Operation Clean Hands

By Robert Remington – President 

What does ‘clean hands’ really mean?

Am I sure that my hands are safe and germ-free after washing them?

Is it true that washing with soap and water kills harmful germs that will make me sick?

Why are my hands red and dry after washing so often?

There is no better time to address these questions and to discuss some of the myths and facts.

Soap and water remove protein and dirt from the skin on your hands and removes germs as well; at least some of the bacteria and viruses; to a certain degree.

Study after study has shown that people all over the world have a hard time following hand washing recommendations. Compliance with hand washing is a never-ending struggle.

If the germs on your hands are removed where do they go?

Most of them make it down the drain, however, many get splashed on the counter, tap, and other surfaces – where they rapidly multiply in the millions.

One hospital study showed that pseudomonas, a common bacterium, migrated up the tap and created a biofilm in the water pipe that was infecting the nurse’s hands. This was later proven to be the cause of the outbreak.

 

Abstract 

Pseudomonas aeruginosa has emerged as a major pathogen in nosocomial infections. Biofilm formation allows the microorganism to persist in hospital water systems for extended periods, which have been associated with nosocomial infections. 

FEMS Microbiology Letters, Volume 343, Issue 1, June 2013, Pages 77–81, 

Both medicated and regular soap combined with our chlorinated water dries out your hands, and after about 10-15 handwashes per day the integrity of your skin starts to deteriorate, resulting in “Volcano Hands”.

The type of soap that you use is also very important; the more expensive soaps contain moisturizers and caring substances. One product we recommend for washing your hands is Dermotan. This is a liquid soap we import from Germany that is used successfully for 40 years in the operating rooms as a pre- scrub for surgery and, is also used in neonatal wards and geriatric facilities for bathing those with highly sensitive skin. Dermotan has been used in combination with Manorapid in Canada for over 25 years allowing many professionals to keep their hands intact and be able to continue working without skin problems.

 

Elain Larson is a leading expert in the USA on hand Hygiene: 

“Twenty-five percent of the nurses in one study, had dry damaged skin”, writes Larson.” Ironically, the nurses may be exacerbating the very thing that handwashing seeks to prevent: the spread of infectious bacteria. Larson says, “healthy skin sheds 10 million particles a day, and 10 percent of those harbour bacteria. Dry damaged skin flakes off more readily than healthy, lubricated skin and thus dispenses more bacteria. Damaged skin also harbours more pathogens than healthy skin.”

The key take-way is that we are washing our hands more often than we ever have in the past leading to increased damage to our skin making us all more susceptible to the spread of harmful pathogens.

 

How can we be safe?

In 1860 Semmelweis, a pioneer in hand antiseptics published his findings in Austria proving the need to disinfect our hands to stop the spread of disease-causing pathogens. 

In North America, we have been using anti-microbial soaps that have been known to cause antibiotic resistance as they are too weak to kill all the germs on your hands. Chlorohexidine scrubs are more effective and have a long persistence effect, however, studies have shown that there are harmful effects from the prolonged use of this chemical.

Characteristics of Antiseptic Ingredients Used in Hand Hygiene:

The active ingredients include:

1. Triclosan
2. Chlorhexidine
3. Chloroxylenol
4. Iodine containing compounds
5. Benzalkonium Chloride
6. Benzethonium Chloride
7. Alcohols Aliphatic

You need to use a high-quality alcohol hand sanitizer if you want to kill germs on your hands and stop the spread of harmful diseases.

I feel like I could write a book about this subject however, in this short article I will give you just a few examples of what you need to look for.

An Ideal hand rub product should have the following properties:

• Broad-spectrum of efficacy
• Be fast acting
• Possess high efficacy vs. transient pathogens
• Have excellent skin compatibility
• Should be fast drying
• Should be easy to apply
• Be non-allergenic
• Be non-irritating

 

Alcohol-based formulas must be easy to apply and rub into your skin; the valleys on the skin’s surface area where the germs are hiding. A liquid alcohol rinse (rub) is the most effective and easiest to apply. The technique to apply alcohol is just as important as the technique used for proper handwashing with soap and water.

Please watch this short video illustrating the rub method for hand hygiene. There are more specific protocols for surgical procedures.  Generally, it takes about 30 seconds to disinfect your hands properly.

If you are wearing rings the liquid will flow under the ring killing bacteria. Most gels and foam-based products are not able to flow under rings or jewellery.

Not all alcohol formulas are created equal and most formulas cause your hands to become dry, and some products contain chemicals or additives that are not even tested. The product must be tested; during COVID-19 there are some very scary products that are showing up on the market in Canada from China and even manufactured in Canada by opportunistic companies in back-office makeshift manufacturing companies that are not licenced. There are shortages of hand sanitizers in the market and the untested and unlicensed or “Fake” products could be harmful.

 

Studies also show that when you add gel or foaming agents, the effectiveness drops significantly. Cosmetic appeal over performance should never be sacrificed.

 

In almost all hand disinfectants the alcohol used is ethanol or isopropanol as the active ingredient. The total concentration is generally >60-95 %.

Alcohol disturbs the corneum stratum structure of the skin, particularly the lipid layers. The effect depends largely on the type and concentration of alcohol. However, in contrast to washing, the lipids are not rinsed out but rubbed into the skin once again using the new rub-in method commonly applied today. This means that it does not lead to the defatting of the skin, which is a reason why hand disinfection is more compatible in comparison to handwashing.

Remington Medical has been marketing the MANORAPID alcoholic hand rub, which is used for both hand antisepsis as well as for a surgical scrub since 1998. The Manorapid antiseptic solution was formulated in Germany by the ANTISEPTICA GmbH and the company has been marketing this product all over the world for over 40 years.

Manorapid was tested extensively, according to the European Standard test method EN 12054, which utilizes a quantitative suspension test to evaluate the bactericidal activity of products for hygienic and surgical disinfection used in human medicine.

The DGHM, German Society for Hygiene and Microbiology certified the Manorapid as the product, which meets or exceeds the required disinfectant activity.

The criterion for evaluation with respect to antibacterial efficacy is a reduction in the number of microorganisms by at least 5 log units (99.999%). Manorapid exceeds Canadian standards for hand sanitizing as it is used as a surgical antiseptic.

 

Prevention and control of nosocomial infections 

The practice of good hand hygiene is the simplest, most effective method for preventing the spread of nosocomial infections.

To attain successful compliance with the handwashing procedures, antiseptics and disinfectant preparations must be acceptable to the user. As we have discussed many products used for hand hygiene must be used frequently and can consequently cause damage to the skin. Among the problems encountered are: Toxic-Irritative skin changes, Dyshidrotic Atopic Eczema and Allergic Contact Dermatitis.

Therefore, the most suitable antiseptic agent should possess minimal toxicity and have the lowest possible irritant and allergenic properties.

Manorapid

Bactericidal and fungicidal Spectrum of Effectiveness, test EN12054:

Tested Strain:	cfu after 30 sec.	control cfu:	Mean log Reduction:
Staphylococcus Aureus strain #1	0	325000	> 5.51
Staphylococcus Aureus strain #2	0	170000	>5.23
Staphylococcus Aureus ATCC6538	0	530000	> 5.72
Enterococcus Faecium strain #3	0	105000	> 5.02
Enterococcus Faecium ATCC6057	0	175000	> 5.24
Pseudomonas Aeruginosa strain #5	0	480000	> 5.68
Pseudomonas Aeruginosa ATCC15442	0	705000	> 5.85
Escherichia coli E HEC	0	440000	> 5.64
Escherichia coli ATCC11229	0	200000	> 5.30
Mycobacterium Terrae ATCC15755	0*	*	> 5.95
Candida Albicans ATCC14153	0	300000	> 5.14

٭  After 1 minute, original concentration  was 9.76log/mL

٭  The Manorapid is also an effective fungicidal agent, as can be seen from the table, it readily inactivates the Candida Albicans species.

The higher the log reduction the better.

 

What does 5 log reduction mean?

I am frequently asked to explain what the log reduction means. The term “log” is short for logarithm base 10. Each log reduction simply means a reduction of 90 %, therefore 1 log reduction is a 90 % reduction.

This Table gives the corresponding log reductions:

99 % ————— 2 log reduction

99.9 %————– 3 log reduction

99.99 %———— 4 log reduction

99.999 %———- 5 log reduction

 

Example:

Starting with 100 000 Bacteria

1 log reduction (90 % )  ————- 10 000  bacteria

2 log reduction (99 %)  —————–1000  bacteria

3 log reduction (99.9 %) —————–100 bacteria

4 log reduction (99.99 %)  ————— 10  bacteria

5 log reduction (99.999 %)  —————  1  bacteria

 

We hope that this post was helpful in making informed decisions on your antiseptic and handwashing purchases. Want to ensure your practice, clients, and staff maintain the highest level of cleanliness and hygiene possible? Contact Remington Medical’s dedicated team and find out what products are best for you.