New Technologies in Handwash Products
By Lisa S. Higa
The job of handwashing agents is a dual one. Agents must loosen and kill microbes while preserving the skin's integrity. To assist in this goal, a number of handwash products are available. Since many new handwashing agents have appeared recently, the infection control practitioner selecting products needs to be actively involved to make certain that the agent meets the needs of the facility. Here is a list of the different types of handwashing agents.
- Soap--A cleansing and emulsifying agent made active by the action of an alkali on fat or fatty acids and consisting mainly of sodium or potassium salts of such acids. Nonantimicrobial soap is a detergent-based cleanser--liquid, bar, leaflet, or powder--that is used for physically removing soil and microorganisms. Soaps work as surfactants, breaking the surface tension of water to help in the mechanical removal of soil, yet they have no bacterial activity.
- Lotion--A liquid, medicinal preparation containing one or more insoluble substances and applied externally to skin for conditioning or treating disorders.
- Antimicrobial--Destroying or inhibiting the growth of microorganisms.
- Antiseptic--Opposing sepsis, putrefaction, or decay. "Antiseptic" also means arresting the growth of microorganisms on living tissue. An antiseptic handwash agent shows antimicrobial activity and is designed for use on skin to remove both transient and resident bacterial flora.
Importance of Handwashing
Handwashing before treatment of the first patient of the day, between each patient thereafter, and at the end of the healthcare worker's shift is an effective way to interrupt the transfer of pathogenic microorganisms. In hospitals, patients may have had little exposure to pathogens (e.g., newborns), may be immunocompromised, or may be in a susceptible condition because of a recent illness or operation. Professionals treating these patients inadvertently may bring diseases to the hospital from the home setting, transfer microorganisms from one patient to another, or may carry diseases full circle from the hospital to home by the healthcare worker's unwashed hands. Specific indications effective for handwash include when hands shows signs of visible soil, before contact with patients, after contact with body fluids, after contact with inanimate sources likely to be contaminated, after care of an infected patient, between patients, and before/after gloving.
To encourage healthcare professionals to wash their hands frequently, handwash products must be "user-friendly." One possible side effect of using soaps and antimicrobial products regularly is that skin cracking and dermatitis may occur as a result. Once the skin of a healthcare worker is cracked and irritated, they tend to avoid handwashing thereafter. Even if they comply with hospital protocols, washing skin with dermatitis is less effective in reducing bacteria.
Antimicrobial soaps designed for use in healthcare settings for killing or inhibiting microorganisms on skin are regulated by the FDA. An antimicrobial soap must show in vitro and in vivo activity against skin flora. A surgical hand scrub specifically must provide broad-spectrum, fast-acting, non-irritating characteristics while significantly reducing the number of microorganisms on intact skin. A healthcare personnel handwash must also be a broad-spectrum, antimicrobial agent that is fast-acting, non-irritating, and designed for regular use. It also must reduce the number of transient flora to a baseline level.
The following products are some of the current handwash agents available in the market, many of which were showcased at the recent APIC conference in Minneapolis, Minn. This list is merely an overview of some of the products available to assist in handwashing protocol and reduce the spread of infection.
Avagard Instant Hand Antiseptic
3M Health Care's Avagard Instant Hand Antiseptic represents a new category of alcohol-based waterless hand antiseptics. It is designed to help reduce dryness and maintain skin integrity and will not deactivate chlorhexidene gluconate (CHG), an antimicrobial agent favored by caregivers for its long-lasting effectiveness. Avagard's broad spectrum action kills more than 99% of harmful bacteria within 15 seconds, including MRSA and VRE. Its moisturizing properties come from a built-in location, featuring 3M's patented liquid crystalline emollient technology, which is used in the cosmetic industry. When used multiple times daily, Avagard is more moisturizing and results in less redness and skin breakdown. The hand antiseptic is available in a 500-ml pump, which can be mounted on the wall or in an 88-ml personal-size bottle.
For more information, call (800) 228-3957.
Cal Stat® Handrinse
Cal Stat® is a patented handrinse, effective against MRSA and VRE and inhibitive of bacterial growth for up to four hours. Its non-drying formulation meets the demands of high-frequency applications in today's healthcare environment. Cal Stat® is STERIS' focus product for hand rinsing with a complete spectrum of sizes, including the 1.2 L EZ Touch Dispenser size, 15 oz. pumpettes, and 2 oz. and 4 oz. convenient carrying sizes.
For more information, call (440) 354-2600.
Dial Healthcare Series
Dial's healthcare series features a complete line of efficacious, cosmetically pleasing products that have been formulated to help prevent the dryness and irritation that can result from repeated use of handwash products. The lineup features a mild, dye-free Liquid Dial Sensitive Skin antimicrobial soap and a fragrance-free, high-viscous Instant Hand Sanitizer as well as a host of other products. In the healthcare setting, the Dial brands can help encourage frequent use where safe, effective formulations are a necessity for both caregivers and patients.
For more information, call (800) 253-DIAL.
Endure® & Quick-Care®
Ecolab's Huntington brand Endure® is a skin care system formulated with compatible, active ingredients that work together to deliver SkinSynergy®--designed to be a higher, more sustained level of antimicrobial efficacy and residual activity that is compounded from product to product. Ecolab's Quick-Care® is a one-step waterless alcohol handrinse/surgical scrub that is formulated to improve hand hygiene. It provides rapid antimicrobial action and contains a mild, emollient-enriched formula to smooth and soften skin.
For more information, call (800) 332-6522.
Since its development in 1968 for training medical students at UCLA, the Glo Germ® Company has grown and branched out into the training of daycare centers, restaurants, schools at all levels of learning, and various governmental agencies. With over 30 years of experience, Glo Germ® has become a prominent handwashing demonstration and training medium for individuals who consult or educate about handwashing. With its "germs-you-can-see" technology, Glo Germ® is an excellent way to teach and verify instantly the importance of proper handwashing techniques, which aids in the prevention of cross-contamination.
For more information, call (800) 842-6622.
HandClens® and ThuroClens®
Woodward Laboratories' HandClens® is an alcohol-free instant hand sanitizer that prevents and repairs damaged and dry skin while killing 99.9% of most disease-causing germs within 15 seconds. It is designed for healthcare personnel engaged in numerous patient contacts. HandClens® is an antimicrobial formula that requires no water or rinsing and builds up residual antimicrobial activity in the skin.
ThuroClens® is an alcohol-free hand cleanser designed for use in daily handwashing. This cleanser is cationic, so it will not dry or irritate skin. Anionic soaps strip away positively charged oils that protect the skin. When these oils are stripped away, the skin becomes dry and damaged. The cationic characteristics of ThuroClens® do not strip way these oils.
For more information, call (562) 598-0800.
Kimberly-Clark's KimCare® Moisturizing Instant Hand Antiseptic combines an instant hand sanitizer with a moisturizer. It kills germs without soap and water while conditioning and moisturizing the skin. KimCare® uses the patented Microsponge® Technology that delivers moisturizing properties to the skin. It also kills 99.9% of germs in as little as 15 seconds and is dermatologist-tested and latex-compatible. It contains a 62% ethyl alcohol formula that provides a broad spectrum, fast-acting antimicrobial action with the convenience of waterless application. KimCare® is available in 8-ounce pump bottles, 500 ml pouches for use in dispensers, and in on-the-go foil packets.
For more information, call (888) 346-4652.
LaCrosse Antiseptic Gel Hand Rinse and LaCrosse Lotion Soap
Aplicare's LaCrosse Antiseptic Gel Hand Rinse is ideal for use by healthcare workers in areas without easy access to sinks. It contains 62% ethyl alcohol, which quickly and effectively reduces a broad spectrum of pathogenic microorganisms. It contains emollients, so skin is always soft and smooth. The gel formulation helps to reduce the waste and mess of liquids. Virtually non-staining, it features a pleasant herbal fragrance. The handy 4-ounce bottle fits easily into a lab coat or uniform pocket.
A mild, non-irritating skin cleanser, LaCrosse Antibacterial Lotion Soap is rich and creamy. The soap is formulated to encourage good handwashing practices in patient care environments where cross contamination must be controlled. It quickly forms a rich, creamy lather that effectively removes dirt, dead skin, and bacteria. These are rinsed away, and the emollients condition and soften the skin. The formulation is mild enough for frequent handwashing and is scented pleasantly. The persistent activity of the ingredient Triclosan helps to inhibit the growth of bacteria.
For more information, call (800) 760-3236.
First Scientific's antimicrobial handwash formulated with MicrobNZ® is designed to be a highly efficacious handwash that kills 99.9% of harmful bacteria in 15 seconds. It moisturizes and improves skin condition while providing long-lasting protection. The FDA-compliant formulation contains no irritating active ingredients, can be used as a facility-wide product, and is appropriate for patient, public, and staff handwashing.
For more information, call (888) 304-2092.
No Touch Handwashing/Drying
AMS Midlands' automatic soap dispensing provides a timed scrub to ensure that guidelines will be met when staff members wash their hands. The device also features a dryer, so the process provides one-stop handwashing and drying.
For more information, call (888) 889-5426.
Parachlorometaxylenol 3.3% (PCMX) with emollients is a mild, hand cleansing solution. Preimpregnated surgical scrub brushes provide staff convenience, time savings for the clinical and environmental staff, and decreased cost by eliminating over use of pump hand scrub brushes.
For more information, call (847) 473-1500.
Purell® Instant Hand Sanitizer
GOJO's Purell® Instant Hand Sanitizer kills 99.99% of most common germs, which may cause disease, in as little as 15 seconds. Purell® is a fast, broad-spectrum antimicrobial effective against MRSA, VRE, and C. difficile. With no water or towels needed, it helps to increase handwash compliance. Formulated for frequent use, it contains moisturizers to help prevent dry, irritated skin. Purell® is available in original and aloe formulas and also in the Lasting Care Formula, which provides persistent activity for up to six hours.
For more information, call (800) 321-9647.
Scrubcare and Vionex
Kerr/Metrex's Scrubcare Antimicrobial Skin Lotion complies with OSHA standards and is latex safe--it contains no mineral oil or petrolatum. It helps prevent glove and chemical irritation by soothing dry and chapped skin. The final formula has been tested for germ-killing effectiveness.
Kerr/Metrex's Vionex Antimicrobial Liquid Soap was developed specifically for the healthcare professional. It is gentle enough for 30 to 50 washes per day. With the active ingredient, PCMX, Vionex Soap has 99.94% germ reduction in 30 seconds. The product is available in a 4-oz. flip-top bottle, an 18-oz. pump, and an 800-ml bag-in-box. The Vionex No Rinse Gel is a non-flammable antiseptic handwash gel (with only 10% alcohol) that kills germs with the active ingredient PCMX. The gel cleans skin and kills germs without running water. Accompanying this gel is a skin-wipe towelette that can also kill germs and clean skin without running water.
For more information, call (800) 841-1428.
Care Tech® Laboratories' Surgi-Soft® is an antimicrobial, hand-degerming foam that protects against cross-infection without water. It has 70% ethyl alcohol, the highest alcohol content available in a foamed degermer. Surgi-Soft® is designed to eliminate transient organisms from hands with a single, 60-second application. The product has a thick foaming action and lubricates with emollients to moisturize, soothe, and soften hands. Its 3.2 oz size allows it to be slipped into a worker's pocket.
For more information, call (800) 325-9681.
Sween Infection Control Handwashing Products
Coloplast's Sween Infection Control Handwashing Products are designed to keep skin soft, intact, and healthy after several washes. Kind Touch® lotion skin cleanser is a gentle, all-purpose cleanser designed for people who frequently wash their hands by preventing dryness with its pH balanced formula. Soft Touch® antimicrobial lotion skin cleanser (0.5% PCMX) is a mild antimicrobial cleanser that is gentle for everyday use. Stat Touch® 2 antimicrobial skin cleanser (2% CHG) provides extra strength antimicrobial cleansing with rapid bactericidal action against gram negative and gram positive bacteria, fungi, and yeasts. It has a residual antimicrobial effect against a wide range of microorganisms. Isagel® no-rinse hand cleansing gel (60% ethyl alcohol) offers convenient, on-the-spot infection control when water is not available. It kills 99.5% of all microorganisms in just 15 seconds and is formulated with emollients for extra mildness. Antibacterial Sween® lotion reduces microorganisms on the skin to help decrease the potential for cross contamination.
For more information, call (800) 533-0464.