https://stacks.cdc.gov/view/cdc/6674/cdc_6674_DS1.pdf

Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.

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.

/pdf/guideline-for-hand-hygiene-in-health-care-settings-5dgf1j7b1v.pdf

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.

PROBLEM/CONDITION: Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis and emphysema but has been defined recently as the physiologic finding of nonreversible pulmonary function impairment This surveillance summary reports trends in different measures of COPD during 1971-2000 REPORTING PERIOD COVERED: This report presents national data regarding objectively determined COPD (1971-1994); COPD-associated activity and functional limitations (1980-1996); self-reported COPD prevalence, COPD physician office and hospital outpatient department visits, COPD hospitalizations, and COPD deaths (1980-2000); and COPD emergency department visits (1992-2000) DESCRIPTION OF SYSTEMS: The Centers for Disease Control's National Center for Health Statistics conducts the National Health Interview Survey annually, which includes questions concerning COPD and activity limitations The National Center for Health Statistics collects physician office-visit data in the National Ambulatory Medical Care Survey, emergency department and hospital outpatient department data in the National Hospital Ambulatory Medical Care Survey, hospitalization data in the National Hospital Discharge Survey, and death data in the Mortality Component of the National Vital Statistics System Data regarding pulmonary function were obtained from the National Health and Nutrition Examination Surveys (NHANES) I (1971-1975) and III (1988-1994), and data regarding functional limitation were obtained from NHANES III, Phase 2 (1991-1994) RESULTS: During 2000, an estimated 10 million US adults reported physician-diagnosed COPD However, data from NHANES III estimate that approximately 24 million United States adults have evidence of impaired lung function, indicating that COPD is underdiagnosed During 2000, COPD was responsible for 8 million physician office and hospital outpatient visits, 15 million emergency department visits, 726,000 hospitalizations, and 119,000 deaths During the period analyzed, the most substantial change was the increase in the COPD death rate for women, from 201/100,000 in 1980 to 567/100,000 in 2000, compared with the more modest increase in the death rate for men, from 730/100,000 in 1980 to 826/100,000 in 2000 In 2000, for the first time, the number of women dying from COPD surpassed the number of men dying from COPD (59,936 vs 59,118) Another substantial change observed is that the proportion of the population aged < 55 years with mild or moderate COPD, on the basis of pulmonary function testing, decreased from 1971-1975 to 1988-1994, possibly indicating that the upward trends in COPD hospitalizations and mortality might not continue INTERPRETATION: COPD is a major cause of morbidity, mortality, and disability in the US Despite its ease of diagnosis, COPD remains an underdiagnosed disease, chiefly in its milder and more treatable form

Chronic obstructive pulmonary disease surveillance--United States, 1971-2000.

The etiology of nosocomial infections, the frequency of contaminated hands with the different nosocomial pathogens, and the role of health care workers' hands during outbreaks suggest that a hand hygiene preparation should at least have activity against bacteria, yeasts, and coated viruses. The importance of efficacy in choosing the right hand hygiene product is reflected in the new Centers for Disease Control and Prevention guideline on hand hygiene (J. M. Boyce and D. Pittet, Morb. Mortal. Wkly. Rep. 51:1-45, 2002). The best antimicrobial efficacy can be achieved with ethanol (60 to 85%), isopropanol (60 to 80%), and n-propanol (60 to 80%). The activity is broad and immediate. Ethanol at high concentrations (e.g., 95%) is the most effective treatment against naked viruses, whereas n-propanol seems to be more effective against the resident bacterial flora. The combination of alcohols may have a synergistic effect. The antimicrobial efficacy of chlorhexidine (2 to 4%) and triclosan (1 to 2%) is both lower and slower. Additionally, both agents have a risk of bacterial resistance, which is higher for chlorhexidine than triclosan. Their activity is often supported by the mechanical removal of pathogens during hand washing. Taking the antimicrobial efficacy and the mechanical removal together, they are still less effective than the alcohols. Plain soap and water has the lowest efficacy of all. In the new Centers for Disease Control and Prevention guideline, promotion of alcohol-based hand rubs containing various emollients instead of irritating soaps and detergents is one strategy to reduce skin damage, dryness, and irritation. Irritant contact dermatitis is highest with preparations containing 4% chlorhexidine gluconate, less frequent with nonantimicrobial soaps and preparations containing lower concentrations of chlorhexidine gluconate, and lowest with well-formulated alcohol-based hand rubs containing emollients and other skin conditioners. Too few published data from comparative trials are available to reliably rank triclosan. Personnel should be reminded that it is neither necessary nor recommended to routinely wash hands after each application of an alcohol-based hand rub. Long-lasting improvement of compliance with hand hygiene protocols can be successful if an effective and accessible alcohol-based hand rub with a proven dermal tolerance and an excellent user acceptability is supplied, accompanied by education of health care workers and promotion of the use of the product.

/pdf/epidemiologic-background-of-hand-hygiene-and-evaluation-of-4vnb7d8h7e.pdf

Epidemiologic Background of Hand Hygiene and Evaluation of the Most Important Agents for Scrubs and Rubs

Target organs for cosmetic products safety considerations vehicles of cosmetic products cosmetic ingredients cosmetic products - skincare products, haircare products, other cosmetic products legislation and regulations over the world testingthe cosmetic products cosmetic claims.Featuring contributions from more than 100 leading experts in the field, the Handbook of Cosmetic Science and Technology provides comprehensive multidisciplinary coverage of cosmetic ingredients, finished products, target organs, delivery systems, andcurrent technology in safety, toxicology, and dermatological testing. Discussing modern innovations such as active cosmetics for the hair, skin, and teeth as well as safety, legal, and regulatory standards from around the world, the handbook also covercosmetics for infants and the elderly, formulation of skin cleansing products, delivery systems, including cosmetic patches, and the mechanisms of unwanted reactions to cosmetics.

Handbook of Cosmetic Science and Technology

Hand disinfection with short-chain aliphatic alcohols, so-called "rub-ins" is the method of choice for cross-infection prevention in health care environments, but their irritant potential is not well known. Skin tolerance is a major compliance factor, and a high proportion of health care workers suffer from low-grade irritant contact dermatitis. Therefore, assessment of the irritancy of the skin disinfectant n-propanol 60%, and comparative 100% and 0% solutions, was performed in the setting of experimental low-grade ICD. ICD was induced by overnight patch exposure to H2O, and to 0.3% sodium dodecyl sulfate (SDS), in 12 probands, followed by repeated open exposure to the test substances. Outcome variables were transepidermal water loss (TEWL), and skin surface capacitance. On skin sites pre-irritated by SDS, all n-propanol concentrations (100%, 60%, 0%) increased TEWL. However, a clear divergence appeared between pure n-propanol, and the lower concentrations. In contrast to pure n-propanol, n-propanol 60% and 0% had no significant effect on TEWL on H2O-pre-irritated skin sites. Capacitance of pre-irritated skin sites was increased by exposure to H2O-containing n-propanol solutions (60% and 0%). These results show a clear difference between the irritant potential of n-propanol 100% on one side, and n-propanol 60% and 0% on the other side. The level of pre-existent skin irritation is a pertinent factor in susceptibility to irritation, as the irritant potential of n-propanol 60%, the concentration used in daily practice, and n-propanol 0% (water) became significant only on detergent-irritated skin. Thus, preventive skin care may be a constructive approach in increasing tolerance of modern hand disinfection practices.

Irritancy of the skin disinfectant n-propanol.

Nowadays it seems quite unnecessary to give reference to the unique features and advantages of computers, so indispensable have they become in both everyday and professional life. Not only has their sheer number increased, but also their quality, the mode of interaction between user and computer becoming increasingly intuitive and flexible. The scope of computer applications has also become much broader — including worldwide connectivity via the Internet.

Computers in the Management of Contact Dermatitis

drugs but also occupational allergens) (3–5). To our knowledge, there has never been described an erythema multiforme with contact dermatitis from rubber vulcanization agents. The lesions were the consequence of indirect occupational contact with rubber piping via the intermediary of a detachment gel able to absorb and concentrate rubber allergens. The clinical course of the disease was biphasic: initially, an acute eczema with poor response to topical corticosteroids and then erythema multiforme requiring systemic corticosteroids. The pathophysiological mechanism could be a systemic response due to the strength of the allergen or cytotoxicity as in erythema multiforme with herpetic infection (4, 5). We were amazed by the rapidity of this sensitization to rubber vulcanization agents. An occupational survey found other workers presentingwith a similar eruption at the same factory.

A multilingual European patch test software concept: WinAlldat/ESSCA.

The object of this study was to compare the protective action of a new barrier cream (Excipial Protect®, Spirig Pharma AG, Egerkingen, Switzerland) to its vehicle in the context of hand irritation of apprentice hairdressers caused by repeated shampooing and exposure to hair-care products. This was a double-blind cross-over comparing Excipial Protect® (containing aluminium chlorohydrate 5% as active ingredient) against its vehicle alone. The efficacy of the creams was evaluated taking into account: (1) clinical scores by researchers, (2) biometric measurements, (3) subjective opinions of the subjects. An analysis of variance was performed considering order of application, degree of atopy, and reported number of shampoos. We observed very little difference in efficacy between the protective cream and its vehicle. The presence, however, of aluminium chlorhydrate in the protective cream was shown to have a positive effect against work-related irritation. The cosmetic qualities of the creams seemed, to the participants, to be as important as their real protective and hydrating properties, an important factor in compliance issues.

The efficacy of a protective cream in a real-world apprentice hairdresser environment.

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Irritancy of the skin disinfectant n-propanol.

Computers in the Management of Contact Dermatitis

A multilingual European patch test software concept: WinAlldat/ESSCA.

The efficacy of a protective cream in a real-world apprentice hairdresser environment.