1947-5764/16/$35.00 © 2016 by Begell House, Inc. 235 Plasma Medicine, 6(3–4): 235–245 (2016) Pla sm a - A c tiva te d Va p o r fo r Sa nitiza tio n o f Ha nd s Isam Osman, Aravind Ponukumati, Michael Vargas, Dipesh Bhakta, Berk Ozoglu, & Charles Bailey* School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA 19104 *Address all correspondence to: Charles Bailey, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA 19104, E-mail: shicktopher@gmail.com ABSTRACT: Compliance with established hand hygiene protocols is extremely low in clini- cal units because these protocols mandate long hand-washing times. This phenomenon re- sults in more numerous healthcare-associated infections and severely compromises the health of patients. Poor compliance is motivated by the hand-washing times required by soaps and sanitizers, which can be as long as 2 minutes. Cold atmospheric plasma is an alternative anti- microbial technology that can reduce the time required for sanitization to approximately 5 s. However, despite many advantages, existing plasma devices generate ozone as a toxic byprod- uct in high concentrations, so there is a need for a plasma-based hand sterilization system that: (1) produces enough reactive oxygen and nitrogen chemical species to achieve a microbial kill rate that is able to compete with existing hand-sanitizing technology and (2) counteracts the conversion of plasma into ozone. The design presented here used water vapor to perform these functions and to stabilize reactive plasma species. The plasma system delivers a plasma- DFWLYDWHG ZDWHU YDSRU PL[WXUH WR D KDQG VXUIDFH E\ WKH DFWLRQ RI D KXPLGLｿHU WKDW LV PXFK VDIHU DQG PRUH HIｿFLHQW WKDQ RWKHU SODVPD VDQLWL]DWLRQ V\VWHPV RQ WKH PDUNHW 7KH RSHUDWLRQDO SUR- totype consists of three stages: ultrasonic water vapor generation, dielectric-barrier discharge plasma generation, and a dispensary tubing system. We have shown that the device is capable RI GLVDJJUHJDWLQJ EDFWHULD LQ  V ZLWK VLJQLｿFDQW UHGXFWLRQV LQ R]RQH FRQFHQWUDWLRQV WKURXJK the use of water vapor. KEY WORDS: plasma medicine, sanitization, healthcare-associated infections, ozone, hand hygiene I. INTRO DUC TIO N Compliance with established hand hygiene protocols is as low as 43.2% in intensive care unit settings. 1 This compliance rate is far below the 90% recommendation from the Joint Commission. 2 Poor handwashing compliance has been associated with cross- transmission of healthcare-associated infections (HAIs) and heightened mortality rates in hospitals. The Centers for Disease Control and Prevention (CDC) has determined that one of the main reasons for substandard hand-washing compliance is the length of time required for these protocols; in fact, most physicians do not comply with the long hand-washing times required for effective sanitization. 3 For example, proper sani- tization using alcohol-based sanitizers (ABS) requires approximately 30 s and using antimicrobial hand soap requires at least 1 min in order to be effective. 3 Neverthe-