Title: Handwashing and gloving for food protection: effectiveness.
Abstract: This paper presents a 2-phase study which evaluated the effectiveness of handwashing compared to gloving, under simulated food service conditions. The first phase evaluated the ability of hand-contaminant bacteria to penetrate compromised vinyl glove barriers. The second phase evaluated the microbial contamination level picked up on the hands from handling contaminated hamburger.
Personal Authors: Fendler, E. J., Dolan, M. J., Williams, R. A., Paulson, D. S.
Author Affiliation: GOJO Industries, Inc., Akron, Ohio, USA.
Reference: Paulson, D. S.

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GOJO combines passion for our Purpose -- saving lives and making life better through well-being solutions -- with scientific knowledge of hand hygiene and skin care. This leads to positive outcomes that make a difference in people's lives. Select a link below for an outcome study summary providing scientific evidence of results achieved.

• Reducing Infection Rates in Healthcare
• Reducing Absenteeism in Schools and Colleges
• Improved Skin Condition in Harsh Environments Prone to Dermatitis
• Reducing Illness and Absenteeism in Military Settings
• Reducing Absenteeism in Workplace Settings
• Hand Hygiene for Food Handlers

Reducing Infection Rates in Healthcare

Study: Comparative efficacy of commercially available alcohol-based hand rubs and World Health Organization-recommended hand rubs: Formulation matters
Results: The novel ABHR formulations met efficacy requirements for both HCPHW and EN 1500 when tested at application volumes typically used in these methods. Moreover, these formulations met HCPHW requirements when tested at a more realistic 2-mL product application. In contrast, the commercial ABHRs and World Health Organization formulations failed to meet HCPHW requirements using a 2-mL application. Importantly, product performance did not correlate with alcohol concentration.
Conclusion: Product formulation can greatly influence the overall antimicrobial efficacy of ABHRs and is a more important factor than alcohol concentration alone. Two novel ABHRs based on 70% ethanol have been formulated to meet global efficacy standards when tested at volumes more representative of normal product use in health care environments.
Reference: AJIC: American Journal of Infection Control. August 2012. Volume 40, Issue 6, Pages 521-525. Sarah L. Edmonds, MS, David R. Macinga, PhD, Patricia Mays-Suko, BS, Collette Duley, BS, Joseph Rutter, BS, William R. Jarvis, MD, James W. Arbogast, PhD.  Published Online: January 24, 2012

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Study: Safety assessment for ethanol-based topical antiseptic use by health care workers: Evaluation of developmental toxicity potential
Conclusion: This study published in Regulatory Toxicology and Pharmacology concluded there is no significant risk of developmental or reproductive toxicity from repeated occupational exposures and high frequency use of alcohol-based hand sanitizers or surgical scrubs. Overall, the data support the conclusion that alcohol-based hand sanitizer products are safe for their intended use in hand hygiene as a critical infection prevention strategy in healthcare settings.

Study: Effectiveness of a comprehensive hand hygiene program for reduction of infection rates in a long-term care facility
Results: Infection rates for LRTIs were reduced from 0.97 to 0.53 infections per 1,000 resident-days (P = .01) following the intervention, a statistically significant decline. Infection rates for SSTIs were reduced from 0.30 to 0.25 infections per 1,000 resident-days (P = .65). A 54% compliance rate was observed among HCP.
Conclusion: This study demonstrates that the use of alcohol-based hand rubs, as part of a comprehensive hand hygiene program for HCP and residents, can decrease infection rates in LTCFs.
Reference: AJIC: American Journal of Infection Control. January 2013. Volume 41, Issue 1, Pages 39-44. Steven J. Schweon, RN, MPH, MSN, CIC, HEM; Sarah L. Edmonds, MS, Jane Kirk, MSN, RN, CIC, Douglas Y. Rowland, PhD, Carmen Acosta, RN, BSN

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Study: Efficacy of Novel Alcohol-Based Hand Rub Products at Typical In-Use Volumes
Abstract: In vivo efficacies of 2 alcohol-based hand rub (ABHR) products (gel and foam) were evaluated at a volume of 1.1 mL. Both met US Food and Drug Administration log10 reduction requirements after a single application and 10 consecutive applications. This is the first study to identify ABHR formulations capable of meeting efficacy requirements with a single-dispenser actuation. 
Reference: Infection Control and Hospital Epidemiology, Vol. 34, No. 3 (March 2013), pp. 299-301.  
David R. Macinga, PhD, Sarah L. Edmonds, MS, Esther Campbell, BS, David J. Shumaker, BS, James W. Arbogast, PhD

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Study: The relative influences of product volume, delivery format and alcohol concentration on dry-time and efficacy of alcohol-based hand rubs
Results: Volumes of six ABHR determined to rub dry in 30 s ranged from 1.7 mL to 2.1 mL, and the rate of drying varied significantly between products. ABHR dry-times increased linearly with application volume and decreased linearly with increasing alcohol concentration, but were not significantly influenced by product format. An ABHR foam (70% EtOH), rinse (80% EtOH), and gel (90% EtOH) each met EN 1500 efficacy requirements when tested at a volume of 3 mL, but failed when tested at volumes that dried in 30 s.HCP. 
Conclusion: Application volume is the primary driver of ABHR dry-time and efficacy, whereas delivery format does not significantly influence either. Although products with greater alcohol concentration dry more quickly, volumes required to meet EN 1500 can take longer than 30 s to dry, even when alcohol concentration is as high as 90%. Future studies are needed to better understand application volumes actually used by healthcare workers in practice, and to understand the clinical efficacy of ABHR at such volumes.
Reference: BMC Infectious Diseases 2014, 14:511 David R Macinga, David J Shumaker, Heinz-Peter Werner, Sarah L Edmonds, Rachel A Leslie, Albert E Parker and James W Arbogast

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Study: Comparative Efficacy of Alcohol-Based Surgical Scrubs: The Importance of Formulation
Abstract: Alcohol-based surgical scrubs (ABSSs) are used to prevent surgical site infections. Chlorhexidine gluconate (CHG) often is added to enhance persistent germicidal activity. The aim of this study was to determine the influence of ABSS product formulation on efficacy. We evaluated three commercially available ABSS formulations and one control alcohol formulation according to the surgical scrub methodology specified by the US Food and Drug Administration (FDA). Only one ABSS formulation met FDA efficacy requirements when tested at the manufacturer’s recommended dosage. In contrast, two ABSS formulations, one of which contained CHG, failed to meet the FDA acceptance criteria for a 3-log10 reduction on day 5, meaning the formulations did not sufficiently reduce bacteria levels on hands on the fifth day of product application. The data suggest that recommendations to include CHG in ABSS formulations should be reconsidered, and product efficacy, skin tolerability, and user acceptability should be evaluated on a case-by-case basis.
Reference: AORN Journal, December 2014, Volume 100, Issue 6, Pages 641-650
David R Macinga, PhD; Sarah L. Edmonds, MS, CCRP; Esther Campbell, BS; Robert R. McCormick, BS

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Study: A close look at alcohol gel as an antimicrobial sanitizing agent.
Results: The Healthcare Personnel Handwash data showed that the mean log reductions from baseline were greatest for the lotion soaps with alcohol gel sanitizer, less for the alcohol alone and the antimicrobial soap alone, and least for the bland soap alone. All of the product regimens showed a low potential for skin irritation.
Conclusion: In terms of both microorganism reduction and skin irritation, the most effective product regimens were the use of alcohol gel sanitizer in combination with either an antimicrobial or a bland soap.
Reference: AJIC: American Journal of Infection Control. 27(4):332-338, August 1999. Paulson, Daryl S. PhD a; Fendler, Eleanor J. PhD b; Dolan, Michael J. BS b; Williams, Ronald A. MS b

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Study: The impact of alcohol hand sanitizer use on infection rates in an extended care facility.
Results: The primary infection types found were urinary tract with Foley catheter, respiratory tract, and wound infections. Comparison of the infection types and rates for the units where hand sanitizer was used with those for the control units where the hand sanitizer was not used showed a 30.4% decrease in infection rates for the 34-month period in the units where hand sanitizer was used.
Conclusion: This study indicates that use of an alcohol gel hand sanitizer can decrease infection rates and provide an additional tool for an effective infection control program.
Reference: AJIC: American Journal of Infection Control. 30(4):226-233, June 2002. Fendler, E. J. PhD a; Ali, Y. PhD a; Hammond, B. S. a; Lyons, M. K. BSN, RN b; Kelley, M. B. CRRN b; Vowell, N. A. RN b

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Study: Use of alcohol hand sanitizer as an infection control strategy in an acute care facility.
Results: The primary infection types (more than 80%) found were urinary tract (UTI) and surgical site (SSI) infections. Infection types and rates for the unit during the period the alcohol hand sanitizer (intervention) was used were compared with the infection types and rates for the same unit when the alcohol hand sanitizer was not used (baseline); the results demonstrated a 36.1% decrease in infection rates for the 10-month period that the alcohol hand sanitizer was used.
Conclusion: This study indicates that use of an alcohol gel hand sanitizer can decrease infection rates and provide an additional tool for an effective infection control program in acute care facilities. (Am J Infect Control 2003;31:109-16.)
Reference: AJIC: American Journal of Infection Control. 31(2):109-116, April 2003. Hilburn, Jessica MT (ASCP), CIC a; Hammond, Brian S. b; Fendler, Eleanor J. PhD b; Groziak, Patricia A. MS b

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Study: Bacterial shedding and desquamation from the hands of healthcare workers correlates with skin condition.
Results: Bacterial dispersal and quantitative skin measurements were obtained from 86 healthcare workers over a 3 day period. The levels of bacteria shed from the hands of the healthcare workers was found to be negatively correlated to corneometer measurements (p < 0.01); and positively correlated to desquamation index (p < 0.02). No correlation was found between levels of shed bacteria and transepidermal water loss. As expected, corneometer measurements were found to be negatively correlated to desquamation index (p < 0.0001).
Conclusion: The results of this hospital study demonstrate that the levels of bacteria shed from the hands of healthcare workers are influenced by the health of the individual's skin; i.e. dry skin sheds more bacteria. This increased bacterial dispersal from dry skin may increase the infection transfer risk for healthcare workers with poor skin condition in the acute care setting.
Reference: American Journal of Infection Control, Volume 34, Issue 5, June 2006, Pages E85-E86. C.A. Kolly, J.W. Arbogast, D.R. Macinga

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Reducing Absenteeism in Schools and Colleges

Study: Effect of hand sanitizer use on elementary school absenteeism.
Results: The overall reduction in absenteeism due to infection in the schools included in this study was 19.8% for schools that used an alcohol gel hand sanitizer compared with the control schools.
Conclusion: Elementary school absenteeism due to infection is significantly reduced when an alcohol gel hand sanitizer is used in the classroom as part of a hand hygiene program.
Reference: AJIC: American Journal of Infection Control. 28(5):340-346, October 2000. Hammond, Brian a; Ali, Yusuf PhD a; Fendler, Eleanor PhD a; Dolan, Michael a; Donovan, Sandra RN, MSN b

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Study: The effect of a comprehensive handwashing program on absenteeism in elementary schools.
Results: Two hundred ninety students from five independent schools were enrolled in the study. Each test classroom had a control classroom, and only the test classroom received the intervention (education program and hand sanitizer). Absenteeism data was collected for 3 months. The number of absences was 50.6% lower in the test group.
Conclusion: The data strongly suggests that a hand hygiene program that combines education and use of a hand sanitizer in the classroom can lower absenteeism and be cost-effective.
Reference: AJIC: American Journal of Infection Control. 30(4):217-220, June 2002. Guinan, Maryellen a,b; McGuckin, Maryanne Dr ScEd, MT (ASCP) c; Ali, Yusef PhD d

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Study: The effect of hand hygiene on illness rate among students in university residence halls.
Results: The overall increase in hand-hygiene behavior and reduction in symptoms, illness rates, and absenteeism between the product group and control group was statistically significant. Reductions in upper respiratory-illness symptoms ranged from 14.8% to 39.9%. Total improvement in illness rate was 20%. The product group had 43% less missed school/work days.
Conclusion: Hand-hygiene practices were improved with increased frequency of handwashing through increasing awareness of the importance of hand hygiene, and the use of alcohol gel hand sanitizer in university dormitories. This resulted in fewer upper respiratory-illness symptoms, lower illness rates, and lower absenteeism.
Reference: AJIC: American Journal of Infection Control. 31(6):364-370, October 2003. White, Cindy PhD a; Kolble, Robin BSN a; Carlson, Rebecca MSN a; Lipson, Natasha BA a; Dolan, Mike BS b; Ali, Yusuf PhD b; Cline, Mojee PhD b*

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Improved Skin Condition in Harsh Environments Prone to Dermatitis

Study: Effectiveness of a hand care regimen with moisturizer in manufacturing facilities where workers are prone to occupational irritant dermatitis.
Results: Comparison of the change in the skin condition of workers using the full hand care regimen with moisturizer versus a control group using a regimen without moisturizer demonstrated significant (p < .05) improvements in multiple measures after 1 to 2 weeks. Corneometer readings consistently showed significant improvement for employees using moisturizer, regardless of their work location.
Conclusion: Improved skin condition resulted from the regular use of an effective skin conditioning hand moisturizer as part of a skin care regimen in work environments in which workers were prone to experiencing occupational irritant contact dermatitis.
Reference: Arbogast JW - Dermatitis - 01-MAR-2004; 15(1): 10-7

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Reducing Illness and Absenteeism in Military Settings

Study: Alcohol-based Instant hand sanitizer use in military settings - a prospective cohort study of army basic trainees.
Results: When compared to the control group, intervention groups experienced 40% less respiratory illness (p < 0.001), 48% less gastrointestinal illness (p < 0.02), 44% less lost training time (p < 0.001), and 31% fewer health care encounters (p < 0.001).
Conclusion: These findings suggest that this intervention is capable of significantly reducing illness in this setting and has the potential to help reduce absenteeism in the military workforce as a whole.
Reference: Military Medicine, Volume 172, Number 11, November 2007 , pp. 1170-1176(7)

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Reducing Absenteeism in Workplace Settings

Study: Impact of a Comprehensive Workplace Hand Hygiene Program on Employer Health Care Insurance Claims and Costs, Absenteeism, and Employee Perceptions and Practices
Objective: The aim of this study was to determine the efficacy of a multi-modal hand hygiene intervention program in reducing health care insurance claims for hygiene preventable infections (eg, cold and influenza), absenteeism, and subjective impact on employees.
Methods: A 13.5-month prospective, randomized cluster controlled trial was executed with alcohol-based hand sanitizer in strategic workplace locations and personal use (intervention group) and brief hand hygiene education (both groups). Four years of retrospective datawere collected for all participants.
Results: Hygiene-preventable health care claims were significantly reduced in the intervention group by over 20% (P<0.05). Absenteeism was positively impacted overall for the intervention group. Employee survey data showed significant improvements in hand hygiene behavior and perception of company concern for employee well-being.
Conclusion: Providing a comprehensive, targeted, yet simple to execute hand hygiene program significantly reduced the incidence of health care claims and increased employee workplace satisfaction.

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Study: Evaluating Effects of an Alcohol Hand Sanitizer Program on Employee Absenteeism: Pilot Results
Results: The observed absenteeism rate for the test population was 0.494 per 100 employee days vs. 0.618 per 100 employee days (p=.097). This suggested intervention with an alcohol hand sanitizer program results in lower absence rates due to illness.
Conclusion: This study demonstrates that using an alcohol-based instant hand sanitizer in conjunction with a simple educational program in a workplace setting could produce a positive effect on absenteeism. The absenteeism rate observed in the intervention population was 21% lower than the non-intervention population.
Reference: This is an unpublished study funded by GOJO Industries.  Authors included: James W. Arbogast, Ph.D., Cristina Ferazzano Yaussay, MPH, Todd Cartner,  Skin Care Science Technology Research and Development.

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Hand Hygiene for Food Handlers

Study: Efficacy evaluation of four hand cleansing regimens for food handlers.
Abstract: This study examined the ability of four handwashing regimens to reduce transient microorganisms on the skin of hands. The efficacy of these regimens was determined using a modified Healthcare Personnel Handwash procedure and Escherichia coli as the transient marker organism. The regimens consisted of a non-antimicrobial hand cleanser, an alcohol gel hand sanitizer, an antibacterial soap and an antibacterial soap plus application of an alcohol gel hand sanitizer.
Conclusion: The most effective configuration for antimicrobial control in the food industry clearly is the combination of the antimicrobial handwash followed by alcohol gel application. This configuration produced a high immediate reduction of transient microorganism, with potential for increased reductions with multiple applications of the antimicrobial hand soap over a period of days.
Reference: Dairy, Food and Environmental Sanitation, Volume 19, Number 10, October 1999, pp. 680-684

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Title: Handwashing and gloving for food protection: examination of the evidence.
Abstract: This paper presents a review on published literature (medical, microbiology, and food industry) related to all aspects of handwashing and gloving. This review demonstrates that there is insufficient scientific evidence to support the premise that the use of gloves on the hands of food-handling personnel prevents the transfer of pathogens to food and, consequently, to support the requirement for no-hand contact with ready-to-eat food.
Personal Authors: Fendler, E. J., Dolan, M. J., Williams, R. A.
Author Affiliation: GOJO Industries, Inc., Akron, Ohio, USA.
Reference: Paulson, D. S.

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