Hand Hygiene for the General Public

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Much contemporary evidence for a causal link between handwashing and risk for infection in community settings comes from industrialized countries. Although many of these studies may be limited by confounding by other variables, evidence of an important role for handwashing in preventing infections is among the strongest available for any factor studied. Reviews of studies linking handwashing and reduced risk for infection have been recently published. The most convincing evidence of the benefits of handwashing for the general public is for prevention of infectious agents found transiently on hands or spread by the fecal-oral route or from the respiratory tract. Plain soaps are considered adequate for this purpose.

Several highly publicized, serious outbreaks from commercially prepared foods have raised questions about food safety and the hygienic practices of food handlers and others in the service professions. Despite public awareness, however, handwashing generally does not meet recommended standards--members of the public wash too infrequently and for short periods of time.

These factors have led to suggestions that antimicrobial products should be more universally used, and a myriad of antimicrobial soaps and skin care products have become commercially available. While antimicrobial drug-containing products are superior to plain soaps for reducing both transient pathogens and colonizing flora, widespread use of these agents has raised concerns about the emergence of bacterial strains resistant to antiseptic ingredients such as triclosan. Such resistance has been noted in England and Japan, and molecular mechanisms for the development of resistance have been proposed. Although in some settings exposure to antiseptics has occurred for years without the appearance of resistance, a recent study described mutants of Escherichia coli selected for resistance to one disinfectant that were also multiply-antibiotic resistant. Some evidence indicates that long-term use of topical antimicrobial agents may alter skin flora. The question remains whether antimicrobial soaps provide sufficient benefit in reducing transmission of infection without added risk or cost.

Hand Hygiene in Health-Care Settings

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Issues regarding hand hygiene practices among health-care professionals have been widely discussed and may be even more complicated than those in the general public. Unless patient care involves invasive procedures or extensive contact with blood and body fluids, current guidelines recommend plain soap for handwashing; however, infection rates in adult or neonatal intensive care units or surgery may be further reduced when antiseptic products are used.

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Dr. Larson is professor of pharmaceutical and therapeutic research, The School of Nursing, and professor of epidemiology, Mailman School of Public Health, Columbia University. She is editor of the American Journal of Infection Control and former chair of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and member of CDC's National Center for Infectious Diseases Board of Scientific Counselors. Address for correspondence: Elaine Larson, Columbia University School of Nursing, 630 W. 168th St., New York, NY 10032, USA; fax: 212-305-0722; e-mail: [email protected]

The source of this article is http://www.cdc.gov

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