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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

 


professional globally.

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

use.

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Bioshields has created appropriate icons for easy visualiz -

ation and understanding of the product application,

intended use of any relevant product and product

highlights. These icons are especially useful to understand

the usage potential of products, as many products have

multiple applications. These icons are displayed prominently on the product labels.

Hand Care

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

corneum), the viable epidermis, the dermis and the hypodermis. The primary function of the skin is to reduce

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

 to 4.6 × 106

. Price

(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,

Sterilization 35

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

normally harmless but when transferred to an immunocompromised person could result in clinical conditions.

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

infections. The flora can be varied; they include Staphylococcus aureus, Pseudomonas, methicillin-resistant

Staphylococcus aureus (MRSA), and vancomycin-resistant

Enterococcus (VRE).

The hygienic hand wash aims on mechanically remove

dirt and loosely adherent transient flora and, simultaneously, to inactivate strongly adherent transient flora

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

flora.

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.

Various agents used are:

¾ 0.5% w/v triclosan

¾ Chlorhexidine

¾ Isopropyl alcohol.

Antiseptics

General Antisepsis

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

medical history. Of particular importance in medical

history, puerperal fever was one of those dreaded diseases

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