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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

  • John M. Boyce (a1) and Didier Pittet (a2)


The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.



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1.Rotter, M. Hand washing and hand disinfection [Chapter 87]. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins, 1999.
2.Labarraque, AG. Instructions and Observations Regarding the Use of the Chlorides of Soda and Lime. Porter, J, ed. [French] New Haven, CT: Baldwin and Treadway, 1829.
3.Semmelweis, I. Etiology, Concept, and Prophylaxis of Childbed Fever. Carter, KC, ed. 1st ed. Madison, WI: The University of Wisconsin Press, 1983.
4.Coppage, CM. Hand Washing in Patient Care [Motion picture]. Washington, DC: US Public Health Service, 1961.
5.Steere, AC, Mallison, GF. Handwashing practices for the prevention of nosocomial infections. Ann Intern Med 1975;83:683-90.
6.Garner, JS, Favero, MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986:7:231–43.
7.Larson, E. Guideline for use of topical antimicrobial agents. Am J Infed Control 1988;16:253-66.
8.Larson, EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69.
9.Hospital Infection Control Practices Advisory Committee (HICPAC). Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol 1995;16:105-13.
10.Garner, JS, Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:5380.
11.Pittet, D, Mourouga, P, Perneger, TV, Members of the Infection Control Program. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;130:126-30.
12.Boyce, JM. It is time for action: improving hand hygiene in hospitals. Ann Intern Med 1999;130:153-5.
13.Selwyn, S. Microbiology and ecology of human skin. Practitioner 1980;224:1059-62.
14.Price, PB. 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;63:301-18.
15.Larson, E. Effects of handwashing agent, handwashing frequency, and clinical area on hand flora. Am J Infect Control 1984;11:7682.
16.Maki, D. Control of colonization and transmission of pathogenic bacteria in the hospital. Ann Intern Med 1978;89(Pt 2):777–80.
17.Larson, EL, Norton Hughes, CA, Pyrak, JD, Sparks, SM, Cagatay, EU, Bartkus, JM. Changes in bacterial flora associated with skin damage on hands of health care personnel. Am J Infect Control 1998;26:513-21.
18.Sprunt, K, Redman, W, Leidy, G. Antibacterial effectiveness of routine hand washing. Pediatrics 1973;52:264-71.
19.Food and Drug Administration. Tentative final monograph for healthcare antiseptic drug products; proposed rule. Federal Register 1994;59:31441-52.
20.Lowbury, EJL. Gram-negative bacilli on the skin. Br J Dermatol 1969;81(suppl 1):5561.
21.Noble, WC. Distribution of the Micrococcaceae. Br J Dermatol 1969;81(suppl 1):2731.
22.McBride, ME, Duncan, WC, Bodey, GP, McBride, CM. Microbial skin flora of selected cancer patients and hospital personnel. J Clin Microbiol 1976;3:1420.
23.Casewell, MW. Role of hands in nosocomial gram-negative infection. In: Maibach, HI, Aly, R, eds. Skin Microbiology: Relevance to Clinical Infection. New York, NY: Springer-Verlag, 1981.
24.Larson, EL, McGinley, KJ, Foglia, AR, Talbot, GH, Leyden, JJ. Composition and anfimicrobic resistance of skin flora in hospitalized and healthy adults. J Clin Microbiol 1986;23:604-8.
25.Ehrenkranz, NJ, Alfonso, BC. Failure of bland soap handwash to prevent hand transfer of patient bacteria to urethral catheters. Infect Control Hosp Epidemiol 1991;12:654-62.
26.Sanderson, PJ, Weissler, S. Recovery of coliforms from the hands of nurses and patients: activities leading to contamination. J Hosp Infect 1992;21:8593.
27.Coello, R, Jiménez, J, García, M, et al. Prospective study of infection, colonization and carriage of methicillin-resistant Staphylococcus aureus in an outbreak affecting 990 patients. Eur J Clin Microbiol Infect Dis 1994;13:7481.
28.Sanford, MD, Widmer, AF, Bale, MJ, Jones, RN, Wenzel, RP, Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus. Clin Inject Dis 1994;19:1123–8.
29.Bertone, SA, Fisher, MC, Mortensen, JE. Quantitative skin cultures at Potential catheter sites in neonates. Infect Control Hosp Epidemiol 1994;15:315-8.
30.Bonten, MJM, Hayden, MK, Nathan, C, VanVoorhis, J, et al. Epidemiology of colonisation of patients and environment with vancomycin-resistant enterococci. Lancet 1996;348:1615-9.
31.Larson, EL, Cronquist, AB, Whittier, S, Lai, L, Lyle, CT, Della Latta, P. Differences in skin flora between inpatients and chronically ill patients. Heart Lung 2000;29:298305.
32.Polakoff, S, Richards, IDG, Parker, MT, Iidwell, OM. Nasal and skin carriage of Staphylococcus aureus by patients undergoing surgical operation. J Hyg (Land) 1967;65:559-66.
33.Leyden, JJ, McGinley, KJ, Nordstrom, KM, Webster, GF. Skin microflora. J Invest Dermatol 1987;88:65s72s.
34.Tuazon, CU, Perez, A, Kishaba, T, Sheagren, JN. Staphylococcus aureus among insulin-injecting diabetic patients. JAMA 1975;231:1272.
35.Kaplowitz, LG, Comstock, JA, Landwehr, DM, Dalton, HP, Mayhall, CG. Prospective study of microbial colonization of the nose and skin and infection of the vascular access site in hemodialysis patients. J Clin Microbiol 1988;26:1257–62.
36.Aly, R, Maibach, HI, Shinefield, HR. Microbial flora of atopic dermatitis. Arch Dermatol 1977;113:780-2.
37.Kirmani, N, Tuazon, CU, Murray, HW, Parrish, AE, Sheagren, JN. Staphylococcus aureus carriage rate of patients receiving long-term hemodialysis. Arch Intern Med 1978;138:1657-9.
38.Goldblum, SE, Ulrich, JA, Goldman, RS, Reed, WP. Nasal and cutaneous flora among hemodialysis patients and personnel: quantitative and qualitative characterization and patterns of staphylococcal carriage. Am J Kidney Dis 1982;11:281-6.
39.Boelaert, JRVan Landuyt, HW, Gordts, BZ, De Baere, YA, Messer, SA, Herwaldt, IA, Nasal and cutaneous carriage of Staphylococcus aureus in hemodialysis patients: the effect of nasal mupirocin. Infect Control Hosp Epidemiol 1996;17:809-11.
40.Zimakoff, J, Pedersen, FB, Bergen, L, et al. Staphylococcus aureus carriage and infections among patients in four haemo- and peritoneal-dialysis centres in Denmark. J Hosp Infect 1996;33:289300.
41.Bibel, DJ, Greenbert, JH, Cook, JL. Staphylococcus aureus and the microbial ecology of atopic dermatitis. Can J Microbiol 1997;23:1062-8.
42.Noble, WC. Dispersal of skin microorganisms. Br J Dermatol 1975;93:477-85.
43.Walter, CW, Kundsin, RB, Shilkret, MA, Day, MM. Spread of staphylococci to the environment. Antibiotics Annual 1959:952-7.
44.Boyce, JM, Opal, SM, Chow, JW, et al. Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol 1994;32:1148-53.
45.McFarland, LV, Mulligan, ME, Kwok, RYY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. NEngl J Med 1989;320:204-10.
46.Samore, MH, Venkataraman, L, DeGirolami, PC, Levin, E, Arbeit, RD, Karchmer, AW. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med 1996;100:3240.
47.Iidwell, OM, Towers, AG, Ballard, J, Gladstone, B. Transfer of microorganisms between nurses and patients in a clean air environment. J Appl Bacterid 1974;37:649-56.
48.Casewell, M, Phillips, I. Hands as route of transmission for Klebsiella species. Br Med J 1977;2:1315-7.
49.Hall, CB, Douglas, RG. Modes of transmission of respiratory syncytial virus. J Pediatr 1981;99:100-2.
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;270:350-3.
51.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;159:821-6.
52.Fox, MK, Langner, SB, Wells, RW. How good are hand washing practices? Am J Nursing 1974;74:1676-8.
53.Ojajärvi, J. Effectiveness of hand washing and disinfection methods in removing transient bacteria after patient nursing. J Hyg (Land) 1980;85:193203.
54.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;18:622-7.
55.Hayden, MK, Blom, DW, Lyle, EA. et al. The risk of hand and glove contamination by healthcare workers (HCWs) after contact with a VRE (+) patient (pt) or the pts environment (env) [Abstract K-1334]. Presented at the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago: American Society for Microbiology, 2001.
56.Scott, E, Bloomfield, SF. The survival and transfer of microbial contamination via cloths, hands and utensils. J Appl Bacteriol 1990;68:271-8.
57.Bauer, TM, Ofner, E, Just, HM, Just, H, Daschner, FD. An epidemiological study assessing the relative importance of airborne and direct contact transmission of microorganisms in a medical intensive care unit. J Hosp Infed 1990;15:301-9.
58.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;32:826-9.
59.Daschner, FD. How cost-effective is the present use of antiseptics? J Hosp Infect 1988;11(suppl A):227–35.
60.Khittle, MAEitzman, DV, Baer, H. Role of hand contamination of personnel in the epidemiology of gram-negative nosocomial infections. J Pediatr 1975;86:433-7.
61.Ayliffe, GAI, Babb, JR, Davies, JG, Lilly, HA. Hand disinfection: a comparison of various agents in laboratory and ward studies. J Hosp Infed 1988;11:226M3.
62.Strausbaugh, LJ, Sewell, DL, Ward, TX, Pfaller, MA, Heitzman, X, Tjoelker, R, High frequency of yeast carriage on hands of hospital personnel. J Clin Microbiol 1994;32:2299-300.
63.Marples, RRTowers, AG. A laboratory model for the investigation of contact transfer of micro-organisms. JHyg (Land) 1979;82:237-48.
64.Mackintosh, CAHoffman, PN. An extended model for transfer of microorganisms via the hands: differences between organisms and the effect of alcohol disinfection. JHyg (Land) 1984;92:345-55.
65.Patrick, DRFmdon, G, Miller, TE. Residual moisture determines the level of touch-contact-associated bacterial transfer following hand washing. Epidemiol Infect 1997;119:319-25.
66.Larson, E. A causal link between handwashing and risk of infection? Examination of the evidence. Infed Control Hosp Epidemiol 1988;9:2836.
67.Larson, E. Skin hygiene and infection prevention: more of the same or different approaches? Clin Infect Dis 1999;29:1287-94.
68.Mortimer, EA Jr, Lipsitz, PJ, Wolinsky, E, Gonzaga, AJ, Rammelkamp, CH Jr. Transmission of staphylococci between newborns. Am J Dis Child 1962;104:289-95.
69.Maki, DG. The use of antiseptics for handwashing by medical personnel. J Chemother 1989;1(suppl 1):311.
70.Massanari, RM, Hierholzer, WJ Jr.A crossover comparison of antiseptic soaps on nosocomial infection rates in intensive care units. Am J Infect Control 1984;12:247-8.
71.Doebbeling, BN, Stanley, GL, Sheetz, CT, et al. Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. N Engl J Med 1992;327:8893.
72.Webster, J, Faoagali, JL, Cartwright, D. Elimination of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit after hand washing with triclosan. J Paediatr Child Health 1994;30:5964.
73.Zafar, AB, Buder, RC, Reese, DJ, Gaydos, IA, Mennonna, PA, Use of 0.3% triclosan (Bacti-Stat*) to eradicate an outbreak of methicillin-resistant Staphylococcus aureus in a neonatal nursery. Am J Infed Control 1995;23:200-8.
74.Pittet, D, Hugonnet, S, Harbarth, S, Mourouga, P, Sauvan, V, Touveneau, S. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356:1307-12.
75.Larson, EL, Early, E, Cloonan, ESugrue, S, Parides, M. An organizational climate intervention associated with increased handwashing and decreased nosocomial infections. Behav Med 2000;26:1422.
76.Fridkin, SK, Pear, SM, Williamson, TH, Galgiani, JN, Jarvis, WR. The role of understaffing in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 1996;17:150-8.
77.Vicca, AENursing staff workload as a determinant of methicillin-resistant Staphylococcus aureus spread in an adult intensive therapy unit. J Hosp Wed 1999;43:109-13.
78.Harbarth, S, Sudre, P, Dharan, S, Cadenas, M, Pittet, D. Outbreak of Enterobader cloacae related to understaffing, overcrowding, and poor hygiene practices. Infed Control Hosp Epidemiol 1999;20:598603.
79.European Committee for Standardization. Chemical Disinfedants and Antiseptics—Hygienic Handrub—Test Method and Requirements (phase2/step2) [European standard EN 1500]. Brussels, Belgium: Central Secretariat 1997.
80.Kramer, ARudolph, P, Kampf, G, Pittet, D. Limited efficacy of alcohol-based hand gels. Lancet 2002;359:1489-90.
81.Sattar, SAAbebe, M, Bueti, AJ, Jampani, H, Newman, J, Hua, S. Activity of an alcohol-based hand gel against human adeno-, rhino-, and rotaviruses using the fingerpad method. Infect Control Hosp Epidemiol 2000;21:516-9.
82.Wolff, MH, Schmitt, J, Rahaus, M, König, A. Hepatitis A virus: a test method for virucidal activity. J Hosp Infect 2001;48(suppl A):S18S22.
83.Steinmann, J. Some principles of virucidal testing. J Hosp Infect 2001;48(suppl A):S15S17.
84.Gould, D, Ream, E. Assessing nurses' hand decontamination performance. Nursing Times 1993;89:4750.
85.Quraishi, ZAMcGuckin, M, Biais, FX. Duration of handwashing in intensive care units: a descriptive study. Am J Infed Control 1984;11:83-7.
86.Lund, S, Jackson, J, Leggett, J, Hales, L, Dworkin, R, Gilbert, D. Reality of glove use and handwashing in a community hospital. Am J Infed Control 1994;22:352-7.
87.Meengs, MR, Giles, BK, Chisholm, CD, Cordell, WH, Nelson, DR. Hand washing frequency in an emergency department. Ann Emerg Med 1994;23:1307-12.
88.Larson, E, McGeer, A, Quraishi, ZA, et al. Effect of an automated sink on handwashing practices and attitudes in high-risk units. Infect Control Hosp Epidemiol 1991;12:422-8.
89.Broughall, JM, Marshman, C, Jackson, B, Bird, P. An automatic monitoring system for measuring handwashing frequency. J Hosp Infect 1984;5:447-53.
90.Ojajärvi, J, Mäkelä, R, Rantasalo I. Failure of hand disinfection with frequent hand washing: a need for prolonged field studies. J Hyg (Land) 1977;79:107-19.
91.Larson, EL, Eke, PI, Wilder, MP, Laughon, BE. Quantity of soap as a variable in handwashing. Infect Control 1987;8:371-5.
92.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.
93.Larson, EL, Eke, PI, Laughon, BE. Efficacy of alcohol-based hand rinses under frequent-use conditions. Antimicrob Agents Chemother 1986;30:542-4.
94.Larson, EL, Laughon, BE. Comparison of four antiseptic products containing Chlorhexidine gluconate. Antimicrob Agents Chemother 1987;31:1572-4.
95.Meers, PD, Yeo, GA. Shedding of bacteria and skin squames after handwashing. J Hyg (Land) 1978;81:99105.
96.Winnefeld, M, Richard, MA, Drancourt, M, Grobb, JJ. Skin tolerance and effectiveness of two hand decontamination procedures in everyday hospital use. Br J Dermatol 2000;143:546-50.
97.Maki, DG, Zilz, MA, Alvarado, CJ. Evaluation of the antibacterial efficacy of four agents for handwashing. In: Nelson, JC, Grassi, C, eds. Current chemotherapy and infectious disease proceedings of the 11th International Congress on Chemotherapy and the 19th ICACC. Washington, DC: American Society for Microbiology, 1979.
98.Boyce, JM, Kelliher, S, Vallande, N. Skin irritation and dryness associated with two hand-hygiene regimens: soap-and-water handwashing versus hand antisepsis with an alcoholic hand gel. Infect Control Hosp Epidemiol 2000;21:442-8.
99.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;21:196-9.
100.Walter, CW. Editorial: disinfection of hands. Am J Surg 1965;109:691-3.
101.Gravens, DL, Butcher, HR Jr, Ballinger, WF, Dewar, NE. Septisol antiseptic foam for hands of operating room personnel: an effective antibacterial agent. Surgery 1973;73:360-7.
102.Eitzen, HE, Ritter, MAFrench, MLV, Gioe, TJ. A microbiological in-use comparison of surgical hand-washing agents. J Bone Joint Surg Am 1979;61-A403-6.
103.Minakuchi, K, Yamamoto, Y, Matsunaga, K, et al. The antiseptic effect of a quick drying rubbing type povidone-iodine alcoholic disinfectant solution. Postgrad Med J 1993;69(suppl 3):S23S26.
104.Babb, JR, Davies, JG, Ayliffe, GAJ. A test procedure for evaluating surgical hand disinfection. J Hosp Infect 1991;18(suppl B):41–9.
105.Bellamy, K, Alcock, R, Babb, JR, Davies, JG, Ayliffe, GA. A test for the assessment of ‘hygienic’ hand disinfection using rotavirus. J Hosp Infect 1993;24:201-10.
106.Ayliffe, GAJ, Babb, JR, Quoraishi, AH. A test for ‘hygienic’ hand disinfection. J Clin Pathol 1978;31:923-8.
107.Lilly, HALowbury, EJL, Wilkins, MD. Detergents compared with each other and with antiseptics as skin ‘degerming’ agents. J Hyg (Lend) 1979;82:8993.
108.Ulrich, JAClinical study comparing hibistat (0.5% Chlorhexidine gluconate in 70% isopropyl alcohol) and betadine surgical scrub (7.5% povidone-iodine) for efficacy against experimental contamination of human skin. Curr Ther Res 1982;31:2730.
109.Bartzokas, CAGibson, MF, Graham, R, Pinder, DC. A comparison of triclosan and Chlorhexidine preparations with 60 per cent isopropyl alcohol for hygienic hand disinfection. J Hosp Infect 1983;4:245-55.
110.Rotter, ML, Koller, W, Wewalka, G, Werner, HP, Ayliffe, GAJ, Babb, JREvaluation of procedures for hygienic hand-disinfection: controlled parallel experiments on the Vienna test model. J Hyg (Land) 1986;96:2737.
111.Kjrlen, H, Andersen, BM. Handwashing and disinfection of heavily contaminated hands—effective or ineffective? J Hosp Infect 1992;21:6171.
112.Namura, S, Nishijima, S, Asada, Y. An evaluation of the residual activity of antiseptic handrub lotions: an ‘in use’ setting study. J Dermatol 1994;21:481-5.
113.Jarvis, JD, Wynne, CD, Enwright, L, Williams, JD. Handwashing and antiseptic-containing soaps in hospital. J Clin Path 1979;32:732-7.
114.Pereira, LJ, Lee, GM, Wade, KJ. An evaluation of five protocols for surgical handwashing in relation to skin condition and microbial counts. J Hosp Infect 1997;36:4965.
115.Larson, EL, Butz, AM, Gullette, DL, Laughon, BA. Alcohol for surgical scrubbing? Infect Control Hosp Epidemiol 1990;11:139-43.
116.Aly, RMaibach, HI. Comparative study on the antimicrobial effect of 0.5% Chlorhexidine gluconate and 70% isopropyl alcohol on the normal flora of hands. Appl Environ Microbiol 1979;37:610-3.
117.Galle, PC, Homesley, HD, Rhyne, AL, Reassessment of the surgical scrub. Surg Gynecol Obstet 1978;147:215-8.
118.Rosenberg, AAlatary, SD, Peterson, AF. Safety and efficacy of the antiseptic Chlorhexidine gluconate. Surg Gynecol Obstet 1976;143:789-92.
119.Ayliffe, GAJ, Babb, JR, Bridges, K, et al. Comparison of two methods for assessing the removal of total organisms and pathogens from the skin. J Hyg (Land) 1975;75:259-74.
120.Larson, EL, Morton, HE. Alcohols [Chapter 11]. In: Block, SS, ed. Disinfection, Sterilization and Preservation. 4th ed. Philadelphia, PA, Lea and Febiger, 1991:642-54.
121.Price, PB. Ethyl alcohol as a germicide. Arch Surg 1939;38:528-42.
122.Harrington, C, Walker, H. The germicidal action of alcohol. Boston Medical and Surgical Journal 1903;148:548-52.
123.Price, PB. New studies in surgical bacteriology and surgical technic. JAMA 1938;111:1993-6.
124.Coulthard, CE, Sykes, G. The germicidal effect of alcohol with special reference to its action on bacterial spores. Pharmaceutical Journal 1936;137:7981.
125.Pohle, WD, Stuart, LS. The germicidal action of cleaning agents— a study of a modification of Price's procedure. J Infect Dis 1940;67:275–81.
126.Gardner, AD. Rapid disinfection of clean unwashed skin: further experiments. Lancet 1948:760-3.
127.Sakuragi, T, Yanagisawa, K, Dan, K, Bactericidal activity of skin disinfectants on methicillin-resistant Staphylococcus aureus. Anesth Analg 1995;81:555-8.
128.Kampf, G, Jarosch, R, Rüden, H. Limited effectiveness of Chlorhexidine based hand disinfectants against methicillin-resistant Staphylococcus aureus (MRSA). J Hosp Infect 1998;38:297303.
129.Kampf, G, Höfer, M, Wendt, C. Efficacy of hand disinfectants against vancomycin-resistant enterococci in vitro. J Hosp Infect 1999;42:143-50.
130.Platt, J, Bucknall, RA. The disinfection of respiratory syncytial virus by iso-propanol and a chlorhexidine-detergent handwash. J Hosp Infect 1985;6:8994.
131.Krilov, LR, Harkness, SH. Inactivation of respiratory syncytial virus by detergents and disinfectants. Pediatr Infect Dis 1993;12:582-4.
132.Sattar, SATetro, J, Springthorpe, VS, Giulivi, A. Preventing the spread of hepatitis B and C viruses: where are germicides relevant? Am J Infect Control 2001;29:187-97.
133.Woolwine, JD, Gerberding, JL. Effect of testing method on apparent activities of antiviral disinfectants and antiseptics. Antimicrob Agents Chemother 1995;39:921-3.
134.Pfflsbury, DM, Iivingood, CS, Nichols, AC. Bacterial flora of the normal skin: report on the effect of various ointment and solutions, with comments on the clinical significance of this study. Arch Dermatol 1942;45:6180.
135.Lowbury, EJL, Lilly, HA, Ayliffe, GAJ. Preoperative disinfection of surgeons' hands: use of alcoholic solutions and effects of gloves on skin flora. Br Med J 1974;4:369-72.
136.Lilly, HA, Lowbury, EJL, Wilkins, MD, Zaggy, A. Delayed antimicrobial effects of skin disinfection by alcohol. JHyg (Land) 1979;82:497500.
137.Ansali, SASpringthorpe, VS, Sattar, SATostowaryk, W, Wells, GA. Comparison of cloth, paper, and warm air drying in eliminating viruses and bacteria from washed hands. Am J Infect Control 1991;19:243-9.
138.Ansati, SASattar, SA. Springthorpe, VS, Wells, GA. Tostowaryk, W. In vivo protocol for testing efficacy of hand-washing agents against viruses and bacteria: experiments with rotavirus and Escherichia coli. Appl Environ Microbiol 1989;55:3113-8.
139.Steinmann, J, Nehrkorn, R, Meyer, A, Becker, K. Two in-vivo protocols for testing virucidal efficacy of handwashing and hand disinfection. Zentralbl Hyg Umuieltmed 1995;196:425-36.
140.Mbithi, JN, Springthorpe, VS, Sattar, SA, Comparative in vivo efficiencies of hand-washing agents against hepatitis A virus (HM-175) and poliovirus type 1 (Sabin). Appi Environ Microbiol 1993;59:3463-9.
141.Schurmann, W, Eggers, HJ. Antiviral activity of an alcoholic hand disinfectant: comparison of the in vitro suspension test with in vivo experiments on hands, and on individual fingertips. Antiviral Res 1983;3:2541.
142.Larson, E, Bobo, L. Effective hand degerming in the presence of blood. J Emerg Med 1992;10:711.
143.Dineen, P, Hildick-Smith, G. Antiseptic care of the hands [Chapter 21]. In: Maibach, HI, Hildick-Smith, G, eds. Skin Bacteria and Their Role in Infection. New York: McGraw-Hill, 1965.
144.Lilly, HALowbury, EJL. Transient skin flora: their removal by cleansing or disinfection in relation to their mode of deposition. J Clin Path 1978;31:919-22.
145.Rotter, M, Koller, W, Wewalka, G. Povidone-iodine and Chlorhexidine glu-conate-containing detergents for disinfection of hands. J Hosp Infect 1980;1:149-58.
146.Rotter, ML. Hygienic hand disinfection. Infect Control 1984;1:1822.
147.Blech, MF, Hartemann, R, Paquin, JL. Activity of non antiseptic soaps and ethanol for hand disinfection. Zentralbl Bakteriol Hyg [B] 1985;181:496512.
148.Leyden, JJ, McGinley, KJ, Kaminer, MS, et al. Computerized image analysis of full-hand touch plates: a method for quantification of surface bacteria on hands and the effect of antimicrobial agents. J Hosp Infect 1991;18(suppl B):1322.
149.Rotter, ML, Koller, W. Test models for hygienic handrub and hygienic handwash: the effects of two different contamination and sampling techniques. J Hosp Infect 1992;20:163-71.
150.Zaragoza, M, Salles, M, Gomez, J, Bayas, JM, Trilla, A. Handwashing with soap or alcoholic solutions? A randomized clinical trial of its effectiveness. Am J Infect Control 1999;27:258-61.
151.Paulson, DS, Fendler, EJ, Dolan, MJ, Williams, RA. A close look at alcohol gel as an antimicrobial sanitizing agent. Am J Infect Control 1999;27:332-8.
152.Cardoso, CL, Pereira, HH, Zequim, JC, Guilhermetti, M. Effectiveness of hand-cleansing agents for removing Acinetobader baumannii strain from contaminated hands. Am J Infect Control 1999;27:327-31.
153.Casewell, MW, Law, MM, Desai, N. A laboratory model for testing agents for hygienic hand disinfection: handwashing and Chlorhexidine for the removal of Klebsiella. J Hosp Infect 1988;12:163-75.
154.Wade, JJ, Desai, N, Casewell, MW. Hygienic hand disinfection for the removal of epidemic vancomycin-resistant Enterococcus faecium and gentamicin-resistant Enterobacter cloacae. J Hosp Infect 1991;18:211-8.
155.Huang, Y, Oie, S, Kamiya, A. Comparative effectiveness of hand-cleansing agents for removing methicillin-resistant Staphylococcus aureus from experimentally contaminated fingertips. Am J Infect Control 1994;22:224-7.
156.Lowbury, EJL, Lilly, HA. Disinfection of the hands of surgeons and nurses. Br Med J 1960;1:5184.
157.Berman, RE, Knight, RA. Evaluation of hand antisepsis. Arch Environ Health 1969;18:781-3.
158.Rotter, ML, Simpson, RA, Koller, W. Surgical hand disinfection with alcohols at various concentrations: parallel experiments using the new proposed European standards method. Infect Control Hosp Epidemiol 1998;19:778-81.
159.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;26:507-12.
160.Jones, MV, Rowe, GB, Jackson, B, Pritchard, NJ. The use of alcoholic paper wipes for routine hand cleansing: results of trials in two hospitals. J Hosp Infect 1986;8:268-74.
161.Butz, AM, Laughon, BE, Gullette, DL, Larson, EL. Alcohol-impregnated wipes as an alternative in hand hygiene. Am J Infect Control 1990;18:70-6.
162.Ojajärvi, J. Handwashing in Finland. J Hosp Infect 1991;18(suppl B):3540.
163.Newman, JLSeitz, JC. Intermittent use of an antimicrobial hand gel for reducing soap-induced irritation of health care personnel. Am J Infect Control 1990;18:194200.
164.Rotter, MLKoller, W, Neumann, R. The influence of cosmetic additives on the acceptability of alcohol-based hand disinfectants. J Hosp Infect 1991;18 (suppl B):5763.
165.Larson, ELAello, AE, Heilman, JM, et al. Comparison of different regimens for surgical hand preparation. AORN J 2001;73:412-20.
166.Larson, EL, Aello, AE, Bastyr, J, et al. Assessment of two hand hygiene regimens for intensive care unit personnel. Crit Care Med 2001;29; 944–51.
167.Ophaswongse, S, Maibach, HI. Alcohol dermatitis: allergic contact dermatitis and contact urticaria syndrome: a review. Contad Dermatitis 1994;30:16.
168.Rilliet, AHunziker, N, Brun, R. Alcohol contact urticaria syndrome (immediate-type hypersensitivity): case report. Dermatologica 1980;161:361-4.
169.Widmer, AEReplace hand washing with use of a waterless alcohol hand rub? Clin Infect Dis 2000;31:13fr43.
170.Bryant, KA, Pearce, J, Stover, B. Flash fire associated with the use of alcc-hoi-based antiseptic agent [Letter]. Am J Infect Control 2002;30:256-7.
171.Hsueh, PRTeng, LJ, Yang, PC, Pan, HL, Ho, SW, Luh, KT. Nosocomial pseu-doepidemic caused by Bacillus cereus traced to contaminated ethyl alcohol from a liquor factory. J Clin Microbiol 1999;37:2280-4.
172.Denton, GW. Chlorhexidine [Chapter 16]. In: Block, SS, ed. Disinfedion, Sterilization and Preservation. 4th ed. Philadelphia, PA. Lea and Febiger, 1991.
173.Narang, HK, Codd, AA. Action of commonly used disinfectants against enteroviruses. J Hosp Infect 1983;4:209-12.
174.Walsh, B, Blakemore, PH, Drabu, YJ. The effect of handcream on the antibacterial activity of Chlorhexidine gluconate. J Hosp Infect 1987;9:30-3.
175.Lowbury, EJLLilly, HA. Use of 4% Chlorhexidine detergent solution (Hibiscrub) and other methods of skin disinfection. Br Med J 1973;1:510-5.
176.Paulson, DS. Comparative evaluation of five surgical hand scrub preparations. AORN J 1994;60:246-56.
177.Stingerli, LLapomarda, V, Lisi, R. Occupational hand dermatitis in hospital environments. Contact Dermatitis 1995;33:172-6.
178.Marrie, TJ, Costerton, JW. Prolonged survival of Serratia marcescens in Chlorhexidine. Appl Environ Microbiol 1981;42:1093-102.
179.McAllister, TALucas, CE, Mocan, H, et al. Serratia marcescens outbreak in a paediatric oncology unit traced to contaminated Chlorhexidine. Scott Med J 1989;34:525-8.
180.Vigeant, P, Loo, VG, Bertrand, C, et al. An outbreak of Serratia marcescens infections related to contaminated Chlorhexidine. Infect Control Hosp Epidemiol 1998;19:791-4.
181.Vu-Thien, H, Darbord, JC, Moissenet, D, et al. Investigation of an outbreak of wound infections due to Alcaligenes xylosoxidans transmitted by Chlorhexidine in a burns unit. Eur J Clin Microbiol 1998;17:724-6.
182.Larson, E, Talbot, GH. An approach for selection of health care personnel handwashing agents. Infect Control 1986;7:419-24.
183.Davies, J, Babb, JR, Ayliffe, GAJ, Wilkins, MD. Disinfection of the skin of the abdomen. Br J Surg 1978;65:855-8.
184.Larson, E, Mayur, K, Laughon, BAInfluence of two handwashing frequencies on reduction in colonizing flora with three handwashing products used by health care personnel. Am J Infect Control 1988;17:83-8.
185.Soulsby, ME, Barnett, JB, Maddox, S. Brief report the antiseptic efficacy of chlorxylenol-containing vs. Chlorhexidine gluconate-containing surgical scrub preparations. Infect Control 1986;7:223-6.
186.Aly, R, Maibach, HI. Comparative antibacterial efficacy of a 2-minute surgical scrub with Chlorhexidine gluconate, povidone-iodine, and chlorox-ylenol sponge-brushes. Am J Infect Control 1988;16:173-7.
187.Archibald, LK, Cori, A, Shah, B, et al. Serratia marcescens outbreak associated with extrinsic contamination of 1% chlorxylenol soap. Infect Control Hosp Epidemiol 1997;18:704-9.
188.Lowbury, EJL, Lilly, HA, Bull, JR. Disinfection of hands: removal of resident bacteria. Br Med J 1963;1:1251-6.
189.Kundsin, RB, Walter, CW. The surgical scrub—practical consideration. Arch Surg 1973;107:75-7.
190.Lockhart, J. How toxic is hexachlorophene? Pediatrics 1972;50:229-35.
191.Shuman, RM, Leech, RW, Alvord, EC Jr.Neurotoxicity of hexachlorophene in humans: II. a clinicopathological study of 46 premature infants. Arch Neurol 1975;32:320-5.
192.Dixon, RE, Kaslow, RA, Mallison, GF, Bennett, JV. Staphylococcal disease outbreaks in hospital nurseries in the United States—December 1971 through March 1972. Pediatrics 1973;51:413-6.
193.Kaslow, RA, Dixon, RE, Martin, SM, et al. Staphylococcal disease related to hospital nursery bathing practices—a nationwide epidemiologic investigation. Pediatrics 1973;51:418-29.
194.American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Academy of Obstetricians and Gynecologists, 1997.
195.Gottardi, W. Iodine and iodine compounds [Chapter 8]. In: Block, SS, ed. Disinfection, Sterilization and Preservation. 4th ed. Philadelphia, PA. Lea and Febiger; 1991.
196.Anderson, RLIodophor antiseptics: intrinsic microbial contamination with resistant bacteria. Infect Control Hosp Epidemiol 1989;10:443-6.
197.Goldenheim, PD. In vitro efficacy of povidone-iodine solution and cream against methicillin-resistant Staphylococcus aureus. Postgrad Med J 1993;69(suppl 3):S62S65.
198.Traoré, O, Fayard, SF, Laveran, H. An in-vitro evaluation of the activity of povidone-iodine against nosocomial bacterial strains. J Hosp Infect 1996;34:217-22.
199.McLure, AR, Gordon, J. In-vitro evaluation of povidone-iodine and Chlorhexidine against methicillin-resistant Staphylococcus aureus. J Hosp Infect 1992;21:291-9.
200.Davies, JG, Babb, JR, Bradley, CR, Ayliffe, GAJ. Preliminary study of test methods to assess the virucidal activity of skin disinfectants using poliovirus and bacteriophages. J Hosp Infed 1993;25:125-31.
201.Rotter, MLHand washing and hand disinfection [Chapter 79]. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore, MD: Williams & Wilkins, 1996.
202.Wade, JJ, Casewell, MW. The evaluation of residual antimicrobial activity on hands and its clinical relevance. J Hosp Infect 1991;18(suppl B):23–8.
203.Aly, RMaibach, HI. Comparative evaluation of Chlorhexidine gluconate (Hibiclens®) and povidone-iodine (E-Z Scrub®) sponge/brushes for presurgical hand scrubbing. Curr Ther Res 1983;34:740-5.
204.Herruzo-Cabrera, R, Vizcaino-Alcaide, MJ, Fdez-AciZero, MJ. Usefulness of an alcohol solution of N-duopropenide for the surgical antisepsis of the hands compared with handwashing with iodine-povidone and Chlorhexidine: clinical essay. J Surgical Research 2000;94:612.
205.Hingst, VJuditzki, I, Heeg, P, Sonntag, HG. Evaluation of the efficacy of surgical hand disinfection following a reduced application time of 3 instead of 5 min. J Hosp Infect 1992;20:7986.
206.Faoagali, J, Fong, J, George, N, Mahoney, P, O'Rourke, V. Comparison of the immediate, residual, and cumulative antibacterial effects of Novaderm R Novascrub R Betadine Surgical Scrub, Hibiclens, and liquid soap. Am J Infect Control 1995;23:337-43.
207.Pereira, LI, Lee, GM, Wade, KJ. The effect of surgical handwashing routines on the microbial counts of operating room nurses. Am J Infect Control 1990;18:354-64.
208.Peterson, AF, Rosenberg, A. Comparative evaluation of surgical scrub preparations. Surg Gynecol Obstet 1978;146:63-5.
209.Berkelman, RL, Holland, BW, Anderson, RL. Increased bactericidal activity of dilute preparations of povidone-iodine solutions. J Clin Microbiol 1982;15:635-9.
210.Merianos, JJ. Quaternary ammonium antimicrobial compounds [Chapter 13]. In: Block, SS, ed. Disinfection, Sterilization and Preservation. 4th ed. Philadelphia, PA. Lea and Febiger; 1991.
211.Dixon, RE, Kaslow, RA, Mackel, DC, Fulkerson, CC, Mallison, GF. Aqueous quaternary ammonium antiseptics and disinfectants: use and misuse. JAMA 1976;236:2415-7.
212.Sautter, RL, Mattman, LH, Legaspi, RC. Serratia marcescens meningitis associated with a contaminated benzalkonium chloride solution. Infect Control 1984;5:223-5.
213.Oie S, Kamiya. Microbial contamination of antiseptics and disinfectants. Am J Infect Control 1996;24:389-95.
214.Hayes, RA, Trick, WE, Vernon, MO, et al. Comparison of three hand hygiene (HH) methods in a surgical intensive care unit (SICU) [Abstract K-1337]. Presented at the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago, IL: American Society for Microbiology, 2001.
215.Dyer, DL, Gerenraich, KB, Wadhams, PS. Testing a new alcohol-free hand sanitzer to combat infection. AORN J 1998;68:239-51.
216.Jones, RD, Jampani, HB, Newman, JL, Lee, AS. Triclosan: a review of effectiveness and safety in health care settings. Am J Infect Control 2000;28:184-96.
217.Ward, WH, Holdgate, GARowsell, S, et al. Kinetic and structural characteristics of the inhibition of enoyl (acyl carrier protein) reductase by triclosan. Biochemistry 1999;38:12514-25.
218.Heath, RJ, Ii, J, Roland, GE. Inhibition of the Staphylococcus aureus NADPH-dependent enoyl-acyl carrier protein reductase by triclosan and hexachlorophene. J Biol Chem 2000;275:4654-9.
219.Faoagali, JLGeorge, N, Fong, J, Davy, J, Dowser, M. Comparison of the antibacterial efficacy of 4% Chlorhexidine gluconate and 1% triclosan handwash products in an acute clinical ward. Am J Infect Control 1999;27:320-6.
220.Barry, MA, Craven, DE, Goularte, TA, Lichtenberg, DA. Serratia marcescens contamination of antiseptic soap containing triclosan: implications for nosocomial infection. Infect Control 1984;5:427-30.
221.Lowbury, EJLLilly, HA, Bull, JP. Disinfection of hands: removal of transient organisms. Br Med J 1964;2:230-3.
222.Rotter, MLSemmelweis' sesquicentennial: a little-noted anniversary of handwashing. Current Opinion in Infectious Diseases 1998;11:457-60.
223.Manivannan, G, Brady, MJ, Cahalan, PT, et al. Immediate, persistent and residual antimicrobial efficiency of Surfacine™ hand sanitizer [Abstract]. Infection Control Hosp Epidemiol 2000;21:105.
224.Gershenfeld, L. Povidone-iodine as a sporicide. Am J Pharm 1962;134:7981.
225.Russell, AD. Chemical sporicidal and sporostatic agents [Chapter 22]. In: Block, SS, ed. Disinfection, Sterilization and Preservation. 4th ed. Philadelphia, PA: Lea and Febiger, 1991.
226.Johnson, S, Gerding, DN, Olson, MM, et al. Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission. Am J Med 1990;88:137-40.
227.Russell, AD. Mechanisms of bacterial insusceptibility to biocides. Am J Infect Control 2001;29:259-61.
228.Cookson, BD, Bolton, MC, Platt, JH. Chlorhexidine resistance in methicillin-resistant Staphylococcus aureus or just an elevated MIC? An in vitro and in vivo assessment. Antimicrob Agents Chemother 1991;35:19972002.
229.McMurry, LM, Oethinger, M, Levy, SB. Overexpression of marA, soxS, or aar AB produces resistance to triclosan in laboratory and clinical strains of Escherichia coli. FEMS Microbiol Lett 1998;166:305-9.
230.Chuanchuen, RBeinlich, K, Hoang, TT, et al. Cross-resistance between triclosan and antibiotics in Pseudomonas aeruginosa is mediated by multidrug efflux pumps: exposure of a susceptible mutant strain to triclosan selects nfxB mutants overexpressing MexCD-OprJ. Antimicrob Agents Chemother 2001;45:428-32.
231.Gröschel, DHM, Pruett, TL. Surgical antisepsis [Chapter 36]. In: Block, SS, ed. Disinfection, Sterilization and Preservation. 4th ed. Philadelphia, PA: Lea and Febiger, 1991.
232.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;161:493-9.
233.Dewar, NE, Gravens, DL, Effectiveness of septisol antiseptic foam as a surgical scrub agent. Appi Microbiol 1973;26:544-9.
234.Grinbaum, RS, de Mendonça, JS, Cardo, DM. An outbreak of handscrub-bing-related surgical site infections in vascular surgical procedures. Infect Control Hosp Epidemiol 1995;16:198202.
235.AORN Recommended Practices Committee. Recommended practices for surgical hand scrubs. In: Fogg, D, Parker, N, Shevlin, D, eds. Standards, Recommended Pradices, and Guidelines. Denver, CO: AORN, 2001.
236.Larson, E, Anderson, JK, Baxendale, L, Bobo, L. Effects of a protective foam on scrubbing and gloving. Am J Infect Control 1993;21:297301.
237.Mulberry, G, Snyder, AT, Heilman, J, Pyrek, J, Stahl, J. Evaluation of awater-less, scrubless Chlorhexidine gluconate/ethanol surgical scrub for antimicrobial efficacy. Am J Infect Control 2001;29:377-82.
238.Dineen, P. An evaluation of the duration of the surgical scrub. Surg Gynecol Obstet 1969;129:1181-4.
239.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;26:93-8.
240.O'Shaughnessy, M, O'Malley, VP, Corbett, G, Given, HE. Optimum duration of surgical scrub-time [Short note]. Br J Surg 1991;78:685-6.
241.Wheelock, SM, Lookinland, S. Effect of surgical hand scrub time on subsequent bacterial growth. AORN J 1997;65:1087-98.
242.Deshmukh, N, Kjellberg, SI, Kramer, JW. A comparison of 5-minute povidone-iodine scrub and 1-minute povidone-iodine scrub followed by alcohol foam. Military Medicine 1998;163:145-7.
243.Kikuchi-Numagami, K, Saishu, T, Fukaya, M, Kanazawa, E, Tagami, H. Irritancy of scrubbing up for surgery with or without a brush. Acta Derm Venereal 1999;79:230-2.
244.Dineen, RThe use of a polyurethane sponge in surgical scrubbing. Surg Gynecol Obstet 1966;123:595-8.
245.Bornside, GH, Crowder, VH Jr, Cohn, I Jr. A bacteriological evaluation of surgical scrubbing with disposable iodophor-soap impregnated polyurethane scrub sponges. Surgery 1968;64:743-51.
246.McBride, ME, Duncan, WC, Knox, JM. An evaluation of surgical scrub brushes. Surg Gynecol Obstet 1973;137:934-6.
247.Berman, RE, Knight, RA. Evaluation of hand antisepsis. Arch Environ Health 1969;18:781-3.
248.Loeb, MB, Wilcox, L, Smaili, F, Walter, S, Duff, Z. A randomized trial of surgical scrubbing with a brush compared to antiseptic soap alone. Am J Infect Control 1997;25:11-5.
249.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;26:404-12.
250.Tupker, RA. Detergents and cleansers [Chapter 7]. In: van der Valk, PGM, Maibach, HI, eds. The Irritant Contad Dermatitis Syndrome. New York, NY: CRC Press, 1996.
251.Wilhelm, KP. Prevention of surfactant-induced irritant contact dermatitis. Curr Probi Dermatol 1996;25:7885. Haan, P, Meester, HHM, Bruynzeel, DP. Irritancy of alcohols [Chapter 6]. In: van der Valk, PGM, Maibach, HI, eds. The Irritant Contad Dermatitis Syndrome. New York, NY: CRC Press, 1996.
253.Lübbe, J, Ruffieux, C, van Melle, G, Perrenoud, D. Irritancy of the skin disinfectant n-propanol. Contad Dermatitis 2001;45:226-31.
254.Ohlenschlaeger, J, Friberg, J, Ramsing, D, Agner, T. Temperature dependency of skin susceptibility to water and detergents. Acta Derm Venereol 1996;76:274-6.
255.Emilson, ALindberg, M, Forslind, B. The temperature effect of in vitro penetration of sodium lauryl sulfate and nickel chloride through human skin. Acta Derm Venereol 1993;73:203-7. Groot, AC. Contact allergy to cosmetics: causative ingredients. Contact Dermatitis 1987;17:2634.
257.Schnuch, AUter, W, Geier, J, Frosch, PJ, Rustemeyer, T. Contact allergies in healthcare workers—results from the IVDK. Acta Derm Venereol 1998;78:358-63.
258.Rastogi, SC, Heydorn, S, Johansen, JD, Basketter, DAFragrance chemicals in domestic and occupational products. Contad Dermatitis 2001;45:221-5.
259.Uter, WSchnuch, A. Geier, J, Pfahlberg, A. Gefeller, O. Association between occupation and contact allergy to the fragrance mix: a multifactorial analysis of national surveillance data. Occup Environ Med 2001;58:392-8.
260.Perrenoud, D, Bircher, A, Hunziker, T, et al. Frequency of sensitization to 13 common preservatives in Switzerland. Contact Dermatitis 1994;30:276-9.
261.Kiec-Swierczynska, M, Krecisz, B. Occupational skin diseases among the nurses in the region of Lodz. Int J Occup Med Environ Health 2000;13:179-84.
262.Garvey, LH, Roed-Petersen, J, Husum, B. Anaphylactic reactions in anaesthetised patients—four cases of Chlorhexidine allergy. Acta Anaesthesiol Scand 2001;45:1290-4.
263.Pham, NH, Weiner, JM, Reisner, GS, Baldo, BA. Anaphylaxis to Chlorhexidine. Case report Implication of immunoglobulin E antibodies and identification of an allergenic determinant. Clin Exp Allergy 2000;30:1001-7.
264.Nishioka, K, Seguchi, T, Yasuno, H, Yamamoto, T, Tominaga, K. The results of ingredient patch testing in contact dermatitis elicited by povidone-iodine preparations. Contact Dermatitis 2000;42:90-4.
265.Wong, CSM, Beck, MH. Allergic contact dermatitis from triclosan in antibacterial handwashes. Contact Dermatitis 2001;45:307.
266.Guin, JD, Goodman, J. Contact urticaria from benzyl alcohol presenting as intolerance to saline soaks. Contact Dermatitis 2001;45:182-3.
267.Podda, M, Zollner, T, Grundmann-Kollmann, M, Kaufmann, R, Boehncke, WF. Allergie contact dermatitis from benzyl alcohol during topical antimy-cotic treatment. Contact Dermatitis 1999;41:302-3.
268.Yesudian, PD, King, CM. Allergic contact dermatitis from stearyl alcohol in Efudix® cream. Contad Dermatitis 2001;45:313-4.
269.Aust, LB, Maibach, HI. Incidence of human skin sensitization to isostearyl alcohol in two separate groups of panelists. Contact Dermatitis 1980;6:269-71.
270.Funk, JO, Maibach, HI. Propylene glycol dermatitis: re-evaluation of an old problem. Contact Dermatitis 1994;31:236-41.
271.Hannuksela, M. Moisturizers in the prevention of contact dermatitis. Curr Probl Dermatol 1996;25:214-20.
272.Berndt, U, Wigger-Alberti, W, Gabard, B, Eisner, R. Efficacy of a barrier cream and its vehicle as protective measures against occupational irritant contact dermatitis. Contact Dermatitis 2000;42:7780.
273.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;28:302-10.
274.Larson, E, Killien, M. Factors influencing handwashing behavior of patient care personnel. Am J Infect Control 1982;10:93-9.
275.Zimakoff, J, Kjelsberg, AB, Larsen, SO, Holstein, B. A multicenter questionnaire investigation of attitudes toward hand hygiene, assessed by the staff in fifteen hospitals in Denmark and Norway. Am J Infect Control 1992;20:5864.
276.Mayer, JADubbert, PM, Miller, M, Burkett, PA, Chapman, SW. Increasing handwashing in an intensive care unit. Infect Control 1986;7:259-62.
277.Ojajärvi, J. The importance of soap selection for routine hand hygiene in hospital. J Hyg (Und) 1981;86:275-83.
278.Scott, D, Barnes, A, Lister, M, Arkell, P. An evaluation of the user acceptability of Chlorhexidine handwash formulations. J Hosp Infed 1991;18(suppl B):51–5.
279.Taylor, LJ. An evaluation of handwashing techniques—2. Nursing Times 1978,74:108–10.
280.Preston, GALarson, ELStamm, WE. The effect of private isolation rooms on patient care practices, colonization and infection in an intensive care unit. Am J Med 1981;70:641-5.
281.Kaplan, LM, McGuckin, M. Increasing handwashing compliance with more accessible sinks. Infect Control 1986;7:408-10.
282.Freeman, J. Prevention of nosocomial infections by location of sinks for hand washing adjacent to the bedside [Abstract 60]. In: Program and abstracts of the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy. Washington, DC: American Society for Microbiology, 1993:130.
283.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;160:1017-21.
284.Pittet, D. Compliance with hand disinfection and its impact on hospital-acquired infections. J Hosp Infect 2001;48(suppl A):S40S46.
285.Wurtz, R, Moye, G, Jovanovic, B. Handwashing machines, handwashing compliance, and potential for cross-contamination. Am J Infect Control 1994;22:228-30.
286.Kohan, C, Ligi, C, Dumigan, DG, Boyce, JM. The importance of evaluating product dispensers when selecting alcohol-based handrubs. Am J Infect Control 2002 (in press).
287.Boyce, JM. Antiseptic techology: access, affordability, and acceptance. Emerg Infect Diseases 2001;7:231-3.
288.Taylor, LJ. An evaluation of handwashing techniques—1. Nursing Times 1978:54-5.
289.Albert, RK, Condie, E. Hand-washing patterns in medical intensive-care units. N Engl J Med 1981;304:1465-6.
290.Larson, E. Compliance with isolation technique. Am J Infect Control 1983;11:221-5.
291.Donowitz, LG. Handwashing technique in a pediatric intensive care unit. Am J Dis Child 1987;141:683-5.
292.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 J Infect Control 1989;17:330-9.
293.DeCarvalho, M, Lopes, JMA, Pellitteri, M. Frequency and duration of handwashing in a neonatal intensive care unit. Pediatr Infect Dis J 1989;8:179-80.
294.Graham, M. Frequency and duration of handwashing in an intensive care unit. Am J Infect Control 1990;18:7780.
295.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;11:191-3.
296.Simmons, B, Bryant, J, Neiman, K, Spencer, L, Arheart, K. The role of handwashing in prevention of endemic intensive care unit infections. Infect Control Hosp Epidemiol 1990;11:589-94.
297.Pettinger, ANetfleman, MD. Epidemiology of isolation precautions. Infect Control Hosp Epidemiol 1991;12:303-7.
298.Lohr, JAIngram, DL, Dudley, SM, Lawton, EL, Donowitz, LG. Hand washing in pediatric ambulatory settings: an inconsistent practice. Am J Dis Child 1991;145:1198-9.
299.Raju, TNK, Kobler, C. Improving handwashing habits in the newborn nurseries. Am J Med Sci 1991;302:355-8.
300.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.
301.Zimakoff, J, Stormark, M, Larsen, SO. Use of gloves and handwashing behaviour among health care workers in intensive care units. A multicentre investigation in four hospitals in Denmark and Norway. J Hosp Infed 1993;24:63-7.
302.Pelke, S, Ching, D, Easa, D, Melish, ME. Gowning does not affect colonization or infection rates in a neonatal intensive care unit. Arch Pediatr Adolesc Med 1994;148:1016-20.
303.Gould, D. Nurses' hand decontamination practice: results of a local study. J Hosp Infect 1994;28:1530.
304.Shay, DK, Maloney, SA. Montecalvo, M, et al. Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections. J Infect Dis 1995;172:9931000.
305.Berg, DE, Hershow, RC, Ramirez, CA. Control of nosocomial infections in an intensive care unit in Guatemala City. Clin Infect Dis 1995;21:588-93.
306.Tibballs, J. Teaching hospital medical staff to handwash. Med J Aust 1996;164:395-8.
307.Slaughter, S, Hayden, MK, Nathan, C, et al. A comparison of the effect of universal use of gloves and gowns with that of glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care unit. Ann Intern Med 1996;125:448-56.
308.Dorsey, ST, Cydulka, RK, Emerman, CL, Is handwashing teachable?: failure to improve handwashing behavior in an urban emergency department. Acad Emerg Med 1996;3:360-5.
309.Watanakunakorn, C, Wang, C, Hazy, J. An observational study of hand washing and infection control practices by healthcare workers. Infect Control Hosp Epidemiol 1998;19:858-60.
310.Avila-Agüero, MLUmaZa, MA, Jiménez, AL, Faingezicht, I, Paris, MM. Handwashing practices in a tertiary-care, pediatric hospital and the effect on an educational program. Clin Perform Qual Health Care 1998;6:70-2.
311.Kirkland, KB, Weinstein, JM. Adverse effects of contact isolation. Lancet 1999;354:1177-8.
312.Maury, E, Alzieu, M, Baudel, JLet al. Availability of an alcohol solution can improve hand disinfection compliance in an intensive care unit. Am J Respir Crit Care Med 2000;162:324-7.
313.Muto, CASistrom, MG, Farr, BM. Hand hygiene rates unaffected by installation of dispensers of a rapidly acting hand antiseptic. Am J Infect Control 2000;28:273-6.
314.Jarvis, WRHandwashing—the Semmelweis lesson forgotten? Lancet 1994;344:1311-2.
315.Larson, E, Kretzer, EKCompliance with handwashing and barrier precautions. J Hosp Infect 1995;30 (suppl) :88106.
316.Sproat, LJ, Inglis, TJJ. A multicentre survey of hand hygiene practice in intensive care units. J Hosp Infect 1994;26:137-48.
317.Kretzer, EK, Larson, EL. Behavioral interventions to improve infection control practices. Am J Infect Control 1998;26:245-53.
318.Voss, AWidmer, AF. No time for handwashing!? Handwashing versus alcoholic rub: can we afford 100% compliance? Infect Control Hosp Epidemiol 1997;18:205-8.
319.Larson, E. Handwashing and skin physiologic and bactériologie aspects. Infect Control 1985;6:1423.
320.Thompson, BL, Dwyer, DM, Ussery, XT, Denman, S, Vacek, P, Schwartz, B. Handwashing and glove use in a long-term care facility. Infect Control Hosp Epidemiol 1997;18:97103.
321.Doebbeling, BN, Pfaller, MA, Houston, AK, Wenzel, RR. Removal of nosocomial pathogens from the contaminated glove. Ann Intern Med 1988;109:394-S.
322.McLane, C, Chenelly, S, Sylwestrak, ML, Kirchhoff, KT. A nursing practice problem: failure to observe aseptic technique. Am J Infect Control 1983;11:178-82.
323.Pittet, D. Improving compliance with hand hygiene in hospitals. Infect Control Hosp Epidemiol 2000;21:381-6.
324.Teare, LHandwashing Liasion Group. Hand washing: a modest measure—with big effects. Br Med J 1999;318:686.
325.Teare, EL, Cookson, B, French, GLet al. UK handwashing initiative. J Hosp Infed 1999;43:13.
326.Larson, EL, Bryan, JL, Adler, LM, Blane, C. A multifaceted approach to changing handwashing behavior. Am J Infect Control 1997;25:310.
327.Weeks, AWhy I don't wash my hands between each patient contact [Letter]. Br Med J 1999;319:518.
328.Webster, J. Handwashing in a neonatal intensive care nursery: product acceptability and effectiveness of Chlorhexidine gluconate 4% and triclosan 1%. J Hosp Infect 1992;21:137-41.
329.Kelen, GD, Green, GB, Hexter, DAet al. Substantial improvement in compliance with universal precautions in an emergency department following institution of policy. Arch Intern Med 1991;151:2051-6.
330.Lundberg, GD. Changing physician behavior in ordering diagnostic tests [Editorial]. JAMA 1998;280:2036.
331.Phillips, DF. “New look” reflects changing style of patient safety enhancement. JAMA 1999;281:217-9.
332.Harbarth, S, Martin, Y, Rohner, R, Henry, N, Auckenthaler, R, Pittet, D. Effect of delayed infection control measures on a hospital outbreak of methicillin-resistant Staphylococcus aureus. J Hosp Infed 2000;46:43-9.
333.Early, E, Batde, K, Cantwell, E, English, J, Lavin, JE, Larson, E. Effect of several interventions on the frequency of handwashing among elementary public school children. Am J Infect Control 1998;26:263-9.
334.Butz, AM, Larson, E, Fosarelli, R, Yolken, R. Occurrence of infectious symptoms in children in day care homes. Am J Infect Control 1990;18:347-53.
335.Kimel, LS. Handwashing education can decrease illness absenteeism. J Sch Nurs 1996;12:14-6,18.
336.Master, D, Hess Longe, S, Dickson, H. Scheduled hand washing in an elementary school population. Farn Med 1997;29:336-9.
337.Roberts, L, Smith, W, Jorm, L, Patel, M, Douglas, RM, McGilchrist, C. Effect of infection control measures on the frequency of upper respiratory infection in child care: a randomized, controlled trial. Pediatrics 2000;105:738-42.
338.Roberts, LJorm, L, Patel, M, Smith, W, Douglas, RM, McGilchrist, C. Effect of infection control measures on the frequency of diarrheal episodes in child care: a randomized, controlled trial. Pediatrics 2000;105:743-6.
339.Khan, MU. Interruption of shigellosis by handwashing. Trans R Soc Trop Med Hyg 1982;76:164-8.
340.Shahid, NS, Greenough, WB, Samadi, AR, Huq, MI, Rahman, N. Hand washing with soap reduces diarrhoea and spread of bacterial pathogens in a Bangladesh village. J Diarrhoeal Dis Res 1996;14:85-9.
341.Stanton, BF, Clemens, JD. An educational intervention for altering water-sanitation behaviors to reduce childhood diarrhea in urban Bangladesh. Am J Epidemiol 1987;125:292301.
342.McGinley, KJ, Larson, ELLeyden, JJ. Composition and density of microflora in the subungual space of the hand. J Clin Microbiol 1988;26:950-3.
343.Hedderwick, SA, McNeil, SALyons, MJ, Kauffman, CA. Pathogenic organisms associated with artificial fingernails worn by healthcare workers. Infect Control Hosp Epidemiol 2000;21:505-9.
344.Baumgardner, CA, Maragos, CS, Larson, EL. Effects of nail polish on microbial growth of fingernails: dispelling sacred cows. AORN J 1993;58:84-8.
345.Wynd, CASamstag, DE, Lapp, AM. Bacterial carriage on the fingernails of OR nurses. AORN J 1994;60:796805.
346.Gross, ACutright, DE, D'Allessandro SM. Effect of surgical scrub on microbial population under the fingernails. Am J Surg 1979;138:463-7.
347.Pottinger, J, Burns, S, Manske, C. Bacterial carriage by artificial versus natural nails. Am J Infect Control 1989;17:340-4.
348.McNeil, SAFoster, 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;32:367-72.
349.Rubin, DM. Prosthetic fingernails in the OR. AORN J 1988;47:944-5,948.
350.Moolenaar, RL, Crutcher, M, 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;21:80-5.
351.Passaro, DJ, Waring, L, Amstrong, R, et al. Postoperative Serratia marcescens wound infections traced to an out-of-hospital source. J Infect Dis 1997;175:992-5.
352.Foca, M, Jakob, K, Whittier, S, et al. Endemie Pseudomonas aeruginosa infection in a neonatal intensive care unit. N Engl J Med 2000;343:695700.
353.Parry, MF, Grant, B, Yukna, M, et al. Candida osteomyelitis and diskitis after spinal surgery: an outbreak that implicates artificial nail use. Clin Infect Dis 2001;32:352-7.
354.Garner, JS, Simmons, BE, Guideline for isolation precautions in hospitals. Infect Control 1983;4(suppl 4):245325.
355.CDC. Recommendations for prevention of HIV transmission in healthcare settings: MMWR 1987;36(suppl 2S):3S18S.
356.Occupational Safety and Health Administration. 29 CFR Part 1910.1030. Occupational exposure to bloodborne pathogens: final rule. Federal Register 1991;29 CFR Part 1910:1030.
357.Hartstein, AI, Denny, MAMorthland, VH, LeMonte, AM, Pfaller, MAControl of methicillin-resistant Staphylococcus aureus in a hospital and an intensive care unit. Infect Control Hosp Epidemiol 1995;16:405-11.
358.Maki, DG, McCormick, RD, Zilz, MAStolz, SM, Alvarado, CJ. An MRSA outbreak in a SICU during universal precautions: new epidemiology for nosocomial MRSA downside for universal precautions [Abstract 473]. In: Program and abstracts of the 30th Interscience Conference on Antimicrobial Agents and Chemotherapy. Washington, DC: American Society for Microbiology, 1990.
359.Kotilainen, HRBrinker, JE, Avato, JL, Gantz, NM. Latex and vinyl examination gloves: quality control procedures and implications for health care workers. Arch Intern Med 1989;149:2749-53.
360.Reingold, ALKane, MA. Hightower, AW. Failure of gloves and other protective devices to prevent transmission of hepatitis B virus to oral surgeons. JAMA 1988;259:2558-60.
361.Korniewicz, DM, Laughon, BE, Butz, A, Larson, E. Integrity of vinyl and latex procedures gloves. Nurs Res 1989;38:144-6.
362.DeGroot-Kosolcharoen, J, Jones, JM. Fermeability of latex and vinyl gloves to water and blood. Am J Infect Control 1989;17:196201.
363.Korniewicz, DM, Kirwin, M, Cresci, K, Markut, C, Larson, E. In-use comparison of latex gloves in two high-risk units: surgical intensive care and acquired immunodeficiency syndrome. Heart Lung 1992;21:81-4.
364.Korniewicz, DM, Kirwin, M, Cresci, K, et al. Barrier protection with examination gloves: double versus single. Am J Infect Control 1994;22:12-5.
365.Sistrom, MG, Muto, CA, Neal, J, Strain, BA, Farr, BM. Glove leakage rates as a function of latex content and brand: caveat emptor [Abstract 24]. In: Program and abstracts of the 10th Annual Meeting of Society of Healthcare Epidemiology of America. Orlando, Florida, 1998.
366.Flanagan, H, Farr, B. Continued evaluation of glove leakage rates at the University of Virginia. Presented at the 11th Annual Meeting of the Society for Healthcare Epidemiology of America. Toronto, Canada, April 1, 2001.
367.Korniewicz, DM, Laughon, BE, Cyr, WH, Lyde, CD, Larson, E. Leakage of virus through used vinyl and latex examination gloves. J Clin Microbiol 1990;28:787-8.
368.Rego, ARoley, L. In-use barrier integrity of gloves: latex and nitrile superior to vinyl. Am J Infect Control 1999;27:405-10.
369.Fisher, MD, Reddy, VR. Williams, FM, Un, KY, Thacker, JG, Edlich, RF. Biomechanical performance of powder-free examination gloves. J Emerg Med 1999;17:1011-8.
370.Edlich, RF, Suber, F, Neal, JG, Jackson, EM, Williams, FM. Integrity of powder-free examination gloves to bacteriophage penetration. J Biomed Mater Res 1999;48:755-8.
371.Murray, CABurke, FJT, McHugh, S. An assessment of the incidence of punctures in latex and non-latex dental examination gloves in routine clinical practice. Br Dental Journal 2001;190:377-80.
372.Jones, RD, Jampani, H, Mulberry, G, Rizer, RL. Moisturizing alcohol hand gels for surgical hand preparation. AORN J 2000;71:584-99.
373.Patterson, JE, Vecchio, J, Pantelick, EL, et al. Association of contaminated gloves with transmission oiAcinetobacter calcoaceticus var. antitratus in an intensive care unit. Am J Med 1991;91:479-83.
374.Lowbury, EJL. Aseptic methods in the operating suite. Lancet 1968;1:705-9.
375.Hoffman, PN, Cooke, EM, McCarville, MR, Emmerson, AM. Microorganisms isolated from skin under wedding rings worn by hospital staff. Br Med J 1985;290:206-7.
376.Jacobson, G, Thiele, JE, McCune, JH, Farrell, LD. Handwashing: ringwear-ing and number of microorganisms. Nurs Res 1985;34:186-8.
377.Hayes, RATrick, WE, Vernon, MO, et al. Ring use as a risk factor (RF) for hand colonization in a surgical intensive care unit (SICU) [Abstract K-1333]. In: Program and abstracts of the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy. Washington, DC: American Society for Microbiology, 2001.
378.Salisbury, DM, Huffilz, R, Treen, LM, Bollin, GE, Gautam, S. The effect of rings on microbial load of health care workers' hands. Am J Infect Control 1997;25:24-7.
379.Spire, B, Barré-Sinoussi, F, Montagnier, L, Chermann, JC. Inactivation of lymphadenopathy associated virus by chemical disinfectants. Lancet 1984;2:899901.
380.Martin, LS, McDougal, JS, Loskoski, SL. Disinfection and inactivation of the human T lymphotropic virus type III/lymphadenopathy-associated virus. J Infect Dis 1985;152:400-3.
381.Resnick, L, Veren, K, Salahuddin, SZ, Tondreau, S, Markham, PD. Stability and inactivation of HTLV-III/LAV under clinical and laboratory environments. JAMA 1986;255:1887-91.
382.van Bueren, J, Larkin, DP, Simpson, RA. Inactivation of human immunodeficiency virus type 1 by alcohols. J Hosp Infect 1994;28:137-48.
383.Montefiori, DC, Robinson, WE Jr, Modliszewski, A, Mitchell, WM. Effective inactivation of human immunodeficiency virus with Chlorhexidine antiseptics containing detergents and alcohol. J Hosp Infect 1990;15:279-82.
384.Wood, APayne, D. The action of three antiseptics/disinfectants against enveloped and non-enveloped viruses. J Hosp Infect 1998;38:283-95.
385.Harbison, MAHammer, SM. Inactivation of human immunodeficiency virus by Betadine products and Chlorhexidine. J Acauir Immune Defic Syndr 1989;2:1620.
386.Lavelle, GC, Gubbe, SL, Neveaux, JL, Bowden, BJ. Evaluation of an antimicrobial soap formula for virucidal efficacy in vitro against human immunodeficiency virus in a blood-virus mixture. Antimicrob Agents Chemother 1989;33:2034-6.
387.Bond, WW, Favero, MS, Petersen, NJ, Ebert, JW. Inactivation of hepatitis B virus by intermediate-to-high level disinfectant chemicals. J Clin Microbiol 1983;18:535-8.
388.Kobayashi, H, Tsuzuki, M, Koshimizu, K, et al. Susceptibility of hepatitis B virus to disinfectants or heat. J Clin Microbiol 1984;20:214-6.
389.Kurtz, JB. Virucidal effect of alcohols against echovirus 11 [Letter]. Lancet 1979;1:496-7.
390.Sattar, SARaphael, RA, Lochnan, H, Springthorpe, VS. Rotavirus inactivation by chemical disinfectants and antiseptics used in hospitals. Can J Microbiol 1983;29:1464-9.
391.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;29:136-42.
392.Gould, D, Chamberlain, A. The use of a ward-based educational teaching package to enhance nurses' compliance with infection control procedures. J Clin Nursing 1997;6:5567.
393.Aspöck, C, Koller, W. A simple hand hygiene exercise. Am J Infect Control 1999;27:370-2.
394.McGuckin, M, Waterman, R, Porten, L, et al. Patient education model for increasing handwashing compliance [Practice forum]. Am J Infect Control 1999;27:309-14.
395.Khatib, M, Jamaleddine, G, Abdallah, A, Ibrahim, Y. Hand washing and use of gloves while managing patients receiving mechanical ventilation in the ICU. Chest 1999;116:172-5.
396.Haley, RW, Bregman, DA. The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit. J Infect Dis 1982;145:875-85.
397.Pittet, D, Boyce, JM. Hand hygiene and patient care: pursuing the Semmelweis legacy. Lancet Infectious Diseases 2001 April:9-20.
398.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.
399.O'Boyle, CA, Henly, SJ, Duckett, LJ. Nurses' motivation to wash their hands: a standardized measurement approach. Applied Nursing Research 2001;14:136-45.
400.Semmelweis, IEDie adiologie, der begriff und die prophylaxis des kindbettfiebers. Pest, Wien und Leipzig: CA Hartleben's Verlags-Expedition 1861.
401.Eggimann, EHarbarth, 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;355:1864-8.
402.Bull, DANeumayer, LA, Hunter, GC, et al. Improved sterile technique diminishes the incidence of positive line cultures in cardiovascular patients. J Surgical Research 1992;52:106-10.
403.Hirschmann, H, Fux, L, Podusel, J, 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.
404.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;62:690-5.
405.Doebbeling, BN, Li, N, Wenzel, RP. An outbreak of hepatitis A among health care workers: risk factors for transmission. Am J Public Health 1993;83:1679-84.
406.Standaert, SM, Hutcheson, RH, Schaffher, W. Nosocomial transmission of Salmonella gastroenteritis to laundry workers in a nursing home. Infect Control Hosp Epidemiol 1994;15:22-6.
407.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;17:587-92.
408.Schaffner, W, Lefkowitz, LB Jr, Goodman, JS, Koenig, MG. Hospital outbreak of infections with group a streptococci traced to an asymptomatic anal carrier. N Engl J Med 1969;280:1224-5.
409.Viglionese, ANottebart, VF, Bodman, HAPlatt, R. Recurrent group A streptococcal carriage in a health care worker associated with widely separated nosocomial outbreaks. Am J Med 1991;91(suppl 3B):329S33S.
410.Ojajärvi, J. An evaluation of antiseptics used for hand disinfection in wards. J Hyg (Land) 1976;76:7582.
411.Mermel, LAJosephson, SL, Dempsey, J, Parenteau, S, Perry, C Magill. Outbreak of Shigella sonnei in a clinical microbiology laboratory. J Clin Microbiol 1997;35:3163-5.
412.McBride, ME. Microbial flora of in-use soap products. Appl Environ Microbiol 1984;48:338-41.
413.Kabara, JJ, Brady, MB. Contamination of bar soaps under “in use” condition. J Environ Pathol Toxicol Oncol 1984;5:114.
414.Heinze, JE, Yackovich, E. Washing with contaminated bar soap is unlikely to transfer bacteria. Epidem Inf 1988;101:135–42.
415.Bannan, FAJudge, LE. Bacteriological studies relating to handwashing: 1. the inability of soap bars to transmit bacteria. Am J Public Health 1965;55:915-21.
416.Field, EAMcGowan, P, Pearce, PK, Martin, MV. Rings and watches: should they be removed prior to operative dental procedures? J Dent 1996;24:65-9.
417.Lowbury, EJL, Lilly, HAGloved hand as applicator of antiseptic to operation sites. Lancet 1975;2:153-6.
418.AORN Recommended Practices Committee. Recommended practices for surgical hand scrubs. AORN J 1999;69:842-50.
419.Grohskopf, LARoth, VR, Feikin, DR, et al. Serratia liquefaciens bloodstream infections from contamination of epoetin alfa at a hemodialysis center. N Engl J Med 2001;344:1491-7.
420.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;49:81-4.
421.Heeg, EDoes hand care ruin hand disinfection? J Hosp Infect 2001;48(suppl A) :S37S39.
422.McGuckin, M, Waterman, R. Starr, J, et al. Evaluation of a patient-empowering hand hygiene programme in the U.K. J Hosp Infed 2001;48:222-7.
423.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.