB, Goodman, IS, Koenig, MG. Hospital outbreak of infections with group A streptococci traced to an asymptomatic anal carrier. New Engl J Med 1969;280:12241225.CrossRefGoogle Scholar
16.Shahid, NS, Greenough, WB, Samadi, AR, Huq, MI. Hand washing with soap reduces diarrhoea and spread of bacterial pathogens in a Bangladesh village. J Diarrhoeal Dis Res 1996;14:8589.Google Scholar
17.Luby, SP, Agboatwalla, M, Painter, J, Altaf, A, Billhimer, WL, Hoekstra, RM. Effect of intensive handwashing promotion on childhood diarrhea in high-risk communities in Pakistan: a randomized controlled trial. JAMA 2004;291:25472554.CrossRefGoogle ScholarPubMed
18.Ejemot, R, Ehiri, J, Meremikwu, M, Critchley, J. Hand washing for preventing diarrhoea. Cochrane Database Syst Rev 2008:CD004265.Google Scholar
19.Bettin, K, Clabots, C, Mathie, P, Willard, K, Gerding, DN. Effectiveness of liquid soap vs Chlorhexidine gluconate for the removal of Clostridium difficile from bare hands and gloved hands. Infect Control Hosp Epidemiol 1994;15:697702.CrossRefGoogle ScholarPubMed
20.Hubner, NO, Kampf, G, Loffler, H, Kramer, A. Effect of a 1 min hand wash on the bactericidal efficacy of consecutive surgical hand disinfection with standard alcohols and on skin hydration. Int J Hyg Environ Health 2006;209:285291.CrossRefGoogle ScholarPubMed
21.Weber, DJ, Sickbert-Bennett, E, Gergen, MF, Rutala, WA. Efficacy of selected hand hygiene agents used to remove Bacillus atrophaeus (a surrogate of Bacillus anthracis) from contaminated hands. JAMA 2003;289:12741277.CrossRefGoogle ScholarPubMed
22.Russell, AD. Chemical sporicidal and sporostatic agents. In: Block, SS, ed. Disinfection, sterilization and preservation. 4th ed. Philadelphia, PA: Lea and Febiger, 1991:365376.Google Scholar
23.Larson, EL, Eke, PI, Laughon, BE. Efficacy of alcohol-based hand rinses under frequent-use conditions. Antimicrob Agents Chemother 1986;30:542544.CrossRefGoogle ScholarPubMed
24.Larson, EL, Aiello, AE, Bastyr, J, et al.Assessment of two hand hygiene regimens for intensive care unit personnel. Crit Care Med 2001;29:944951.Google Scholar
25.Pittet, D, Hugonnet, S, Harbarth, S, et al.Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356:13071312.CrossRefGoogle ScholarPubMed
26.Widmer, AF. Replace hand washing with use of a waterless alcohol hand rub? Clin Infect Dis 2000;31:136143.CrossRefGoogle ScholarPubMed
27.Maury, E, Alzieu, M, Baudel, JL, et al.Availability of an alcohol solution can improve hand disinfection compliance in an intensive care unit. Am J Respir Crit Care Med 2000;162:324327.CrossRefGoogle Scholar
28.Bischoff, WE, Reynolds, TM, Sessler, CN, Edmond, MB, Wenzel, RP. Handwashing compliance by health care workers: the impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med 2000;160:10171021.CrossRefGoogle ScholarPubMed
29.Boyce, JM. Scientific basis for handwashing with alcohol and other waterless antiseptic agents. In: Rutala, WA, ed. Disinfection, sterilization and antisepsis: principles and practices in healthcare facilities. Washington, DC: Association for Professionals in Infection Control and Epidemiology, Inc., 2001:140151.Google Scholar
30.Graham, M. Frequency and duration of handwashing in an intensive care unit. Am J Infect Control 1990;18:7781.CrossRefGoogle Scholar
31.Picheansathian, W. A systematic review on the effectiveness of alcohol-based solutions for hand hygiene. Int J Nurs Pract 2004;10:39.CrossRefGoogle ScholarPubMed
32.Maki, DG. The use of antiseptics for handwashing by medical personnel. J Chemother 1989;1 (suppl):311.CrossRefGoogle ScholarPubMed
33.Massanari, RM, Hierholzer, WJ Jr. A crossover comparison of antiseptic soaps on nosocomial infection rates in intensive care units. Am J Infect Control 1984;12:247248.Google Scholar
34.Mortimer, EA, Lipsitz, PJ, Wolinsky, E, et al.Transmission of staphylococci between newborns. Am J Dis Child 1962;104:289295.CrossRefGoogle ScholarPubMed
35.Pessoa-Silva, CL, Dharan, S, Hugonnet, S, et al.Dynamics of bacterial hand contamination during routine neonatal care. Infect Control Hosp Epidemiol 2004;25:192197.Google Scholar
36.Ehrenkranz, NJ, Alfonso, BC. Failure of bland soap handwash to prevent hand transfer of patient bacteria to urethral catheters. Infect Control Hosp Epidemiol 1991;12:654662.CrossRefGoogle ScholarPubMed
37.McFarland, LV, Mulligan, ME, Kwok, RY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. New Engl J Med 1989;320:204210.CrossRefGoogle ScholarPubMed
38.Casewell, M, Phillips, I. Hands as route of transmission for Klebsiella species. BMJ 1977;2:13151317.CrossRefGoogle ScholarPubMed
39.Duckro, AN, Blom, DW, Lyle, EA, Weinstein, RA, Hayden, MK. Transfer of vancomycin-resistant enterococci via health care worker hands. Arch Intern Med 2005;165:302307.Google Scholar
40.Semmelweis, I. Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers [The etiology, concept and prophylaxis of childbed fever]. Pest, Hungary; Wien, Austria; und Leipzig, Germany: Hartleben Verlag-Expedition, 1861.Google Scholar
41.Hayden, MK, Blom, DW, Lyle, EA, Moore, CG, Weinstein, RA. Risk of hand or glove contamination after contact with patients colonized with vancomycin-resistant Enterococcus or the colonized patients’ environment. Infect Control Hosp Epidemiol 2008;29:149154.CrossRefGoogle ScholarPubMed
42.Ojajärvi, J. Effectiveness of hand washing and disinfection methods in removing transient bacteria after patient nursing. J Hyg (London) 1980;85:193203.CrossRefGoogle ScholarPubMed
43.Wendt, C, Knautz, D, Baum, H. Differences in hand hygiene behavior related to the contamination risk of healthcare activities in different groups of health care workers. Infect Control Hosp Epidemiol 2004;25:203206.CrossRefGoogle Scholar
44.Hirschmann, H, Fux, L, Podusel, JS, et al.The influence of hand hygiene prior to insertion of peripheral venous catheters on the frequency of complications. J Hosp Infect 2001;49:199203.CrossRefGoogle ScholarPubMed
45.Lucet, JC, Rigaud, MP, Mentre, F, et al.Hand contamination before and after different hand hygiene techniques: a randomized clinical trial. J Hosp Infect 2002;50:276280.CrossRefGoogle ScholarPubMed
46.Samore, MH, Venkataraman, L, DeGirolami, PC, Levin, E, Karchmer, AW. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med 1996;100:3240.Google Scholar
47.Boyce, JM, Potter-Bynoe, G, Chenevert, C, King, T. Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications. Infect Control Hosp Epidemiol 1997;18:622627.Google Scholar
48.Ray, AJ, Hoyen, CK, Taub, TF, Eckstein, EC, Donskey, CJ. Nosocomial transmission of vancomycin-resistant enterococci from surfaces. JAMA 2002;287:14001401.CrossRefGoogle ScholarPubMed
49.Bhalla, A, Pultz, NJ, Gries, DM, et al.Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients. Infect Control Hosp Epidemiol 2004;25:164167.CrossRefGoogle ScholarPubMed
50.Olsen, RJ, Lynch, P, Coyle, MB, Cummings, J, Bokete, T, Stamm, WE. Examination gloves as barriers to hand contamination in clinical practice. JAMA 1993;270:350353.CrossRefGoogle ScholarPubMed
51.Tenorio, AR, Badri, SM, Sahgal, NB, et al.Effectiveness of gloves in the prevention of hand carriage of vancomycin-resistant Enterococcus species by health care workers after patient care. Clin Infect Dis 2001;32:826829.Google Scholar
52.Doebbeling, BN, Pfaller, MA, Houston, AK, Wenzel, RP. Removal of nosocomial pathogens from the contaminated glove: implications for glove reuse and handwashing. Ann Intern Med 1988;109:394398.CrossRefGoogle ScholarPubMed
53.Eggimann, P, Harbarth, S, Constantin, MN, Touveneau, S, Chevrolet, JC, Pittet, D. Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet 2000;355:18641868.Google Scholar
54.Kampf, G, Loftier, H. Dermatological aspects of a successful introduction and continuation of alcohol-based hand rubs for hygienic hand disinfection. J Hosp Infect 2003;55:17.CrossRefGoogle ScholarPubMed
55.Kampf, G, Löffler, H. Prevention of irritant contact dermatitis among health care workers by using evidence-based hand hygiene practices: a review. Ind Health 2007;45:645652.Google Scholar
56.European standard EN 1499. Chemical disinfectants and antiseptics. Hygienic hand wash. Test method and requirements. Brussels, Belgium: European Committee for Standardization, 1997.Google Scholar
57.Widmer, AF, Conzelmann, M, Tomic, M, Frei, R, Stranden, AM. Introducing alcohol-based hand rub for hand hygiene: the critical need for training. Infect Control Hosp Epidemiol 2007;28:5054.CrossRefGoogle ScholarPubMed
58.Ohlenschlaeger, J, Friberg, J, Ramsing, D, Agner, T. Temperature dependency of skin susceptibility to water and detergents. Acta Derm Venereal 1996;76:274276.Google Scholar
59.Emilson, A, Lindbert, M, Forslind, B. The temperature effect of in vitro penetration of sodium lauryl sulfate and nickel chloride through human skin. Acta Derm Venereol 1993;73:203207.CrossRefGoogle ScholarPubMed
60.Berardesca, E, Vignoli, GP, Distante, F, Brizzi, P, Rabbiosi, G. Effects of water temperature on surfactant-induced skin irritation. Contact Dermatitis 1995;32:8387.CrossRefGoogle ScholarPubMed
61.Larson, EL, Eke, PI, Wilder, MP, Laughon, BE. Quantity of soap as a variable in handwashing. Infect Control 1987;8:371375.CrossRefGoogle ScholarPubMed
62.Larson, E, Leyden, JJ, McGinley, KJ, Grove, GL, Talbot, GH. Physiologic and microbiologic changes in skin related to frequent handwashing. Infect Control 1986;7:5963.CrossRefGoogle ScholarPubMed
63.Larson, EL, Laughon, BE. Comparison of four antiseptic products containing Chlorhexidine gluconate. Antimicrob Agents Chemother 1987;31:15721574.CrossRefGoogle ScholarPubMed
64.Taylor, LJ. An evaluation of handwashing techniques—1. Nurs Times 1978;74:5455.Google Scholar
65.Mermel, LA, Josephson, SL, Dempsey, J, Parenteau, S, Perry, C, Magill, N. Outbreak of Shigella sonnei in a clinical microbiology laboratory. J Clin Microbiol 1997;35:31633165.CrossRefGoogle Scholar
66.Patrick, DR, Findon, G, Miller, TE. Residual moisture determines the level of touch-contact-associated bacterial transfer following hand washing. Epidemiol Infect 1997;119:319325.CrossRefGoogle ScholarPubMed
67.Griffith, CJ, Malik, R, Cooper, RA, Looker, N, Michaels, B. Environmental surface cleanliness and the potential for contamination during handwashing. Am J Infect Control 2003;31:9396.CrossRefGoogle ScholarPubMed
68.Ansari, SA, Springthorpe, VS, Sattar, SA, Tostowaryk, W, Wells, GA. Comparison of cloth, paper, and warm air drying in eliminating viruses and bacteria from washed hands. Am J Infect Control 1991;19:243249.Google Scholar
69.Larson, EL, McGinley, KJ, Foglia, A, et al.Handwashing practices and resistance and density of bacterial hand flora on two pediatric units in Lima, Peru. Am J Infect Control 1992;20:6572.CrossRefGoogle ScholarPubMed
70.Heinze, JE, Yackovich, F. Washing with contaminated bar soap is unlikely to transfer bacteria. Epidemiol Infect 1988;101:135142.CrossRefGoogle ScholarPubMed
71.Bannan, EA, Judge, LF. Bacteriological studies relating to handwashing 1: the inability of soap bars to transmit bacteria. Am J Public Health 1965;55:915922.CrossRefGoogle ScholarPubMed
72.McBride, ME. Microbial flora of in-use soap products. App Environ Microbiol 1984;48:338341.CrossRefGoogle ScholarPubMed
73.Subbannayya, K, Bhat, GK, Junu, VG, Shetty, S, Jisho, MG. Can soaps act as fomites in hospitals? J Hosp Infect 2006;62:244245.Google Scholar
74.Hegde, PP, Andrade, AT, Bhat, K. Microbial contamination of “in use” bar soap in dental clinics. Indian J Dent Res 2006;17:7073.CrossRefGoogle ScholarPubMed
75.Rabier, V, Bataillon, S, Joljvet-Gougeon, A, Chapplain, JM, Beuchee, A, Betremieux, P. Hand washing soap as a source of neonatal Serratia marcescens outbreak. Acta Paediatr 2008;97:13811385.CrossRefGoogle ScholarPubMed
76.Das, A, Mandai, L, Chatterjee, SS, Ray, P, Marwaha, RK. Is hand washing safe? J Hosp Infect 2008;69:303304.CrossRefGoogle ScholarPubMed
77.Hoffman, PN, Cooke, EM, McCarville, MR, Emmerson, AM. Micro-organisms isolated from skin under wedding rings worn by hospital staff. BMJ 1985;290:206207.CrossRefGoogle ScholarPubMed
78.Salisbury, DM, Hutfilz, P, Treen, LM, Bollin, GE, Gautam, S. The effect of rings on microbial load of health care workers' hands. Am J Infect Control 1997;25:2427.Google Scholar
79.Field, EA, McGowan, P, Pearce, PK. Rings and watches: should they be removed prior to operative dental procedures? J Dent 1996;24:6569.Google Scholar
80.Fagernes, M, Lingaas, E, Bjark, P. Impact of a single plain finger ring on the bacterial load on the hands of healthcare workers. Infect Control Hosp Epidemiol 2007;28:11911195.CrossRefGoogle ScholarPubMed
81.Wongworawat, MD, Jones, SG. Influence of rings on the efficacy of hand sanitization and residual bacterial contamination. Infect Control Hosp Epidemiol 2007;28:351353.CrossRefGoogle ScholarPubMed
82.McNeil, SA, Foster, CL, Hedderwick, SA, Kauffman, CA. Effect of hand cleansing with antimicrobial soap or alcohol-based gel on microbial colonization of artificial fingernails worn by health care workers. Clin Infect Dis 2001;32:367372.CrossRefGoogle ScholarPubMed
83.Hedderwick, SA, McNeil, SA, Kauffman, CA. Pathogenic organisms associated with artificial fingernails worn by healthcare workers. Infect Control Hosp Epidemiol 2000;21:505509.CrossRefGoogle ScholarPubMed
84.Pottinger, J, Burns, S, Manske, C. Bacterial carriage by artificial versus natural nails. Am J Infect Control 1989;17:340344.CrossRefGoogle ScholarPubMed
85.Passaro, DJ, Waring, L, Armstrong, R, et al.Postoperative Serratia marcescens wound infections traced to an out-of-hospital source. J Infect Dis 1997;175:992995.Google Scholar
86.Parry, M, Grant, B, Yukna, M, et al.Candida osteomyelitis and diskitis after spinal surgery: an outbreak that implicates artificial nail use. Clin Infect Dis 2001;32:352357.CrossRefGoogle ScholarPubMed
87.Weber, DJ, Rutala, WA, Blanchet, CN, Jordan, M, Gergen, MF. Faucet aerators: a source of patient colonization with Stenotrophomonas maltophilia. Am J Infect Control 1999;27:5963.CrossRefGoogle ScholarPubMed
88.Cross, DF, Benchimol, A, Dimond, EG. The faucet aerator— a source of Pseudomonas infection. New Engl J Med 1966;274:14301431.Google Scholar
89.Price, PB. The bacteriology of normal skin: a new quantitative test applied to a study of the bacterial flora and the disinfectant action of mechanical cleansing. J Infect Dis 1938;63:301318.Google Scholar
90.Furukawa, KTT, Suzuki, H, Norose, Y. Are sterile water and brushes necessary for handwashing before surgery in Japan. J Nippon Med Sch 2005;72:149154.CrossRefGoogle ScholarPubMed
91.Dineen, P. An evaluation of the duration of the surgical scrub. Surg Gynecol Obstet 1969;129:11811184.Google ScholarPubMed
92.Bornside, GH, Crowder, VH Jr, Cohn, I Jr.A bacteriological evaluation of surgical scrubbing with disposable iodophor-soap impregnated polyurethane scrub sponges. Surgery 1968;64:743751.Google Scholar
93.McBride, ME, Duncan, WC, Knox, JM. An evaluation of surgical scrub brushes. Surg Gynecol Obstet 1973;137:934936.Google ScholarPubMed
94.Meers, PD, Yeo, GA. Shedding of bacteria and skin squames after handwashing. J Hyg (London) 1978;81:99105.Google Scholar
95.Hobson, DW, Woller, W, Anderson, L, Guthery, E. Development and evaluation of a new alcohol-based surgical hand scrub formulation with persistent antimicrobial characteristics and brushless application. Am J Infect Control 1998;26:507512.Google Scholar
96.Loeb, MB, Wilcox, L, Smaill, F, Walter, S, Duff, Z. A randomized trial of surgical scrubbing with a brush compared to antiseptic soap alone. Am J Infect Control 1997;25:1115.CrossRefGoogle ScholarPubMed
97.Boyce, JM, Potter-Bynoe, G, Opal, SM, Dziobek, L, Medeiros, AA. A common-source outbreak of Staphylococcus epidermidis infections among patients undergoing cardiac surgery. J Infect Dis 1990;161:493499.Google Scholar
98.Larson, EL, Butz, AM, Gullette, DL, Laughon, BA. Alcohol for surgical scrubbing? Infect Control Hosp Epidemiol 1990;11:139143.Google Scholar
99.Grinbaum, RS, de Mendonca, JS, Cardo, DM. An outbreak of hand-scrubbing-related surgical site infections in vascular surgical procedures. Infect Control Hosp Epidemiol 1995;16:198202.Google Scholar
100.Mulberry, G, Snyder, AT, Heilman, J, Pyrek, J, Stahl, J. Evaluation of a waterless, scrubless Chlorhexidine gluconate/ethanol surgical scrub for antimicrobial efficacy. Am J Infect Control 2001;29:377382.CrossRefGoogle Scholar
101.Rotter, ML, Kampf, G, Suchomel, M, Kundi, M. Population kinetics of the skin flora on gloved hands following surgical hand disinfection with 3 propanol-based hand rubs: a prospective, randomized, double-blind trial. Infect Control Hosp Epidemiol 2007;28:346350.CrossRefGoogle ScholarPubMed
102.Gupta, C, Czubatyj, AM, Briski, LE, Malani, AK. Comparison of two alcohol-based surgical scrub solutions with an iodine-based scrub brush for presurgical antiseptic effectiveness in a community hospital. J Hosp Infect 2007;65:6571.Google Scholar
103.Tanner, J, Swarbrook, S, Stuart, J. Surgical hand antisepsis to reduce surgical site infection. Cochrane Database Syst Rev 2008:CD004288.Google Scholar
104.Squier, C, Yu, VL, Stout, JE. Waterborne nosocomial infections. Curr Infect Dis Rep 2000;2:490496.CrossRefGoogle ScholarPubMed
105.Galle, PC, Homesley, HD, Rhyne, AL. Reassessment of the surgical scrub. Surg Gynecol Obstet 1978;147:215218.Google Scholar
106.Hingst, V, Juditzki, I, Heeg, P. Evaluation of the efficacy of surgical hand disinfection following a reduced application time of 3 instead of 5 minutes. J Hosp Infect 1992;20:7986.Google Scholar
107.Pereira, LJ, Lee, GM, Wade, KJ. The effect of surgical handwashing routines on the microbial counts of operating room nurses. Am J Infect Control 1990;18:354364.Google Scholar
108.Lowbury, EJL, Lilly, HA. Disinfection of the hands of surgeons and nurses. BMJ 1960;1:14451450.Google Scholar
109.O'Farrell, DA, Kenny, G, O'Sullivan, M, Nicholson, P, Stephens, M, Hone, R. Evaluation of the optimal hand-scrub duration prior to total hip arthroplasty. J Hosp Infect 1994;26:9398.CrossRefGoogle ScholarPubMed
110.O'Shaughnessy, M, O'Maley, VP, Corbe», G. Optimum duration of surgical scrub-time. Br J Surg 1991;78:685686.Google Scholar
111.Wheelock, SM, Lookinland, S. Effect of surgical hand scrub time on subsequent bacterial growth. AORN J 1997;65:10871098.Google Scholar
112.Heeg, P, Ulmer, R, Schwenzer, N. Verbessern Haendewaschen und Verwendung der Handbuerste das Ergebnis der Chirurgischen Haende-desinfektion? [Does handwashing and use of brush improve the result of surgical hand disinfection?]. Hyg Mediz 1988;13:270272.Google Scholar
113.Rotter, ML, Koller, W. Effekt der sequentiellen Anwendung von Chlor-hexidinseife und einer alkoholischen CHX-Praeparation versus Flüssigseife und einer solchen Praeparation bei der Chirurgischen Haende-desinfektion. [Effect of sequential use of Chlorhexidine soap and an alcoholic-chlorhexidine preparation versus liquid soap and alcoholic-chlorhexidine preparation on surgical hand disinfection]. Hyg Mediz 1990;15:437404.Google Scholar
114.Kampf, G, Ostermeyer, C, Heeg, P. Surgical hand disinfection with a propanol-based hand rub: equivalence of shorter application times. J Hosp Infect 2005;59:304310.Google Scholar
115.Kampf, G, Ostermeyer, C. Influence of applied volume on efficacy of 3-minute surgical reference disinfection method prEN 12791. App Environ Microbiol 2004;70:70667069.CrossRefGoogle ScholarPubMed
116.Larson, EL, Aiello, AE, Heilman, JM, et al.Comparison of different regimens for surgical hand preparation. AORN J 2001;73:412418.CrossRefGoogle ScholarPubMed
117.Ojajärvi, J, Mäkelä, P, Rantasalo, I. Failure of hand disinfection with frequent hand washing: a need for prolonged field studies. J Hyg (London) 1977;79:107119.Google Scholar
118.Boyce, JM, Kelliher, S, Vallande, N. Skin irritation and dryness associated with two hand-hygiene regimens: soap-and-water hand washing versus hand antisepsis with an alcoholic hand gel. Infect Control Hosp Epidemiol 2000;21:442448.CrossRefGoogle ScholarPubMed
119.Larson, E, Friedman, C, Cohran, J, Treston-Aurand, J, Green, S. Prevalence and correlates of skin damage on the hands of nurses. Heart Lung 1997;26:404412.CrossRefGoogle Scholar
120.Larson, E, Girard, R, Pessoa-Silva, CL, Boyce, J, Donaldson, L, Pittet, D. Skin reactions related to hand hygiene and selection of hand hygiene products. Am J Infect Control 2006;34:627635.Google Scholar
121.Bissett, L. Skin care: an essential component of hand hygiene and infection control. Br J Nurs 2007;16:976981.Google Scholar
122.Graham, M, Nixon, R, Burrell, LJ, Böiger, C, Johnson, PD, Grayson, ML. Low rates of cutaneous adverse reactions to alcohol-based hand hygiene solution during prolonged use in a large teaching hospital. Antimicrob Agents Chemother 2005;49:44044405.Google Scholar
123.Winnefeld, M, Richard, MA, Drancourt, M, Grob, JJ. Skin tolerance and effectiveness of two hand decontamination procedures in everyday hospital use. Br J Dermatol 2000;143:546550.Google Scholar
124.Larson, E, McGinley, KJ, Grove, GL, Leyden, JJ, Talbot, GH. Physiologic, microbiologic, and seasonal effects of handwashing on the skin of health care personnel. Am J Infect Control 1986;14:5159.Google Scholar
125.Scott, D, Barnes, A, Lister, M, Arkell, P. An evaluation of the user acceptability of Chlorhexidine handwash formulations. J Hosp Infect 1991;18:5155.CrossRefGoogle ScholarPubMed
126.Larson, E, Killien, M. Factors influencing handwashing behavior of patient care personnel. Am J Infect Control 1982;10:9399.Google Scholar
127.Ojajärvi, J. The importance of soap selection for routine hand hygiene in hospital. J Hyg (London) 1981;86:275283.CrossRefGoogle ScholarPubMed
128.Mayer, JA, Dubbert, PM, Miller, M, Burkett, PA, Chapman, SW. Increasing handwashing in an intensive care unit. Infect Control 1986;7:259262.Google Scholar
129.Boyce, JM. Antiseptic technology: access, affordability and acceptance. Emerg Inf Dis 2001;7:231233.CrossRefGoogle ScholarPubMed
130.Pittet, D, Allegranzi, B, Sax, H, Chraiti, MN, Griffiths, W, Richet, H. Double-blind, randomized, crossover trial of 3 hand rub formulations: fast-track evaluation of tolerability and acceptability. Infect Control Hosp Epidemiol 2007;28:13441351.CrossRefGoogle ScholarPubMed
131.Walsh, B, Blakemore, PH, Drubu, YJ. The effect of handcream on the antibacterial activity of Chlorhexidine gluconate. J Hosp Infect 1987;9:3033.Google Scholar
132.Jones, RD, Jampani, H, Mulberry, G, Rizer, RL. Moisturizing alcohol hand gels for surgical hand preparation. AORN J 2000;71:584592.Google Scholar
133.Sartor, C, Jacomo, V, Duvivier, C, Tissot-Dupont, H, Sambuc, R, Drancourt, M. Nosocomial Serratia marcescens infections associated with extrinsic contamination of a liquid nonmedicated soap. Infect Control Hosp Epidemiol 2000;21:196199.Google Scholar
134.Brooks, SE, Walczak, MA, Malcolm, S, Hameed, R. Intrinsic Klebsiella pneumoniae contamination of liquid germicidal hand soap containing Chlorhexidine. Infect Control Hosp Epidemiol 2004;25:883885.Google Scholar
135.Parasakthi, N, Vadivelu, J, Ariffin, H, Iyer, L, Palasubramaniam, S, Arasu, A. Epidemiology and molecular characterization of nosocomially transmitted multidrug-resistant Klebsiella pneumoniae. Int J Infect Dis 2000;4:123128.Google Scholar
136.Pittet, D, Simon, A, Hugonnet, S, Pessoa-Silva, CL, Sauvan, V, Perneger, TV. Hand hygiene among physicians: performance, beliefs, and perceptions. Ann Intern Med 2004;141:18.Google Scholar
137.Kohan, C, Ligi, C, Dumigan, DG, Boyce, JM. The importance of evaluating product dispensers when selecting alcohol-based handrubs. Am J Infect Control 2002;30:373375.Google Scholar
138.Dharan, S, Hugonnet, S, Sax, H, Pittet, D. Evaluation of interference of a hand care cream with alcohol-based hand disinfection. Occup Environ Dermatol 2001;49:8184.Google Scholar
139.Heeg, P. Does hand care ruin hand disinfection? J Hosp Infect 2001;48(suppl A):S37S39.Google Scholar
140.Marchetti, MG, Kampf, G, Finzi, G, Salvatorelli, G. Evaluation of the bactericidal effect of five products for surgical hand disinfection according to prEN 12054 and prEN 12791. J Hosp Infect 2003;54:6367.Google Scholar
141.Grohskopf, LA, Roth, VR, Feikin, DR, et al.Serratia liquefaciens bloodstream infections from contamination of epoetin alfa at a hemodialysis center. New Engl J Med 2001;344:14911497.CrossRefGoogle Scholar
142.Archibald, LK, Cori, A, Shah, B, et al.Serratia marcescens outbreak associated with extrinsic contamination of 1% chlorxylenol soap. Infect Control Hosp Epidemiol 1997;18:704709.Google Scholar
143.Schwanitz, HJ, Riehl, U, Schlesinger, T, Bock, M, Skudlik, C, Wulfhorst, B. Skin care management: educational aspects. Int Arch Occup Environ Health 2003;76:374381.Google Scholar
144.McCormick, RD, Buchman, TL, Maki, DG. Double-blind, randomized trial of scheduled use of a novel barrier cream and an oil-containing lotion for protecting the hands of health care workers. Am J Infect Control 2000;28:302310.Google Scholar
145.Berndt, U, Wigger-Alberti, W, Gabard, B, Eisner, P. Efficacy of a barrier cream and its vehicle as protective measures against occupational irritant contact dermatitis. Contact Dermatitis 2000;42:7780.CrossRefGoogle ScholarPubMed
146.Ramsing, DW, Agner, T. Preventive and therapeutic effects of a moisturizer: an experimental study of human skin. Acta Derma Venereol 1997;77:335337.CrossRefGoogle ScholarPubMed
147.Kampf, G, Ennen, J. Regular use of hand cream can attenuate skin dryness and roughness caused by frequent hand washing. BMC Dermatol 2006;6:1.Google Scholar
148.Kotilainen, HR, Brinker, JP, Avato, JL, Gantz, NM. Latex and vinyl examination gloves: quality control procedures and implications for health care workers. Arch Intern Med 1989;149:27492753.Google Scholar
149.Korniewicz, DM, Laughon, BE, Butz, A. Integrity of vinyl and latex procedures gloves. Nurs Res 1989;38:144146.Google Scholar
150.Reingold, AL, Kane, MA, Hightower, AW. Failure of gloves and other protective devices to prevent transmission of Hepatitis B virus to oral surgeons. JAMA 1988;259:25582560.Google Scholar
151.United States Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens. Fed Regist 2001;66(12):53175325. To be codified at 29 CFR 1910.1030.Google Scholar
152.Beltrami, EM, Kozak, A, Williams, IT, et al.Transmission of HIV and hepatitis C virus from a nursing home patient to a health care worker. Am J Infect Control 2003;31:168175.Google Scholar
153.United States Centers for the Prevention and Control of Disease. Update: human immunodeficiency virus infections in health-care workers exposed to blood of infected patients. Morb Mortal Wkly Rep MMWR 1987;36:285289.Google Scholar
154.Patterson, JE, Vecchio, J, Pantelick, EL, et al.Association of contaminated gloves with transmission of Acinetobacter calcoaceticus var. anitratus in an intensive care unit. Am J Med 1991;91:479483.Google Scholar
155.Bobulsky, GS, Al-Nassir, WN, Riggs, MM, Sethi, AK, Donskey, CJ. Clostridium difficile skin contamination in patients with C. difficile-associated disease. Clin Infect Dis 2008;46:447450.CrossRefGoogle ScholarPubMed
156.Pittet, D, Dharan, S, Touveneau, S, Sauvan, V, Perneger, TV. Bacterial contamination of the hands of hospital staff during routine patient care. Arch Intern Med 1999;159:821826.Google Scholar
157.Hagos, B, Kibwage, IO, Mwongera, M, Muthotho, JN, Githiga, IM, Mukindia, GG. The microbial and physical quality of recycled gloves. East Afr Med J 1997;74:224226.Google Scholar
158.Tietjen, L, Bossemeyer, D, Mcintosh, N. Infection prevention guidelines for healthcare facilities with limited resources. Baltimore, MD; Jhpiego, 2003.Google Scholar
159.Foca, M, Jakob, K, Whittier, S, et al.Endemic Pseudomonas aeruginosa infection in a neonatal intensive care unit. New Engl J Med 2000;343:695700.Google Scholar
160.Moolenaar, RL, Crutcher, JM, San Joaquin, VH, et al.A prolonged outbreak of Pseudomonas aeruginosa in a neonatal intensive care unit: did staff fingernails play a role in disease transmission? Infect Control Hosp Epidemiol 2000;21:8085.Google Scholar
161.Gordin, FM, Schultz, ME, Huber, R, Zubairi, S, Stock, F, Kariyil, J. A cluster of hemodialysis-related bacteremia linked to artificial fingernails. Infect Control Hosp Epidemiol 2007;28:743744.Google Scholar
162.Gupta, A, Delia-Latta, P, Todd, B, et al.Outbreak of extended-spectrum β-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit linked to artificial nails. Infect Control Hosp Epidemiol 2004;25:210215.Google Scholar
163.Larson, EL, Early, E, Cloonan, P, Sugrue, S, Parìdes, M. An organizational climate intervention associated with increased handwashing and decreased nosocomial infections. Behav Med 2000;26:1422.Google Scholar
164.Lankford, MG, Zembower, TR, Trick, WE, Hacek, DM, Noskin, GA, Peterson, LR. Influence of role models and hospital design on hand hygiene of healthcare workers. Emerg Infect Dis 2003;9:217223.Google Scholar
165.Tibballs, J. Teaching hospital medical staff to handwash. Med J Aust 1996;164:395398.Google Scholar
166.Rosenthal, VD, McCormick, RD, Guzman, S, Villamayor, C, Orellano, PW. Effect of education and performance feedback on handwashing: the benefit of administrative support in Argentinean hospitals. Am J Infect Control 2003;31:8592.Google Scholar
167.Benton, C. Hand hygiene-meeting the JCAHO safety goal: can compliance with CDC hand hygiene guidelines be improved by a surveillance and educational program? Plast Surg Nurs 2007;27:4044.Google Scholar
168.Pessoa-Silva, CL, Hugonnet, S, Pfister, R, et al.Reduction of health care associated infection risk in neonates by successful hand hygiene promotion. Pediatrics 2007;120:e382390.Google Scholar
169.Trick, WE, Vernon, MO, Welbel, SF, Demarais, P, Hayden, MK, Weinstein, RA. Multicenter intervention program to increase adherence to hand hygiene recommendations and glove use and to reduce the incidence of antimicrobial resistance. Infect Control Hosp Epidemiol 2007;28:4249.Google Scholar
170.Ebnother, C, Tanner, B, Schmid, F, La Rocca, V, Heinzer, I, Bregenzer, T. Impact of an infection control program on the prevalence of nosocomial infections at a tertiary care center in Switzerland. Infect Control Hosp Epidemiol 2008;29:3843.Google Scholar
171.Whitby, M, McLaws, M-L, Ross, RW. Why healthcare workers don't wash their hands: a behavioral explanation. Infec Control Hosp Epidemiol 2006;27:484492.CrossRefGoogle Scholar
172.Sax, H, Uckay, I, Richet, H, Allegranzi, B, Pittet, D. Determinants of good adherence to hand hygiene among healthcare workers who have extensive exposure to hand hygiene campaigns. Infect Control Hosp Epidemiol 2007;28:12671274.Google Scholar
173.Whitby, M, Pessoa-Silva, CL, McLaws, ML, et al.Behavioural considerations for hand hygiene practices: the basic building blocks. J Hosp Infect 2007;65:18.Google Scholar
174.Gould, DJ, Chudleigh, JH, Moralejo, D, Drey, N. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev 2007:CD005186.Google Scholar
175.Aboelela, SW, Stone, PW, Larson, EL. Effectiveness of bundled behavioural interventions to control healthcare-associated infections: a systematic review of the literature. J Hosp Infect 2007;66:101108.Google Scholar
176.Caniza, MA, Maron, G, Moore, EJ, Quintana, Y, Liu, T. Effective hand hygiene education with the use of flipcharts in a hospital in El Salvador. J Hosp Infect 2007;65:5864.Google Scholar
177.Lawton, RM, Turon, T, Cochran, RL, Cardo, D. Prepackaged hand hygiene educational tools facilitate implementation. Am J Infect Control 20O6; 34:152154.Google Scholar
178.Duerink, DO, Farida, H, Nagelkerke, NJ, et al.Preventing nosocomial infections: improving compliance with standard precautions in an Indonesian teaching hospital. J Hosp Infect 2006;64:3643.Google Scholar
179.Huang, TT, Wu, SC. Evaluation of a training programme on knowledge and compliance of nurse assistants’ hand hygiene in nursing homes. J Hosp Infect 2008;68:164170.CrossRefGoogle ScholarPubMed
180.Conly, JM, Hill, S, Ross, J, Lertzman, J, Louie, TJ. Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates. Am f Infect Control 1989;17:330339.Google Scholar
181.Dubbert, PM, Dolce, J, Richter, W, Miller, M, Chapman, SW. Increasing ICU staff handwashing: effects of education and group feedback. Infect Control Hosp Epidemiol 1990;11:191193.Google Scholar
182.Raju, TN, Kobler, C. Improving handwashing habits in the newborn nurseries. Am J Med Sc 1991;302:355358.Google Scholar
183.Rosenthal, VD, Guzman, S, Safdar, N. Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. Am J Infect Control 2005;33:392397.Google Scholar
184.Zerr, DM, Allpress, AL, Heath, J, Bornemann, R, Bennett, E. Decreasing hospital-associated rotavirus infection: a multidisciplinary hand hygiene campaign in a children’s hospital. Pediatr Infect Dis J 2005; 24:397403.CrossRefGoogle ScholarPubMed
185.Eldridge, NE, Woods, SS, Bonello, RS, et al.Using the Six Sigma process to implement the Centers for Disease Control and Prevention Guideline for Hand Hygiene in 4 intensive care units. J Gen Intern Med 2006;21(suppl 2):S35S42.Google Scholar
186.Harbarth, S, Pittet, D, Grady, L, et al.Interventional study to evaluate the impact of an alcohol-based hand gel in improving hand hygiene compliance. Pediatr Infect Dis J 2002;21:489495.Google Scholar
187.Brown, SM, Lubimova, AV, Khrustalyeva, NM, et al.Use of an alcohol-based hand rub and quality improvement interventions to improve hand hygiene in a Russian neonatal intensive care unit. Infect Control Hosp Epidemiol 2003;24:172179.Google Scholar
188.McGuckin, M, Waterman, R, Porten, L, et al.Patient education model for increasing handwashing compliance. Am J Infect Control 1999;27:309314.Google Scholar
189.McGuckin, M, Waterman, R, Storr, IJ, et al.Evaluation of a patient-empowering hand hygiene programme in the UK. J Hosp Infect 2001;48:222227.Google Scholar
190.McGuckin, M, Taylor, A, Martin, V, Porten, L, Salcido, R. Evaluation of a patient education model for increasing hand hygiene compliance in an inpatient rehabilitation unit. Am J Infect Control 2004;32:235238.Google Scholar
191.Suresh, G, Cahill, J. How “user friendly” is the hospital for practicing hand hygiene? An ergonomie evaluation. Jt Comm J Qual Patient Saf 2007;33:171179.Google Scholar
192.Ogunsola, FT, Adesiji, YO. Comparison of four methods of hand washing in situations of inadequate water supply. West Afr J Med 2008;27:2428.Google Scholar
193.Larson, E, Silberger, M, Jakob, K, et al.Assessment of alternative hand hygiene regimens to improve skin health among neonatal intensive care unit nurses. Heart lung 2000;29:136142.Google Scholar
194.Voss, A, Widmer, AF. No time for handwashing!? Handwashing versus alcoholic rub: can we afford 100% compliance? Infect Control Hosp Epidemiol 1997;18:205208.Google Scholar
195.Pittet, D. Compliance with hand disinfection and its impact on hospital-acquired infections. J Hosp Infect 2001;48(suppl A):S40S46.Google Scholar
196.Girou, E, Oppein, F. Handwashing compliance in a French university hospital: new perspective with the introduction of hand-rubbing with a waterless alcohol-based solution. J Hosp Infect 2001;48(suppl A):S55S57.Google Scholar
197.Ritchie, K, Iqbal, K, Macpherson, K, Riches, E, Stout, A. The provision of alcohol based products to improve compliance with hand hygiene. Health technology assessment report. Edinburgh, UK: National Health Service Quality Improvement Scotland, 2005.Google Scholar
198.Larson, EL, Quiros, D, Lin, SX. Dissemination of the CDC’s Hand Hygiene Guideline and impact on infection rates. Am J Infect Control 2007;35:666675.Google Scholar
199.Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG. The efficacy of infection surveillance and control programs in preventing nosocomial infections in U.S. hospitals. Am J Epidemiol 1985;121:182205.Google Scholar
200.Grayson, ML, Jarvie, LJ, Martin, R, et al.Significant reductions in meth-icillin-resistant Staphylococcus aureus bacteraemia and clinical isolates associated with a multisite, hand hygiene culture-change program and subsequent successful statewide roll-out. Med JAust 2008;188:633640.Google Scholar
201.World Health Organization (WHO). WHO Guidelines on drinking-water quality. First addendum to 3rd ed. Geneva, Switzerland: World Health Organization, 2006.Google Scholar
202.National Patient Safety Agency. Achieving our aims: evaluating the results of the pilot “cleanyourhands” campaign. London, UK: National Patient Safety Agency, 2004.Google Scholar
203.Wächter, RM, Pronovost, PJ. The 100,000 Lives Campaign: a scientific and policy review. Jt Comm J Qual Patient Saf 2006;32:621627.Google Scholar
204.Stone, S, Slade, R, Fuller, C, et al.Early communication: does a national campaign to improve hand hygiene in the NHS work? Initial English and Welsh experience from the NOSEC study (National Observational Study to Evaluate the “CleanYourHands” Campaign). J Hosp Infect 2007;66:293296.Google Scholar
205.National Patient Safety Agency. CleanYourHands campaign, 2007. Available at http://www.npsa.nhs.uk/cleanyourhands/. Accessed April 23, 2009.Google Scholar
206.Richet, HM, Benbachir, M, Brown, DE, et al.Are there regional variations in the diagnosis, surveillance, and control of methicillin-resistant Staphylococcus aureus? Infect Control Hosp Epidemiol 2003;24:334341.Google Scholar
207.Patient safety alert 04: clean hands help to save lives. London, UK: National Patient Safety Agency, 2004.Google Scholar
208.Sandora, TJ, Shih, MC, Goldmann, DA. Reducing absenteeism from gastrointestinal and respiratory illness in elementary school students: a randomized, controlled trial of an infection-control intervention. Pediatrics 2008;121:e15551562.Google Scholar
209.Morton, JL, Schultz, AA. Healthy hands: use of alcohol gel as an adjunct to handwashing in elementary school children. J Sch Nurs 2004;20:161167.Google Scholar
210.White, C, Kolble, R, Carlson, R, et al.The effect of hand hygiene on illness rate among students in university residence halls. Am J Infect Control 2003;31:364370.Google Scholar
211.Hammond, B, Ali, Y, Fendler, E, Dolan, M, Donovan, S. Effect of hand sanitizer use on elementary school absenteeism. Am J Infect Control 2000;28:340346.Google Scholar
212.Camins, BC, Fraser, VJ. Reducing the risk of health care-associated infections by complying with CDC hand hygiene guidelines, Jt Comm J Qual Patient Saf 2005;31:173179.Google Scholar