Skip to main content
    • Aa
    • Aa

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.

Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

5. AC Steere , GF Mallison . Handwashing practices for the prevention of nosocomial infections. Ann Intern Med 1975;83:683-90.

7. E Larson . Guideline for use of topical antimicrobial agents. Am J Infed Control 1988;16:253-66.

8. EL Larson , 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. JS Garner , Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:5380.

11. D Pittet , P Mourouga , TV Perneger , Members of the Infection Control Program. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;130:126-30.

12. JM Boyce . It is time for action: improving hand hygiene in hospitals. Ann Intern Med 1999;130:153-5.

14. PB Price . 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.

16. D Maki . Control of colonization and transmission of pathogenic bacteria in the hospital. Ann Intern Med 1978;89(Pt 2):777–80.

17. EL Larson , CA Norton Hughes , JD Pyrak , SM Sparks , EU Cagatay , JM Bartkus . Changes in bacterial flora associated with skin damage on hands of health care personnel. Am J Infect Control 1998;26:513-21.

20. EJL Lowbury . Gram-negative bacilli on the skin. Br J Dermatol 1969;81(suppl 1):5561.

21. WC Noble . Distribution of the Micrococcaceae. Br J Dermatol 1969;81(suppl 1):2731.

23. MW Casewell . Role of hands in nosocomial gram-negative infection. In: HI Maibach , R Aly , eds. Skin Microbiology: Relevance to Clinical Infection. New York, NY: Springer-Verlag, 1981.

25. NJ Ehrenkranz , BC Alfonso . Failure of bland soap handwash to prevent hand transfer of patient bacteria to urethral catheters. Infect Control Hosp Epidemiol 1991;12:654-62.

26. PJ Sanderson , S Weissler . Recovery of coliforms from the hands of nurses and patients: activities leading to contamination. J Hosp Infect 1992;21:8593.

27. R Coello , J Jiménez , M García , 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. MD Sanford , AF Widmer , MJ Bale , RN Jones , RP Wenzel , Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus. Clin Inject Dis 1994;19:1123–8.

29. SA Bertone , MC Fisher , JE Mortensen . Quantitative skin cultures at Potential catheter sites in neonates. Infect Control Hosp Epidemiol 1994;15:315-8.

30. MJM Bonten , MK Hayden , C Nathan , J VanVoorhis , et al. Epidemiology of colonisation of patients and environment with vancomycin-resistant enterococci. Lancet 1996;348:1615-9.

31. EL Larson , AB Cronquist , S Whittier , L Lai , CT Lyle , P Della Latta . Differences in skin flora between inpatients and chronically ill patients. Heart Lung 2000;29:298305.

33. JJ Leyden , KJ McGinley , KM Nordstrom , GF Webster . Skin microflora. J Invest Dermatol 1987;88:65s72s.

34. CU Tuazon , A Perez , T Kishaba , JN Sheagren . Staphylococcus aureus among insulin-injecting diabetic patients. JAMA 1975;231:1272.

, , . . ;:-2.36. R Aly HI Maibach HR Shinefield Microbial flora of atopic dermatitis Arch Dermatol 1977 113 780

37. N Kirmani , CU Tuazon , HW Murray , AE Parrish , JN Sheagren . Staphylococcus aureus carriage rate of patients receiving long-term hemodialysis. Arch Intern Med 1978;138:1657-9.

39. JR Boelaert HW Van Landuyt , BZ Gordts , YA De Baere , SA Messer , IA Herwaldt , Nasal and cutaneous carriage of Staphylococcus aureus in hemodialysis patients: the effect of nasal mupirocin. Infect Control Hosp Epidemiol 1996;17:809-11.

40. J Zimakoff , FB Pedersen , L Bergen , 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. DJ Bibel , JH Greenbert , JL Cook . Staphylococcus aureus and the microbial ecology of atopic dermatitis. Can J Microbiol 1997;23:1062-8.

42. WC Noble . Dispersal of skin microorganisms. Br J Dermatol 1975;93:477-85.

45. LV McFarland , ME Mulligan , RYY Kwok , WE Stamm . Nosocomial acquisition of Clostridium difficile infection. NEngl J Med 1989;320:204-10.

46. MH Samore , L Venkataraman , PC DeGirolami , E Levin , RD Arbeit , AW Karchmer . Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med 1996;100:3240.

48. M Casewell , I Phillips . Hands as route of transmission for Klebsiella species. Br Med J 1977;2:1315-7.

49. CB Hall , RG Douglas . Modes of transmission of respiratory syncytial virus. J Pediatr 1981;99:100-2.

50. RJ Olsen , P Lynch , MB Coyle , J Cummings , T Bokete , WE Stamm . Examination gloves as barriers to hand contamination in clinical practice. JAMA 1993;270:350-3.

51. D Pittet , S Dharan , S Touveneau , V Sauvan , TV Perneger . Bacterial contamination of the hands of hospital staff during routine patient care. Arch Intern Med 1999;159:821-6.

52. MK Fox , SB Langner , RW Wells . How good are hand washing practices? Am J Nursing 1974;74:1676-8.

54. JM Boyce , G Potter-Bynoe , C Chenevert , T King . Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications. Infect Control Hosp Epidemiol 1997;18:622-7.

56. E Scott , SF Bloomfield . The survival and transfer of microbial contamination via cloths, hands and utensils. J Appl Bacteriol 1990;68:271-8.

57. TM Bauer , E Ofner , HM Just , H Just , FD Daschner . 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. AR Tenorio , SM Badri , NB Sahgal , 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. FD Daschner . How cost-effective is the present use of antiseptics? J Hosp Infect 1988;11(suppl A):227–35.

65. DR Patrick G Fmdon , TE Miller . Residual moisture determines the level of touch-contact-associated bacterial transfer following hand washing. Epidemiol Infect 1997;119:319-25.

67. E Larson . Skin hygiene and infection prevention: more of the same or different approaches? Clin Infect Dis 1999;29:1287-94.

68. EA Mortimer Jr, PJ Lipsitz , E Wolinsky , AJ Gonzaga , CH Rammelkamp Jr. Transmission of staphylococci between newborns. Am J Dis Child 1962;104:289-95.

. . ;():–.69. DG Maki The use of antiseptics for handwashing by medical personnel J Chemother 1989 1 suppl 1311

71. BN Doebbeling , GL Stanley , CT Sheetz , 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. J Webster , JL Faoagali , D Cartwright . 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. AB Zafar , RC Buder , DJ Reese , IA Gaydos , PA Mennonna , 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. D Pittet , S Hugonnet , S Harbarth , P Mourouga , V Sauvan , S Touveneau . Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356:1307-12.

75. EL Larson , E Early , E Cloonan S Sugrue , M Parides . An organizational climate intervention associated with increased handwashing and decreased nosocomial infections. Behav Med 2000;26:1422.

76. SK Fridkin , SM Pear , TH Williamson , JN Galgiani , WR Jarvis . The role of understaffing in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 1996;17:150-8.

77. AE Vicca Nursing staff workload as a determinant of methicillin-resistant Staphylococcus aureus spread in an adult intensive therapy unit. J Hosp Wed 1999;43:109-13.

80. A Kramer P Rudolph , G Kampf , D Pittet . Limited efficacy of alcohol-based hand gels. Lancet 2002;359:1489-90.

83. J Steinmann . Some principles of virucidal testing. J Hosp Infect 2001;48(suppl A):S15S17.

86. S Lund , J Jackson , J Leggett , L Hales , R Dworkin , D Gilbert . Reality of glove use and handwashing in a community hospital. Am J Infed Control 1994;22:352-7.

87. MR Meengs , BK Giles , CD Chisholm , WH Cordell , DR Nelson . Hand washing frequency in an emergency department. Ann Emerg Med 1994;23:1307-12.

88. E Larson , A McGeer , ZA Quraishi , 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. JM Broughall , C Marshman , B Jackson , P Bird . An automatic monitoring system for measuring handwashing frequency. J Hosp Infect 1984;5:447-53.

93. EL Larson , PI Eke , BE Laughon . Efficacy of alcohol-based hand rinses under frequent-use conditions. Antimicrob Agents Chemother 1986;30:542-4.

94. EL Larson , BE Laughon . Comparison of four antiseptic products containing Chlorhexidine gluconate. Antimicrob Agents Chemother 1987;31:1572-4.

96. M Winnefeld , MA Richard , M Drancourt , JJ Grobb . Skin tolerance and effectiveness of two hand decontamination procedures in everyday hospital use. Br J Dermatol 2000;143:546-50.

100. CW Walter . Editorial: disinfection of hands. Am J Surg 1965;109:691-3.

104. JR Babb , JG Davies , GAJ Ayliffe . A test procedure for evaluating surgical hand disinfection. J Hosp Infect 1991;18(suppl B):41–9.

105. K Bellamy , R Alcock , JR Babb , JG Davies , GA Ayliffe . A test for the assessment of ‘hygienic’ hand disinfection using rotavirus. J Hosp Infect 1993;24:201-10.

106. GAJ Ayliffe , JR Babb , AH Quoraishi . A test for ‘hygienic’ hand disinfection. J Clin Pathol 1978;31:923-8.

109. CA Bartzokas MF Gibson , R Graham , DC Pinder . A comparison of triclosan and Chlorhexidine preparations with 60 per cent isopropyl alcohol for hygienic hand disinfection. J Hosp Infect 1983;4:245-55.

111. H Kjrlen , BM Andersen . Handwashing and disinfection of heavily contaminated hands—effective or ineffective? J Hosp Infect 1992;21:6171.

112. S Namura , S Nishijima , Y Asada . An evaluation of the residual activity of antiseptic handrub lotions: an ‘in use’ setting study. J Dermatol 1994;21:481-5.

113. JD Jarvis , CD Wynne , L Enwright , JD Williams . Handwashing and antiseptic-containing soaps in hospital. J Clin Path 1979;32:732-7.

114. LJ Pereira , GM Lee , KJ Wade . An evaluation of five protocols for surgical handwashing in relation to skin condition and microbial counts. J Hosp Infect 1997;36:4965.

115. EL Larson , AM Butz , DL Gullette , BA Laughon . Alcohol for surgical scrubbing? Infect Control Hosp Epidemiol 1990;11:139-43.

121. PB Price . Ethyl alcohol as a germicide. Arch Surg 1939;38:528-42.

122. C Harrington , H Walker . The germicidal action of alcohol. Boston Medical and Surgical Journal 1903;148:548-52.

123. PB Price . New studies in surgical bacteriology and surgical technic. JAMA 1938;111:1993-6.

125. WD Pohle , LS Stuart . The germicidal action of cleaning agents— a study of a modification of Price's procedure. J Infect Dis 1940;67:275–81.

126. AD Gardner . Rapid disinfection of clean unwashed skin: further experiments. Lancet 1948:760-3.

127. T Sakuragi , K Yanagisawa , K Dan , Bactericidal activity of skin disinfectants on methicillin-resistant Staphylococcus aureus. Anesth Analg 1995;81:555-8.

128. G Kampf , R Jarosch , H Rüden . Limited effectiveness of Chlorhexidine based hand disinfectants against methicillin-resistant Staphylococcus aureus (MRSA). J Hosp Infect 1998;38:297303.

129. G Kampf , M Höfer , C Wendt . Efficacy of hand disinfectants against vancomycin-resistant enterococci in vitro. J Hosp Infect 1999;42:143-50.

130. J Platt , RA Bucknall . The disinfection of respiratory syncytial virus by iso-propanol and a chlorhexidine-detergent handwash. J Hosp Infect 1985;6:8994.

131. LR Krilov , SH Harkness . Inactivation of respiratory syncytial virus by detergents and disinfectants. Pediatr Infect Dis 1993;12:582-4.

132. SA Sattar J Tetro , VS Springthorpe , A Giulivi . Preventing the spread of hepatitis B and C viruses: where are germicides relevant? Am J Infect Control 2001;29:187-97.

133. JD Woolwine , JL Gerberding . Effect of testing method on apparent activities of antiviral disinfectants and antiseptics. Antimicrob Agents Chemother 1995;39:921-3.

135. EJL Lowbury , HA Lilly , GAJ Ayliffe . Preoperative disinfection of surgeons' hands: use of alcoholic solutions and effects of gloves on skin flora. Br Med J 1974;4:369-72.

137. SA Ansali VS Springthorpe , SA Sattar W Tostowaryk , GA Wells . Comparison of cloth, paper, and warm air drying in eliminating viruses and bacteria from washed hands. Am J Infect Control 1991;19:243-9.

141. W Schurmann , HJ Eggers . 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. E Larson , L Bobo . Effective hand degerming in the presence of blood. J Emerg Med 1992;10:711.

144. HA Lilly EJL Lowbury . Transient skin flora: their removal by cleansing or disinfection in relation to their mode of deposition. J Clin Path 1978;31:919-22.

145. M Rotter , W Koller , G Wewalka . Povidone-iodine and Chlorhexidine glu-conate-containing detergents for disinfection of hands. J Hosp Infect 1980;1:149-58.

148. JJ Leyden , KJ McGinley , MS Kaminer , 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. ML Rotter , W Koller . 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. M Zaragoza , M Salles , J Gomez , JM Bayas , A Trilla . Handwashing with soap or alcoholic solutions? A randomized clinical trial of its effectiveness. Am J Infect Control 1999;27:258-61.

151. DS Paulson , EJ Fendler , MJ Dolan , RA Williams . A close look at alcohol gel as an antimicrobial sanitizing agent. Am J Infect Control 1999;27:332-8.

152. CL Cardoso , HH Pereira , JC Zequim , M Guilhermetti . Effectiveness of hand-cleansing agents for removing Acinetobader baumannii strain from contaminated hands. Am J Infect Control 1999;27:327-31.

153. MW Casewell , MM Law , N Desai . 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. JJ Wade , N Desai , MW Casewell . 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. Y Huang , S Oie , A Kamiya . 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. EJL Lowbury , HA Lilly . Disinfection of the hands of surgeons and nurses. Br Med J 1960;1:5184.

157. RE Berman , RA Knight . Evaluation of hand antisepsis. Arch Environ Health 1969;18:781-3.

158. ML Rotter , RA Simpson , W Koller . 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. DW Hobson , W Woller , L Anderson , E Guthery . 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. MV Jones , GB Rowe , B Jackson , NJ Pritchard . The use of alcoholic paper wipes for routine hand cleansing: results of trials in two hospitals. J Hosp Infect 1986;8:268-74.

161. AM Butz , BE Laughon , DL Gullette , EL Larson . Alcohol-impregnated wipes as an alternative in hand hygiene. Am J Infect Control 1990;18:70-6.

162. J Ojajärvi . Handwashing in Finland. J Hosp Infect 1991;18(suppl B):3540.

163. JL Newman JC Seitz . Intermittent use of an antimicrobial hand gel for reducing soap-induced irritation of health care personnel. Am J Infect Control 1990;18:194200.

164. ML Rotter W Koller , R Neumann . The influence of cosmetic additives on the acceptability of alcohol-based hand disinfectants. J Hosp Infect 1991;18 (suppl B):5763.

165. EL Larson AE Aello , JM Heilman , et al. Comparison of different regimens for surgical hand preparation. AORN J 2001;73:412-20.

166. EL Larson , AE Aello , J Bastyr , et al. Assessment of two hand hygiene regimens for intensive care unit personnel. Crit Care Med 2001;29; 944–51.

167. S Ophaswongse , HI Maibach . Alcohol dermatitis: allergic contact dermatitis and contact urticaria syndrome: a review. Contad Dermatitis 1994;30:16.

168. A Rilliet N Hunziker , R Brun . Alcohol contact urticaria syndrome (immediate-type hypersensitivity): case report. Dermatologica 1980;161:361-4.

169. AE Widmer Replace hand washing with use of a waterless alcohol hand rub? Clin Infect Dis 2000;31:13fr43.

170. KA Bryant , J Pearce , B Stover . Flash fire associated with the use of alcc-hoi-based antiseptic agent [Letter]. Am J Infect Control 2002;30:256-7.

173. HK Narang , AA Codd . Action of commonly used disinfectants against enteroviruses. J Hosp Infect 1983;4:209-12.

174. B Walsh , PH Blakemore , YJ Drabu . The effect of handcream on the antibacterial activity of Chlorhexidine gluconate. J Hosp Infect 1987;9:30-3.

175. EJL Lowbury HA Lilly . Use of 4% Chlorhexidine detergent solution (Hibiscrub) and other methods of skin disinfection. Br Med J 1973;1:510-5.

176. DS Paulson . Comparative evaluation of five surgical hand scrub preparations. AORN J 1994;60:246-56.

180. P Vigeant , VG Loo , C Bertrand , et al. An outbreak of Serratia marcescens infections related to contaminated Chlorhexidine. Infect Control Hosp Epidemiol 1998;19:791-4.

183. J Davies , JR Babb , GAJ Ayliffe , MD Wilkins . Disinfection of the skin of the abdomen. Br J Surg 1978;65:855-8.

184. E Larson , K Mayur , BA Laughon Influence 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.

186. R Aly , HI Maibach . 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. LK Archibald , A Cori , B Shah , et al. Serratia marcescens outbreak associated with extrinsic contamination of 1% chlorxylenol soap. Infect Control Hosp Epidemiol 1997;18:704-9.

188. EJL Lowbury , HA Lilly , JR Bull . Disinfection of hands: removal of resident bacteria. Br Med J 1963;1:1251-6.

189. RB Kundsin , CW Walter . The surgical scrub—practical consideration. Arch Surg 1973;107:75-7.

191. RM Shuman , RW Leech , EC Alvord Jr. Neurotoxicity of hexachlorophene in humans: II. a clinicopathological study of 46 premature infants. Arch Neurol 1975;32:320-5.

196. RL Anderson Iodophor antiseptics: intrinsic microbial contamination with resistant bacteria. Infect Control Hosp Epidemiol 1989;10:443-6.

198. O Traoré , SF Fayard , H Laveran . An in-vitro evaluation of the activity of povidone-iodine against nosocomial bacterial strains. J Hosp Infect 1996;34:217-22.

199. AR McLure , J Gordon . In-vitro evaluation of povidone-iodine and Chlorhexidine against methicillin-resistant Staphylococcus aureus. J Hosp Infect 1992;21:291-9.

200. JG Davies , JR Babb , CR Bradley , GAJ Ayliffe . Preliminary study of test methods to assess the virucidal activity of skin disinfectants using poliovirus and bacteriophages. J Hosp Infed 1993;25:125-31.

202. JJ Wade , MW Casewell . The evaluation of residual antimicrobial activity on hands and its clinical relevance. J Hosp Infect 1991;18(suppl B):23–8.

204. R Herruzo-Cabrera , MJ Vizcaino-Alcaide , MJ Fdez-AciZero . 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. V Hingst I Juditzki , P Heeg , HG Sonntag . 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. J Faoagali , J Fong , N George , P Mahoney , V O'Rourke . 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. LI Pereira , GM Lee , KJ Wade . The effect of surgical handwashing routines on the microbial counts of operating room nurses. Am J Infect Control 1990;18:354-64.

211. RE Dixon , RA Kaslow , DC Mackel , CC Fulkerson , GF Mallison . Aqueous quaternary ammonium antiseptics and disinfectants: use and misuse. JAMA 1976;236:2415-7.

213. Kamiya Oie S . Microbial contamination of antiseptics and disinfectants. Am J Infect Control 1996;24:389-95.

215. DL Dyer , KB Gerenraich , PS Wadhams . Testing a new alcohol-free hand sanitzer to combat infection. AORN J 1998;68:239-51.

216. RD Jones , HB Jampani , JL Newman , AS Lee . Triclosan: a review of effectiveness and safety in health care settings. Am J Infect Control 2000;28:184-96.

217. WH Ward , GA Holdgate S Rowsell , et al. Kinetic and structural characteristics of the inhibition of enoyl (acyl carrier protein) reductase by triclosan. Biochemistry 1999;38:12514-25.

218. RJ Heath , J Ii , GE Roland . Inhibition of the Staphylococcus aureus NADPH-dependent enoyl-acyl carrier protein reductase by triclosan and hexachlorophene. J Biol Chem 2000;275:4654-9.

219. JL Faoagali N George , J Fong , J Davy , M Dowser . 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.

221. EJL Lowbury HA Lilly , JP Bull . Disinfection of hands: removal of transient organisms. Br Med J 1964;2:230-3.

222. ML Rotter Semmelweis' sesquicentennial: a little-noted anniversary of handwashing. Current Opinion in Infectious Diseases 1998;11:457-60.

226. S Johnson , DN Gerding , MM Olson , et al. Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission. Am J Med 1990;88:137-40.

227. AD Russell . Mechanisms of bacterial insusceptibility to biocides. Am J Infect Control 2001;29:259-61.

228. BD Cookson , MC Bolton , JH Platt . 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. LM McMurry , M Oethinger , SB Levy . 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. R Chuanchuen K Beinlich , TT Hoang , 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.

232. JM Boyce , G Potter-Bynoe , SM Opal , L Dziobek , AA Medeiros . A common-source outbreak of Staphylococcus epidermidis infections among patients undergoing cardiac surgery. J Infect Dis 1990;161:493-9.

234. RS Grinbaum , JS de Mendonça , DM Cardo . An outbreak of handscrub-bing-related surgical site infections in vascular surgical procedures. Infect Control Hosp Epidemiol 1995;16:198202.

236. E Larson , JK Anderson , L Baxendale , L Bobo . Effects of a protective foam on scrubbing and gloving. Am J Infect Control 1993;21:297301.

237. G Mulberry , AT Snyder , J Heilman , J Pyrek , J Stahl . Evaluation of awater-less, scrubless Chlorhexidine gluconate/ethanol surgical scrub for antimicrobial efficacy. Am J Infect Control 2001;29:377-82.

239. DA O'Farrell , G Kenny , M O'Sullivan , P Nicholson , M Stephens , R Hone . Evaluation of the optimal hand-scrub duration prior to total hip arthroplasty. J Hosp Infect 1994;26:93-8.

240. M O'Shaughnessy , VP O'Malley , G Corbett , HE Given . Optimum duration of surgical scrub-time [Short note]. Br J Surg 1991;78:685-6.

241. SM Wheelock , S Lookinland . Effect of surgical hand scrub time on subsequent bacterial growth. AORN J 1997;65:1087-98.

243. K Kikuchi-Numagami , T Saishu , M Fukaya , E Kanazawa , H Tagami . Irritancy of scrubbing up for surgery with or without a brush. Acta Derm Venereal 1999;79:230-2.

248. MB Loeb , L Wilcox , F Smaili , S Walter , Z Duff . A randomized trial of surgical scrubbing with a brush compared to antiseptic soap alone. Am J Infect Control 1997;25:11-5.

249. E Larson , C Friedman , J Cohran , J Treston-Aurand , S Green . Prevalence and correlates of skin damage on the hands of nurses. Heart Lung 1997;26:404-12.

251. KP Wilhelm . Prevention of surfactant-induced irritant contact dermatitis. Curr Probi Dermatol 1996;25:7885.

253. J Lübbe , C Ruffieux , G van Melle , D Perrenoud . Irritancy of the skin disinfectant n-propanol. Contad Dermatitis 2001;45:226-31.

256. AC de Groot . Contact allergy to cosmetics: causative ingredients. Contact Dermatitis 1987;17:2634.

257. A Schnuch W Uter , J Geier , PJ Frosch , T Rustemeyer . Contact allergies in healthcare workers—results from the IVDK. Acta Derm Venereol 1998;78:358-63.

258. SC Rastogi , S Heydorn , JD Johansen , DA Basketter Fragrance chemicals in domestic and occupational products. Contad Dermatitis 2001;45:221-5.

259. W Uter A Schnuch . J Geier , A Pfahlberg . O Gefeller . 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. D Perrenoud , A Bircher , T Hunziker , et al. Frequency of sensitization to 13 common preservatives in Switzerland. Contact Dermatitis 1994;30:276-9.

262. LH Garvey , J Roed-Petersen , B Husum . Anaphylactic reactions in anaesthetised patients—four cases of Chlorhexidine allergy. Acta Anaesthesiol Scand 2001;45:1290-4.

263. NH Pham , JM Weiner , GS Reisner , BA Baldo . Anaphylaxis to Chlorhexidine. Case report Implication of immunoglobulin E antibodies and identification of an allergenic determinant. Clin Exp Allergy 2000;30:1001-7.

264. K Nishioka , T Seguchi , H Yasuno , T Yamamoto , K Tominaga . The results of ingredient patch testing in contact dermatitis elicited by povidone-iodine preparations. Contact Dermatitis 2000;42:90-4.

265. CSM Wong , MH Beck . Allergic contact dermatitis from triclosan in antibacterial handwashes. Contact Dermatitis 2001;45:307.

266. JD Guin , J Goodman . Contact urticaria from benzyl alcohol presenting as intolerance to saline soaks. Contact Dermatitis 2001;45:182-3.

267. M Podda , T Zollner , M Grundmann-Kollmann , R Kaufmann , WF Boehncke . Allergie contact dermatitis from benzyl alcohol during topical antimy-cotic treatment. Contact Dermatitis 1999;41:302-3.

268. PD Yesudian , CM King . Allergic contact dermatitis from stearyl alcohol in Efudix® cream. Contad Dermatitis 2001;45:313-4.

269. LB Aust , HI Maibach . Incidence of human skin sensitization to isostearyl alcohol in two separate groups of panelists. Contact Dermatitis 1980;6:269-71.

270. JO Funk , HI Maibach . Propylene glycol dermatitis: re-evaluation of an old problem. Contact Dermatitis 1994;31:236-41.

271. M Hannuksela . Moisturizers in the prevention of contact dermatitis. Curr Probl Dermatol 1996;25:214-20.

272. U Berndt , W Wigger-Alberti , B Gabard , R Eisner . Efficacy of a barrier cream and its vehicle as protective measures against occupational irritant contact dermatitis. Contact Dermatitis 2000;42:7780.

273. RD McCormick , TL Buchman , DG Maki . 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. E Larson , M Killien . Factors influencing handwashing behavior of patient care personnel. Am J Infect Control 1982;10:93-9.

275. J Zimakoff , AB Kjelsberg , SO Larsen , B Holstein . 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.

278. D Scott , A Barnes , M Lister , P Arkell . An evaluation of the user acceptability of Chlorhexidine handwash formulations. J Hosp Infed 1991;18(suppl B):51–5.

280. GA Preston EL Larson WE Stamm . 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.

283. WE Bischoff , TM Reynolds , CN Sessler , MB Edmond , RP Wenzel . Handwashing compliance by health care workers. The impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med 2000;160:1017-21.

284. D Pittet . Compliance with hand disinfection and its impact on hospital-acquired infections. J Hosp Infect 2001;48(suppl A):S40S46.

285. R Wurtz , G Moye , B Jovanovic . Handwashing machines, handwashing compliance, and potential for cross-contamination. Am J Infect Control 1994;22:228-30.

286. C Kohan , C Ligi , DG Dumigan , JM Boyce . The importance of evaluating product dispensers when selecting alcohol-based handrubs. Am J Infect Control 2002 (in press).

287. JM Boyce . Antiseptic techology: access, affordability, and acceptance. Emerg Infect Diseases 2001;7:231-3.

289. RK Albert , E Condie . Hand-washing patterns in medical intensive-care units. N Engl J Med 1981;304:1465-6.

290. E Larson . Compliance with isolation technique. Am J Infect Control 1983;11:221-5.

292. JM Conly , S Hill , J Ross , J Lertzman , TJ Louie . 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.

294. M Graham . Frequency and duration of handwashing in an intensive care unit. Am J Infect Control 1990;18:7780.

295. PM Dubbert , J Dolce , W Richter , M Miller , SW Chapman . Increasing ICU staff handwashing: effects of education and group feedback. Infect Control Hosp Epidemiol 1990;11:191-3.

297. A Pettinger MD Netfleman . Epidemiology of isolation precautions. Infect Control Hosp Epidemiol 1991;12:303-7.

298. JA Lohr DL Ingram , SM Dudley , EL Lawton , LG Donowitz . Hand washing in pediatric ambulatory settings: an inconsistent practice. Am J Dis Child 1991;145:1198-9.

299. TNK Raju , C Kobler . Improving handwashing habits in the newborn nurseries. Am J Med Sci 1991;302:355-8.

300. EL Larson , KJ McGinley , A Foglia . 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. J Zimakoff , M Stormark , SO Larsen . 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. S Pelke , D Ching , D Easa , ME Melish . Gowning does not affect colonization or infection rates in a neonatal intensive care unit. Arch Pediatr Adolesc Med 1994;148:1016-20.

303. D Gould . Nurses' hand decontamination practice: results of a local study. J Hosp Infect 1994;28:1530.

304. DK Shay , SA Maloney . M Montecalvo , et al. Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections. J Infect Dis 1995;172:9931000.

305. DE Berg , RC Hershow , CA Ramirez . Control of nosocomial infections in an intensive care unit in Guatemala City. Clin Infect Dis 1995;21:588-93.

307. S Slaughter , MK Hayden , C Nathan , 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. ST Dorsey , RK Cydulka , CL Emerman , Is handwashing teachable?: failure to improve handwashing behavior in an urban emergency department. Acad Emerg Med 1996;3:360-5.

309. C Watanakunakorn , C Wang , J Hazy . An observational study of hand washing and infection control practices by healthcare workers. Infect Control Hosp Epidemiol 1998;19:858-60.

311. KB Kirkland , JM Weinstein . Adverse effects of contact isolation. Lancet 1999;354:1177-8.

312. E Maury , M Alzieu , JL Baudel et al. Availability of an alcohol solution can improve hand disinfection compliance in an intensive care unit. Am J Respir Crit Care Med 2000;162:324-7.

313. CA Muto MG Sistrom , BM Farr . Hand hygiene rates unaffected by installation of dispensers of a rapidly acting hand antiseptic. Am J Infect Control 2000;28:273-6.

314. WR Jarvis Handwashing—the Semmelweis lesson forgotten? Lancet 1994;344:1311-2.

315. E Larson , EK Kretzer Compliance with handwashing and barrier precautions. J Hosp Infect 1995;30 (suppl) :88106.

316. LJ Sproat , TJJ Inglis . A multicentre survey of hand hygiene practice in intensive care units. J Hosp Infect 1994;26:137-48.

317. EK Kretzer , EL Larson . Behavioral interventions to improve infection control practices. Am J Infect Control 1998;26:245-53.

318. A Voss AF Widmer . No time for handwashing!? Handwashing versus alcoholic rub: can we afford 100% compliance? Infect Control Hosp Epidemiol 1997;18:205-8.

320. BL Thompson , DM Dwyer , XT Ussery , S Denman , P Vacek , B Schwartz . Handwashing and glove use in a long-term care facility. Infect Control Hosp Epidemiol 1997;18:97103.

321. BN Doebbeling , MA Pfaller , AK Houston , RR Wenzel . Removal of nosocomial pathogens from the contaminated glove. Ann Intern Med 1988;109:394-S.

322. C McLane , S Chenelly , ML Sylwestrak , KT Kirchhoff . A nursing practice problem: failure to observe aseptic technique. Am J Infect Control 1983;11:178-82.

325. EL Teare , B Cookson , GL French et al. UK handwashing initiative. J Hosp Infed 1999;43:13.

326. EL Larson , JL Bryan , LM Adler , C Blane . A multifaceted approach to changing handwashing behavior. Am J Infect Control 1997;25:310.

327. A Weeks Why I don't wash my hands between each patient contact [Letter]. Br Med J 1999;319:518.

328. J Webster . 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. GD Kelen , GB Green , DA Hexter et al. Substantial improvement in compliance with universal precautions in an emergency department following institution of policy. Arch Intern Med 1991;151:2051-6.

332. S Harbarth , Y Martin , R Rohner , N Henry , R Auckenthaler , D Pittet . Effect of delayed infection control measures on a hospital outbreak of methicillin-resistant Staphylococcus aureus. J Hosp Infed 2000;46:43-9.

333. E Early , K Batde , E Cantwell , J English , JE Lavin , E Larson . Effect of several interventions on the frequency of handwashing among elementary public school children. Am J Infect Control 1998;26:263-9.

334. AM Butz , E Larson , R Fosarelli , R Yolken . Occurrence of infectious symptoms in children in day care homes. Am J Infect Control 1990;18:347-53.

335. LS Kimel . Handwashing education can decrease illness absenteeism. J Sch Nurs 1996;12:14-6,18.

338. L Roberts L Jorm , M Patel , W Smith , RM Douglas , C McGilchrist . Effect of infection control measures on the frequency of diarrheal episodes in child care: a randomized, controlled trial. Pediatrics 2000;105:743-6.

339. MU Khan . Interruption of shigellosis by handwashing. Trans R Soc Trop Med Hyg 1982;76:164-8.

344. CA Baumgardner , CS Maragos , EL Larson . Effects of nail polish on microbial growth of fingernails: dispelling sacred cows. AORN J 1993;58:84-8.

345. CA Wynd DE Samstag , AM Lapp . Bacterial carriage on the fingernails of OR nurses. AORN J 1994;60:796805.

346. A Gross DE Cutright , D'Allessandro SM. Effect of surgical scrub on microbial population under the fingernails. Am J Surg 1979;138:463-7.

347. J Pottinger , S Burns , C Manske . Bacterial carriage by artificial versus natural nails. Am J Infect Control 1989;17:340-4.

348. SA McNeil CL Foster , SA Hedderwick , CA Kauffman . 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. DM Rubin . Prosthetic fingernails in the OR. AORN J 1988;47:944-5,948.

351. DJ Passaro , L Waring , R Amstrong , et al. Postoperative Serratia marcescens wound infections traced to an out-of-hospital source. J Infect Dis 1997;175:992-5.

352. M Foca , K Jakob , S Whittier , et al. Endemie Pseudomonas aeruginosa infection in a neonatal intensive care unit. N Engl J Med 2000;343:695700.

353. MF Parry , B Grant , M Yukna , et al. Candida osteomyelitis and diskitis after spinal surgery: an outbreak that implicates artificial nail use. Clin Infect Dis 2001;32:352-7.

357. AI Hartstein , MA Denny VH Morthland , AM LeMonte , MA Pfaller Control of methicillin-resistant Staphylococcus aureus in a hospital and an intensive care unit. Infect Control Hosp Epidemiol 1995;16:405-11.

359. HR Kotilainen JE Brinker , JL Avato , NM Gantz . Latex and vinyl examination gloves: quality control procedures and implications for health care workers. Arch Intern Med 1989;149:2749-53.

360. AL Reingold MA Kane . AW Hightower . Failure of gloves and other protective devices to prevent transmission of hepatitis B virus to oral surgeons. JAMA 1988;259:2558-60.

361. DM Korniewicz , BE Laughon , A Butz , E Larson . Integrity of vinyl and latex procedures gloves. Nurs Res 1989;38:144-6.

362. J DeGroot-Kosolcharoen , JM Jones . Fermeability of latex and vinyl gloves to water and blood. Am J Infect Control 1989;17:196201.

364. DM Korniewicz , M Kirwin , K Cresci , et al. Barrier protection with examination gloves: double versus single. Am J Infect Control 1994;22:12-5.

368. A Rego L Roley . In-use barrier integrity of gloves: latex and nitrile superior to vinyl. Am J Infect Control 1999;27:405-10.

369. MD Fisher , VR Reddy . FM Williams , KY Un , JG Thacker , RF Edlich . Biomechanical performance of powder-free examination gloves. J Emerg Med 1999;17:1011-8.

370. RF Edlich , F Suber , JG Neal , EM Jackson , FM Williams . Integrity of powder-free examination gloves to bacteriophage penetration. J Biomed Mater Res 1999;48:755-8.

371. CA Murray FJT Burke , S McHugh . 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. RD Jones , H Jampani , G Mulberry , RL Rizer . Moisturizing alcohol hand gels for surgical hand preparation. AORN J 2000;71:584-99.

373. JE Patterson , J Vecchio , EL Pantelick , et al. Association of contaminated gloves with transmission oiAcinetobacter calcoaceticus var. antitratus in an intensive care unit. Am J Med 1991;91:479-83.

375. PN Hoffman , EM Cooke , MR McCarville , AM Emmerson . Microorganisms isolated from skin under wedding rings worn by hospital staff. Br Med J 1985;290:206-7.

376. G Jacobson , JE Thiele , JH McCune , LD Farrell . Handwashing: ringwear-ing and number of microorganisms. Nurs Res 1985;34:186-8.

378. DM Salisbury , R Huffilz , LM Treen , GE Bollin , S Gautam . The effect of rings on microbial load of health care workers' hands. Am J Infect Control 1997;25:24-7.

380. LS Martin , JS McDougal , SL Loskoski . Disinfection and inactivation of the human T lymphotropic virus type III/lymphadenopathy-associated virus. J Infect Dis 1985;152:400-3.

381. L Resnick , K Veren , SZ Salahuddin , S Tondreau , PD Markham . Stability and inactivation of HTLV-III/LAV under clinical and laboratory environments. JAMA 1986;255:1887-91.

382. J van Bueren , DP Larkin , RA Simpson . Inactivation of human immunodeficiency virus type 1 by alcohols. J Hosp Infect 1994;28:137-48.

383. DC Montefiori , WE Robinson Jr, A Modliszewski , WM Mitchell . Effective inactivation of human immunodeficiency virus with Chlorhexidine antiseptics containing detergents and alcohol. J Hosp Infect 1990;15:279-82.

384. A Wood D Payne . The action of three antiseptics/disinfectants against enveloped and non-enveloped viruses. J Hosp Infect 1998;38:283-95.

386. GC Lavelle , SL Gubbe , JL Neveaux , BJ Bowden . 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.

390. SA Sattar RA Raphael , H Lochnan , VS Springthorpe . Rotavirus inactivation by chemical disinfectants and antiseptics used in hospitals. Can J Microbiol 1983;29:1464-9.

391. E Larson , M Silberger , K Jakob , 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. D Gould , A Chamberlain . The use of a ward-based educational teaching package to enhance nurses' compliance with infection control procedures. J Clin Nursing 1997;6:5567.

393. C Aspöck , W Koller . A simple hand hygiene exercise. Am J Infect Control 1999;27:370-2.

394. M McGuckin , R Waterman , L Porten , et al. Patient education model for increasing handwashing compliance [Practice forum]. Am J Infect Control 1999;27:309-14.

395. M Khatib , G Jamaleddine , A Abdallah , Y Ibrahim . Hand washing and use of gloves while managing patients receiving mechanical ventilation in the ICU. Chest 1999;116:172-5.

396. RW Haley , DA Bregman . 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. D Pittet , JM Boyce . Hand hygiene and patient care: pursuing the Semmelweis legacy. Lancet Infectious Diseases 2001 April:9-20.

399. CA O'Boyle , SJ Henly , LJ Duckett . Nurses' motivation to wash their hands: a standardized measurement approach. Applied Nursing Research 2001;14:136-45.

401. E Eggimann S Harbarth , MN Constantin , S Touveneau , JC Chevrolet , D Pittet . Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet 2000;355:1864-8.

402. DA Bull LA Neumayer , GC Hunter , et al. Improved sterile technique diminishes the incidence of positive line cultures in cardiovascular patients. J Surgical Research 1992;52:106-10.

403. H Hirschmann , L Fux , J Podusel , 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. LM Drusin , M Sohmer , SL Groshen , MD Spiritos , LB Senterfit , WN Christenson . Nosocomial hepatitis A infection in a paediatric intensive care unit. Arch Dis Child 1987;62:690-5.

405. BN Doebbeling , N Li , RP Wenzel . An outbreak of hepatitis A among health care workers: risk factors for transmission. Am J Public Health 1993;83:1679-84.

406. SM Standaert , RH Hutcheson , W Schaffher . Nosocomial transmission of Salmonella gastroenteritis to laundry workers in a nursing home. Infect Control Hosp Epidemiol 1994;15:22-6.

407. EM Rodriguez , C Parrott , H Rolka , SS Monroe , DM Dwyer . An outbreak of viral gastroenteritis in a nursing home: importance of excluding ill employees. Infect Control Hosp Epidemiol 1996;17:587-92.

408. W Schaffner , LB Lefkowitz Jr, JS Goodman , MG Koenig . Hospital outbreak of infections with group a streptococci traced to an asymptomatic anal carrier. N Engl J Med 1969;280:1224-5.

409. A Viglionese VF Nottebart , HA Bodman R Platt . Recurrent group A streptococcal carriage in a health care worker associated with widely separated nosocomial outbreaks. Am J Med 1991;91(suppl 3B):329S33S.

415. FA Bannan LE Judge . Bacteriological studies relating to handwashing: 1. the inability of soap bars to transmit bacteria. Am J Public Health 1965;55:915-21.

416. EA Field P McGowan , PK Pearce , MV Martin . Rings and watches: should they be removed prior to operative dental procedures? J Dent 1996;24:65-9.

418.AORN Recommended Practices Committee. Recommended practices for surgical hand scrubs. AORN J 1999;69:842-50.

419. LA Grohskopf VR Roth , DR Feikin , et al. Serratia liquefaciens bloodstream infections from contamination of epoetin alfa at a hemodialysis center. N Engl J Med 2001;344:1491-7.

421. E Heeg Does hand care ruin hand disinfection? J Hosp Infect 2001;48(suppl A) :S37S39.

422. M McGuckin , R Waterman . J Starr , et al. Evaluation of a patient-empowering hand hygiene programme in the U.K. J Hosp Infed 2001;48:222-7.

423. E Girou , F Oppein . 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.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 0
Total number of PDF views: 8 *
Loading metrics...

Abstract views

Total abstract views: 377 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd September 2017. This data will be updated every 24 hours.