Advertisement

Antiseptic Stewardship for Alcohol-Based Hand Rubs

  • Günter Kampf
Chapter

Abstract

Alcohol-based hand rubs are usually based on ethanol, propan-2-ol or propan-1-ol. Some of them contain additional non-volatile biocidal agents such as chlorhexidine digluconate, triclosan, benzalkonium chloride, hydrogen peroxide, DDAC, polihexanide, peracetic acid or octenidine dihydrochloride. For the additional biocidal agents, almost all studies indicate a lack of efficacy on the skin and a lack of any health benefit (prevention of infection). Therefore, the risks of these biocidal agents come into the focus. Benzalkonium chloride, triclosan, chlorhexidine digluconate and DDAC can cause a strong and stable MIC increase in numerous mainly Gram-negative bacterial species. Cross-tolerance is frequently found between benzalkonium chloride, triclosan and chlorhexidine digluconate. They can also enhance antibiotic resistance development. Horizontal gene transfer can be successfully induced by chlorhexidine digluconate and triclosan in E. coli. Antibiotic resistance gene expression can be increased by chlorhexidine digluconate in a vanA E. faecium. And efflux pump genes can be up-regulated in some species by benzalkonium chloride and chlorhexidine digluconate. The overall balance provides evidence for a number of relevant risks for additional biocidal agents but no convincing evidence for a health benefit. Alcohol-based hand rubs with additional biocidal agents should therefore be replaced by formulations based on alcohol(s) alone as active agent(s).

References

  1. 1.
    Hingst V, Juditzki I, Heeg P, Sonntag H-G (1992) Evaluation of the efficacy of surgical hand disinfection following a reduced application time of 3 instead of 5 min. J Hosp Infect 20:79–86CrossRefPubMedGoogle Scholar
  2. 2.
    Kampf G (2017) Lack of antimicrobial efficacy of mecetronium etilsulfate in propanol-based hand rubs for surgical hand disinfection. J Hosp Infect 96(2):189–191CrossRefPubMedGoogle Scholar
  3. 3.
    Kampf G (2017) The puzzle of volume, coverage and application time in hand disinfection. Infect Control Hosp Epidemiol 38(7):880–881CrossRefGoogle Scholar
  4. 4.
    Kampf G, Kramer A (2004) Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clin Microbiol Rev 17(4):863–893CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kampf G, Kramer A, Suchomel M (2017) Lack of sustained efficacy for alcohol-based surgical hand rubs containing “residual active ingredients” according to EN 12791. J Hosp Infect 95(2):163–168CrossRefPubMedGoogle Scholar
  6. 6.
    Kampf G, Wigger-Alberti W, Schoder V, Wilhelm KP (2005) Emollients in a propanol-based hand rub can significantly decrease irritant contact dermatitis. Contact Dermatitis 53:344–349CrossRefPubMedGoogle Scholar
  7. 7.
    Lachapelle JM (2014) A comparison of the irritant and allergenic properties of antiseptics. Eur J Dermatol: EJD 24(1):3–9.  https://doi.org/10.1684/ejd.2013.2198CrossRefPubMedGoogle Scholar
  8. 8.
    Löffler H, Kampf G, Schmermund D, Maibach HI (2007) How irritant is alcohol? Br J Dermatol 157(1):74–81CrossRefPubMedGoogle Scholar
  9. 9.
    Lopez-Gigosos RM, Mariscal-Lopez E, Gutierrez-Bedmar M, Garcia-Rodriguez A, Mariscal A (2017) Evaluation of antimicrobial persistent activity of alcohol-based hand antiseptics against bacterial contamination. Eur J Clin Microbiol Infect Dis 36(7):1197–1203.  https://doi.org/10.1007/s10096-017-2908-9CrossRefPubMedGoogle Scholar
  10. 10.
    Misteli H, Weber WP, Reck S, Rosenthal R, Zwahlen M, Füglistaler P, Bolli MK, Örtli D, Widmer AF, Marti WR (2009) Surgical glove perforation and the risk of surgical site infection. Arch Surg 144(6):553–558CrossRefPubMedGoogle Scholar
  11. 11.
    Pittet D, Hugonnet S, Harbarth S, Monronga P, Sauvan V, Touveneau S, Perneger TV (2000) Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 356:1307–1312CrossRefPubMedGoogle Scholar
  12. 12.
    Rochon-Edouard S, Pons JL, Veber B, Larkin M, Vassal S, Lemeland JF (2004) Comparative in vitro and in vivo study of nine alcohol-based handrubs. Am J Infect Control 32(4):200–204.  https://doi.org/10.1016/j.ajic.2003.08.003CrossRefPubMedGoogle Scholar
  13. 13.
    Rosas-Ledesma P, Mariscal A, Carnero M, Munoz-Bravo C, Gomez-Aracena J, Aguilar L, Granizo JJ, Lafuente A, Fernandez-Crehuet J (2009) Antimicrobial efficacy in vivo of a new formulation of 2-butanone peroxide in n-propanol: comparison with commercial products in a cross-over trial. J Hosp Infect 71(3):223–227.  https://doi.org/10.1016/j.jhin.2008.11.007CrossRefPubMedGoogle Scholar
  14. 14.
    Rotter ML, Koller W, Neumann R (1991) The influence of cosmetic additives on the acceptability of alcohol-based hand disinfectants. Journal of Hospital Infection 18 (suppl. B):57–63Google Scholar
  15. 15.
    Sax H, Allegranzi B, Uçkay I, Larson E, Boyce J, Pittet D (2007) ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 67(1):9–21CrossRefGoogle Scholar
  16. 16.
    WHO (2009) WHO guidelines on hand hygiene in health care. First Global Patient Safety Challenge Clean Care is Safer Care, WHO, GenevaGoogle Scholar
  17. 17.
    WHO (2016) Global guidelines for the prevention of surgical site infections. WHO, GenevaGoogle Scholar
  18. 18.
    Wutzler P, Sauerbrei A (2000) Virucidal efficacy of a combination of 0.2% peracetic acid and 80% (v/v) ethanol (PAA-ethanol) as a potential hand disinfectant. J Hosp Infect 46(4):304–308.  https://doi.org/10.1053/jhin.2000.0850CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Institute of Hygiene and Environmental MedicineUniversity of GreifswaldGreifswaldGermany

Personalised recommendations