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Reproducibility and Workability of the European Test Standard EN 12791 Regarding the Effectiveness of Surgical Hand Antiseptics A Randomized, Multicenter Trial

Published online by Cambridge University Press:  21 June 2016

Manfred Rotter ,
Michael Kundi ,
Miranda Suchomel ,
Hans-Peter Harke ,
Axel Kramer ,
Christiane Ostermeyer ,
Peter Rudolph ,
Hans-Günther Sonntag  and
Heinz-Peter Werner
Manfred Rotter*
Affiliation:
Institute of Hygiene and Medical Microbiology, Medical University Vienna, Vienna, Austria
Michael Kundi
Affiliation:
Institute of Environmental Health, Medical University Vienna, Vienna, Austria
Miranda Suchomel
Affiliation:
Institute of Hygiene and Medical Microbiology, Medical University Vienna, Vienna, Austria
Hans-Peter Harke
Affiliation:
Schülke & Mayr, Hamburg, Germany
Axel Kramer
Affiliation:
Institute of Hygiene and Environmental Medicine, University Greifswald, Greifswald, Germany
Christiane Ostermeyer
Affiliation:
Bode, Hamburg, Germany
Peter Rudolph
Affiliation:
Institute of Hygiene and Environmental Medicine, University Greifswald, Greifswald, Germany
Hans-Günther Sonntag
Affiliation:
Hygiene-Institute, University Heidelberg, Heidelberg, Germany
Heinz-Peter Werner
Affiliation:
HygCen, Schwerin, Germany
*
Institute of Hygiene and Medical Microbiology, Medical University, Kinderspitalgasse 15, A-1095 Vienna, Austria, (manfred.rotter@meduniwien.ac.at)
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Abstract

Objectives.

To evaluate the reproducibility and workability of the in vivo test model of the European test standard EN 12791 regarding the effectiveness of surgical hand antiseptics and, as a secondary objective, to evaluate the power of the model to discriminate between the effectiveness of various formulations of surgical hand antiseptics.

Design.

Prospective, randomized, multicenter study with a Latin square design.

Setting.

Five laboratories at 2 universities, 2 disinfectant manufacturers, and 1 private testing institution.

Participants.

Twenty healthy adults in each laboratory.

Intervention.

Surgical hand antisepsis was performed by scrubbing with chlorhexidine gluconate 4% detergent (CHG) or by rubbing the hands with propan-2-OL (70% by volume; Iso 70) or ethanol 85% (E 85); rubbing the hands and forearms for 3 minutes with propan-1-OL (N 60) was used as the reference disinfection procedure. We deliberately chose to use these antiseptics at the given concentrations because they were intended to cover the range of typical antiseptics submitted for approval according to EN 12791.

Methods.

In once-weekly tests, the immediate effects of the 4 antiseptics were established according to the method laid down in EN 12791 by assessing the release of skin flora from the fingertips as viable bacteria counts per milliliter of sampling fluids before treatment and viable bacteria counts immediately after treatment, separately for both hands, such that after 4 weeks each volunteer had used every formulation once.

Results.

The mean log reduction factor (RF) for the release of bacterial skin flora (the log RF was calculated as the log count before treatment minus the log count after treatment) and corresponding standard deviations for the 4 hand antisepsis formulations were as follows: for CHG, 1.1 ± 0.3 colony-forming units (cfu) per milliliter of sampled fluid; for Iso 70, 1.7 ± 0.3 cfu/mL; for E 85, 2.1 ± 0.3 cfu/mL; and for N 60, 2.4 ± 0.4 cfu/mL. The differences between these values proved significant (P<.001) by analysis of variance and in Tukey's “honestly significantly different” (HSD) post hoc test. Although, with regard to their immediate antibacterial activity, the same ranking of these antiseptics was found at all laboratories, the levels of efficacy were significantly different across laboratories (P<.001); no statistical difference was found between left and right hands (P>.01). Relating the log RF values of the other 3 formulations to those of the reference formulation (N 60) abolished differences between laboratories (P = .16); in addition, the interclass correlation coefficient decreased from 9.1% to 4.5%. With 20 volunteers, a minimum difference of 0.47 log between the mean log RFs of the reference formulation and an inferior test formulation will be detected as significant at an α of .05 (1-sided) and a 1 — β value of .8.

Conclusion.

The test method described in EN 12791 yielded the same conclusion on the effectiveness of the tested formulations in every laboratory and proved, therefore, reproducible and workable.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 9 , September 2006 , pp. 935 - 939
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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References

1.Newsom, SW. Pioneers in infection control: Joseph Lister. J Hosp Infect 2003; 55:246–253.Google Scholar
2.Rotter, ML. Special problems in hospital antisepsis. In: Fraise, AP, Lambert, PA, Maillard, J-Y, eds. Kussel, Hugo, and Ayliffe's Principles and Practice of Disinfection, Preservation and Sterilization. 4th ed. Oxford: Blackwell; 2004:540–562.Google Scholar
3.Price, PB. The bacteriology of normal skin; a new quantitative test applied to a study of the bacterial flora and the disinfectant action of mechanical cleaning. J Infect Dis 1938; 63:301–318.Google Scholar
4.Deutsche Gesellschaft für Hygiene und Mikrobiologie (DGHM). Richtlinien für die Prüfung chemischer Desinfektionsmittel [Guidelines for testing chemical disinfectants]. Zbl Bact Hyg Abt I Orig 1958; 173:307–317.Google Scholar
5.Michaud, RN, McGrath, MB, Goss, WA. Improved experimental model for measuring degerming activity on the human hand. Antimicrob Agents Chemother 1972; 2:8–15.Google Scholar
6.Österreichischen Gesellschaft für Hygiene, Mikrobiologie und Präventivmedizin (ÖGHMP). Richtlinie der Österreichischen Gesellschaft für Hygiene, Mikrobiologie und Präventivmedizin (ÖGHMP) vom 4. November 1980 zur Prüfung der Desinfektionswirkung von Verfahren für die Chirurgische Händedesinfektion [Guideline of the Austrian Society for Hygiene, Microbiology and Preventive Medicine (ÖGHMP) dated November 4, 1980, for the evaluation of procedures for surgical hand disinfection]. Hygiene Med 1981; 6:10–16.Google Scholar
7.Deutsche Gesellschaft für Hygiene und Mikrobiologie (DGHM). Richtlinien für die Prüfung und Bewertung chemischer Desinfektionsverfahren [Guidelines for testing and evaluation of chemical disinfection procedures]. Zbl Hyg Bah I Abt Orig B 1981; 172:528–556.Google Scholar
8.American Society for Testing Materials. E 1115-02 Standard Test Method for Evaluation of Surgical Hand Scrub Formulations. West Conshohocken, PA: ASTM International; 2002. Book of Standards, vol 11.05.Google Scholar
9.Food and Drug Administration. Topical antimicrobial drug products for over-the-counter human use: tentative final monograph for health-care antiseptic drug products. Fed Regist 1994; 59:31402–31452.Google Scholar
10. European Norm EN 12791. Surgical hand disinfection—test method and requirements (phase 2/step 2). Brussels: 2005.Google Scholar
11.Larson, EL, Butz, AM, Gullette, DL, Laughon, BA. Alcohols for surgical scrubbing? Infect Control Hosp Epidemiol 1990; 11:139–143.Google Scholar
12.Pereira, LJ, Lee, GM, Wade, KJ. An evaluation of five protocols for surgical handwashing in relation to skin condition and microbial counts. J Hosp Infect 1997; 36:49–65.Google Scholar
13.Hobson, DW, Woller, W, Anderson, L, Guthery, E. Development and evaluation of a new alcohol-based surgical hand scrub formulation with persistent antimicrobial characteristics and brushless application. Am J Infect Control 1998; 26:507–512.Google Scholar
14.Mulberry, G, Snyder, AT, Heilmann, J, Pyrek, J, Stahl, J. Evaluation of a waterless scrubless Chlorhexidine gluconate/ethanol surgical scrub for antimicrobial efficacy. Am J Infect Control 2001; 29:377–382.Google Scholar
15.Rotter, ML. Povidone-iodine and Chlorhexidine gluconate containing detergents for disinfection of hands [letter]. J Hosp Infect 1981; 2:273–276.CrossRefGoogle ScholarPubMed
16.Rotter, ML, Simpson, RA, Koller, W. Surgical hand disinfection with alcohols at various concentrations—parallel experiments using the new proposed European standards (CEN) method. Infect Control Hosp Epidemiol 1998; 19:778–781.Google Scholar
17.Rotter, ML. Hand washing and hand disinfection. In: Mayhall, G, ed. Hospital Epidemiology and Infection Control. 3rd ed. Baltimore: Lippincott, Williams & Wilkins, 2004:1727–1746.Google Scholar
18.Jones, B, Jarvis, P, Lewis, JA, Ebbutt, AF. Trials to assess equivalence: the importance of rigorous methods [published correction appears in BMJ 1996; 31336-39 ]. BMJ 1996; 313:36–39.CrossRefGoogle ScholarPubMed