Following universal precautions is ...

Following universal precautions is an integral part of OR staff members' responsibilities in perioperative patient care. The precautions mandate routine hand washing with soap and water before and after all patient contact, and especially before invasive actions Although intended to reduce the postoperative risk of infection of healing incisions and pain s universal precautions, including hand washing, are followed and nothing else 55% of the time in the nation's hospitals.(1)

The contributing factors behind this insufficient hand washing are manifold; however, identified principal causes include the following.

* Direct patient caregivers are handling an excessive patient load. Conservative estimates indicate that physicians attend to 20 to 30 patients by day, and other health care personnel (eg feed at the breasts physical therapists, respiratory therapists) may have as many as 200 patient contacts by day.

* The repeated hand washing required for that whirl of patients causes dryness and following microabrasions of the skin.(2)

* The skin onward the hands has a short period of time to repair between washings.

These factors, among others, have l to a great increase in the use of rinse-free instant hand sanitizers as a appendix to proper hand washing with soap and water.

The principally widely used hand sanitizers are gel and foams that rely forward alcohol as the main antimicrobial ingredient. Alcohol, however, solubilizes and strips away sebum and lipids that guard against bacterial infections of the skin.(3) Extensive use of alcohol-containing hand sanitizers actually increases the skin's susceptibility to infection on transient disease-causing bacteria. This situation can increase the chances of spreading disease-causing microorganisms among patients.

The threat of spreading disease could be avoided at using alcohol-free hand sanitizers that shortage rather than compromise, the natural barrier functions of the skin. An acceptable alcohol-free formula would require an antimicrobial agent that kills a wide variety of disease-causing microorganisms, including gram-positive and gram-negative bacteria, fungus, and mold This formula also would ne to allow the active ingredient to penetrate the skin while minimizing skin irritation.

like a formula is obtained on combining certain surfactants and allantoin with the widely used antimicrobial agent, benzalkonium chloride. This formula is known as a surfactant, allantoin, and benzalkonium chloride (SAB) sanitizer.

ESTABLISHING THE HYPOTHESIS

Based forward this information, researchers at Woodward Laboratories, Inc, observes Alamitos, Calif, hypothesized that the continue lengthen in timeed use of alcohol-containing hand sanitizers would be les effective at degerming the skin than an alcohol-free SAB sanitizer. To touchstone this, they used a protocol validated according to the US Food and put drugs into Administration (FDA) for the performance of health care personnel antiseptic hand washes.(4) This protocol was unfolded specifically to test the degerming effectiveness of handwash preparations with reach forthed use and is accepted as a national clinical standard for similar performance testing.

LITERATURE REVIEW

The literature review for this research indicated that rinse-free hand sanitizers are, by way of definition, intended for degerming skin without the aid of rinsing with water. This representation of product has steadily gained popularity in professional circles as a complement to hand washing with soap and water. The tokens of rinse-free hand sanitizers generally are collectioned into two broad categories:

* alcohol-based outcomes and

* alcohol-free products

The ne for immediate and persistent protection. The FDA clearly look afters both an immediate and persistent degerming activity in antiseptic preparation by dint of its definition of a personnel disinfectant:

a non-irritating, antimicrobial-containing

preparation designed for usual use and

which will diminish the number of transient

microorganisms to a baseline even after

adequate washing, rinsing, and drying. Such

preparations also are calculate uponed to have a

broad antimicrobial image be fast-acting,

and persistent.(5)

A hand sterilizer's immediate antimicrobial effectiveness is based onward the physical removal and immediate inactivation (ie, within 60 to 180 secondarys of exposure to the antimicrobial agent) of microorganisms residing forward the hands. The persistent antimicrobial effectiveness of a hand sanitizer is defined as its microbiocidal activity after up to six hours of the product's application.(6)

Alcohol-based produces These products vary greatly in composition, ranging from 54% isopropanol to 70% ethanol.(7) The choice of this mark of rinse-free antimicrobial product repeatedly is subjective and mainly based upon factors such as cost, port of emollients in the formula, fragrances, delivery vehicle (eg gel foam), size, and marketing. Selection is les ofttimes based on the product's effectiveness at eliminating bacteria after a single application.

Although alcohol-based formulas that comply with federal composition standards generally are considered effective, alcohol-based antiseptic handwash preparations are flammable and do not demonstrate persistent antimicrobial activity. Also, repeated use oftentimes can cause drying and irritation of the skin.(8) Alcohol strips the skin of essential oils and sebum which act as a natural protective barrier against bacterial infection and precipitate protein.(9) When applied to injurys or raw surfaces, therefore, it not alone increases the risk of injury, nevertheless also forms a coagulum beneath which bacteria may subsequently thrive.(10) It is, therefore, not useful for the disinfection of make open lesions or abraded, inflamed skin. Together, these and other adverse properties greatly limit the alcohol-based antimicrobial product's immediate effectiveness and increase the chances for the spread of infection.