Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units

Bradley Doebbeling, Gail L. Stanley, Carol T. Sheetz, Michael A. Pfaller, Alison K. Houston, Linda Annis, Ning Li, Richard P. Wenzel

Research output: Contribution to journalArticle

382 Citations (Scopus)

Abstract

Background. Effective hand-washing can prevent nosocomial infections, particularly in high-risk areas of the hospital. There are few clinical studies of the efficacy of specific hand-cleansing agents in preventing the transmission of pathogens from health care workers to patients. Methods. For eight months, we conducted a prospective multiple-crossover trial involving 1894 adult patients in three intensive care units (ICUs). In a given month, the ICU used a hand-washing system involving either chlorhexidine, a broad-spectrum antimicrobial agent, or 60 percent isopropyl alcohol with the optional use of a nonmedicated soap; in alternate months the other system was used. Rates of nosocomial infection and hand-washing compliance were monitored prospectively. Results. When chlorhexidine was used, there were 152 nosocomial infections, as compared with 202 when the combination of alcohol and soap was used (adjusted incidence-density ratio [IDR], 0.73; 95 percent confidence interval, 0.59 to 0.90). The largest reduction with chlorhexidine was in gastrointestinal infections (IDR, 0.19; 95 percent confidence interval, 0.05 to 0.64). When chlorhexidine was available, the rates of nosocomial infection declined in each of the ICUs, and health care workers washed their hands more often than when alcohol and soap were used (relative risk, 1.28; 95 percent confidence interval, 1.02 to 1.60). The total volume of alcohol and soap used was 46 percent that of chlorhexidine (P

Original languageEnglish (US)
Pages (from-to)88-93
Number of pages6
JournalNew England Journal of Medicine
Volume327
Issue number2
StatePublished - Jul 9 1992
Externally publishedYes

Fingerprint

Hand Disinfection
Chlorhexidine
Reducing Agents
Cross Infection
Soaps
Intensive Care Units
Alcohols
Confidence Intervals
Hand
Delivery of Health Care
Infectious Disease Transmission
2-Propanol
Incidence
Anti-Infective Agents
Detergents
Cross-Over Studies
Compliance
Infection

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Doebbeling, B., Stanley, G. L., Sheetz, C. T., Pfaller, M. A., Houston, A. K., Annis, L., ... Wenzel, R. P. (1992). Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. New England Journal of Medicine, 327(2), 88-93.

Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. / Doebbeling, Bradley; Stanley, Gail L.; Sheetz, Carol T.; Pfaller, Michael A.; Houston, Alison K.; Annis, Linda; Li, Ning; Wenzel, Richard P.

In: New England Journal of Medicine, Vol. 327, No. 2, 09.07.1992, p. 88-93.

Research output: Contribution to journalArticle

Doebbeling, B, Stanley, GL, Sheetz, CT, Pfaller, MA, Houston, AK, Annis, L, Li, N & Wenzel, RP 1992, 'Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units', New England Journal of Medicine, vol. 327, no. 2, pp. 88-93.
Doebbeling, Bradley ; Stanley, Gail L. ; Sheetz, Carol T. ; Pfaller, Michael A. ; Houston, Alison K. ; Annis, Linda ; Li, Ning ; Wenzel, Richard P. / Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. In: New England Journal of Medicine. 1992 ; Vol. 327, No. 2. pp. 88-93.
@article{7bf0720e199b49c7adf4056a3ebe2674,
title = "Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units",
abstract = "Background. Effective hand-washing can prevent nosocomial infections, particularly in high-risk areas of the hospital. There are few clinical studies of the efficacy of specific hand-cleansing agents in preventing the transmission of pathogens from health care workers to patients. Methods. For eight months, we conducted a prospective multiple-crossover trial involving 1894 adult patients in three intensive care units (ICUs). In a given month, the ICU used a hand-washing system involving either chlorhexidine, a broad-spectrum antimicrobial agent, or 60 percent isopropyl alcohol with the optional use of a nonmedicated soap; in alternate months the other system was used. Rates of nosocomial infection and hand-washing compliance were monitored prospectively. Results. When chlorhexidine was used, there were 152 nosocomial infections, as compared with 202 when the combination of alcohol and soap was used (adjusted incidence-density ratio [IDR], 0.73; 95 percent confidence interval, 0.59 to 0.90). The largest reduction with chlorhexidine was in gastrointestinal infections (IDR, 0.19; 95 percent confidence interval, 0.05 to 0.64). When chlorhexidine was available, the rates of nosocomial infection declined in each of the ICUs, and health care workers washed their hands more often than when alcohol and soap were used (relative risk, 1.28; 95 percent confidence interval, 1.02 to 1.60). The total volume of alcohol and soap used was 46 percent that of chlorhexidine (P",
author = "Bradley Doebbeling and Stanley, {Gail L.} and Sheetz, {Carol T.} and Pfaller, {Michael A.} and Houston, {Alison K.} and Linda Annis and Ning Li and Wenzel, {Richard P.}",
year = "1992",
month = "7",
day = "9",
language = "English (US)",
volume = "327",
pages = "88--93",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "2",

}

TY - JOUR

T1 - Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units

AU - Doebbeling, Bradley

AU - Stanley, Gail L.

AU - Sheetz, Carol T.

AU - Pfaller, Michael A.

AU - Houston, Alison K.

AU - Annis, Linda

AU - Li, Ning

AU - Wenzel, Richard P.

PY - 1992/7/9

Y1 - 1992/7/9

N2 - Background. Effective hand-washing can prevent nosocomial infections, particularly in high-risk areas of the hospital. There are few clinical studies of the efficacy of specific hand-cleansing agents in preventing the transmission of pathogens from health care workers to patients. Methods. For eight months, we conducted a prospective multiple-crossover trial involving 1894 adult patients in three intensive care units (ICUs). In a given month, the ICU used a hand-washing system involving either chlorhexidine, a broad-spectrum antimicrobial agent, or 60 percent isopropyl alcohol with the optional use of a nonmedicated soap; in alternate months the other system was used. Rates of nosocomial infection and hand-washing compliance were monitored prospectively. Results. When chlorhexidine was used, there were 152 nosocomial infections, as compared with 202 when the combination of alcohol and soap was used (adjusted incidence-density ratio [IDR], 0.73; 95 percent confidence interval, 0.59 to 0.90). The largest reduction with chlorhexidine was in gastrointestinal infections (IDR, 0.19; 95 percent confidence interval, 0.05 to 0.64). When chlorhexidine was available, the rates of nosocomial infection declined in each of the ICUs, and health care workers washed their hands more often than when alcohol and soap were used (relative risk, 1.28; 95 percent confidence interval, 1.02 to 1.60). The total volume of alcohol and soap used was 46 percent that of chlorhexidine (P

AB - Background. Effective hand-washing can prevent nosocomial infections, particularly in high-risk areas of the hospital. There are few clinical studies of the efficacy of specific hand-cleansing agents in preventing the transmission of pathogens from health care workers to patients. Methods. For eight months, we conducted a prospective multiple-crossover trial involving 1894 adult patients in three intensive care units (ICUs). In a given month, the ICU used a hand-washing system involving either chlorhexidine, a broad-spectrum antimicrobial agent, or 60 percent isopropyl alcohol with the optional use of a nonmedicated soap; in alternate months the other system was used. Rates of nosocomial infection and hand-washing compliance were monitored prospectively. Results. When chlorhexidine was used, there were 152 nosocomial infections, as compared with 202 when the combination of alcohol and soap was used (adjusted incidence-density ratio [IDR], 0.73; 95 percent confidence interval, 0.59 to 0.90). The largest reduction with chlorhexidine was in gastrointestinal infections (IDR, 0.19; 95 percent confidence interval, 0.05 to 0.64). When chlorhexidine was available, the rates of nosocomial infection declined in each of the ICUs, and health care workers washed their hands more often than when alcohol and soap were used (relative risk, 1.28; 95 percent confidence interval, 1.02 to 1.60). The total volume of alcohol and soap used was 46 percent that of chlorhexidine (P

UR - http://www.scopus.com/inward/record.url?scp=0026645501&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026645501&partnerID=8YFLogxK

M3 - Article

C2 - 1285746

AN - SCOPUS:0026645501

VL - 327

SP - 88

EP - 93

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 2

ER -