To overcome these challanges and to empower infection
control professional, scientists have researched, designed
and developed potent, effective and safe disinfectant and
antiseptic solution for medical, industrial and general
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For generations, handwashing with soap and water has
been considered a measure of personal hygiene. The
concept of cleansing hands with an antiseptic agent
probably emerged in the early 19th century. In 1846,
Ignaz Semmelweis observed that physicians who went
directly from the autopsy suite to the obstetrics ward
has a disagreeable odor on their hand despite washing
their hands with soap and water upon entering the
obstetrics clinic. He postulated that the puerperal fever
that affected so many parturient women was caused by
cadaverous particles transmitted from the autopsy suite
to the obstetrics ward via the hands of the students and
physicians. Perhaps because of the known deodorizing
effect of chlorine compounds, as of May 1847, he insisted
that students and physicians clean their hands with a
chlorine solution between each patient in the clinic. The
maternal mortality subsequently dropped dramatically
and remained low for years. This intervention by
Semmelweis represents the first evidence indicating that
cleansing heavily contaminated hands with an antiseptic
agent between patient contacts may reduce health care
associated transmission of contagious diseases more
effectively than handwashing with plain soap and water.
To understand the objectives of different approaches to
hand cleansing, knowledge of skin and normal bacterial
skin flora is essential. The skin is often known as the
largest organ in the human body. The basic structure
of skin includes the superficial region (i.e. the stratum
water loss, provide protection against abrasive action and
microorganism, and also act as permeability barrier to
the environment. Normal human skin is colonized with
bacteria; different areas of the body have varied bacterial
counts. Total bacterial counts on the hands of medical
personnel have ranged from 3.9 × 104
(1938) divided the bacteria found on skin onto two types,
namely, those normally permanent (resident flora) and
those normally temporary (transient flora). Resident flora,
which are attached to deeper layers of the skin, are more
resistant to removal. The resident flora consists of species
that can resist both the antimicrobial substances excreted
on skin and in sweat and also moderate desiccation. They
also have an innate ability to adhere to epithelial cells.
The predominant flora is composed of coagulase negative
staphylococci, mainly Staphylococcus epidermidis.
Other species implicated are Acinetobacter, Klebsiella,
Corynebacteria and Propionibacteria species. The resident
flora (Noble, 1981) forms microcolonies on skin and is
attached to skin scales, which tend to be shed into the
environment at a great rate, the whole superficial layer of
the skin being shed every few hours. The bacterial flora is
The resident flora is also more resistant to easy removal
by mechanical means. Hence, a minimum of 5 minutes of
diligent hand wash is often required to result in significant
reduction. Transient flora, which colonizes the superficial
layers of the skin, are more amenable to removal by
routine handwashing. They are often acquired by HCWs
during direct contact with contaminated environmental
surfaces within close proximity of the patient. They are
most frequently associated with health care associated
Staphylococcus aureus (MRSA), and vancomycin-resistant
The hygienic hand wash aims on mechanically remove
and parts of the resident skin flora. While the aim of the
hygienic handrub is to reduce the release of members of
the transient microbial skin flora, without regard of the
resident flora, with maximum efficacy and speed to render
hands safe after known or suspected contamination.
It involves the elimination of a substantial part of the
transient flora by ‘killing’ it on the hands rather than by
mechanical removal. A surgical hand scrub procedure
involves the aims at a marked reduction of the resident
Strategies for the prevention of hand associated
microbial transfer must consider the microbial flora to
be of importance in a given situation. In the wards, the
transient flora is often accidentally picked up from an
infections source and must be prevented from being
transmitted via hands to a susceptible target. The normal
skin resident skin flora is often of little consequence
in this situation. However, in the operating area and in
some special situations such as reverse isolation or a
hemodialysis unit or during the outbreaks of hospital
infection, the resident flora may play an additional
important role as a cause of nosocomial infection.
The word hygiene comes from Hygeia, the Greek goddess
of health, who was the daughter of Asclepius, the god of
medicine. The discovery of the germ theory of disease in
the second half of the 19th century, hygiene and sanitation
have been in the forefront of the struggle against illness
and death. Advances in scientific medicine hygiene and
sanitation have resulted in unprecedented longevity and
improved quality of life in the last century and a half of
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