Indications for Alcohol or Bland Soap in Removal of Aerobic Gram-Negative Skin Bacteria: Assessment by a Novel Method

Abstract

AbstractA patient contact model was devised for health care workers (HCWs) to define heavy hand contamination with aerobic gram-negative bacilli (AGNB) that requires alcohol for complete removal. In patients, AGNB quantitation was per ml cup scrub fluid; in HCWs, per ml glove juice. Following 15-second contact, two Proteeae groin carriers yielding ≥ 4 log10 AGNB (high burden) transmitted ≥ 3 log10 in 67% of 24 tests of six HCWs, and ≤ 2 log10 in 29%. Two carriers yielding ≤ 3 log10 (low burden) transmitted ≥ 3 log10 in 8% and ≤ 2 log10 in 38%. At ≤ 2 log10 HCW acquisitions, soap eliminated all AGNB in six of seven tests; alcohol in nine of nine (p > 0.05). At ≥ 3 log10 acquisitions, soap eliminated all AGNB in three of 10; alcohol in eight of eight (p = 0.009). Contact with densely colonized patient skin may cause heavy AGNB contamination of HCWs' hands that generally necessitates alcohol for complete removal.