Burns 27 (2001) 747–752 A new alcohol solution (N -duopropenide) for hygienic (or routine) hand disinfection is more useful than classic handwashing: in vitro and in vivo studies in burn and other intensive care units Rafael Herruzo-Cabrera *, Juan Garcı ´a-Caballero, Marı ´a Jesu ´ s Fernandez-Acen ˜ ero Department of Preentie Medicine, School of Medicine, Auto ´noma Uniersity Madrid, and Serice of Preentie Medicine, Hospital La Paz, Madrid, Spain Accepted 23 January 2001 Abstract Introduction: Standard handwashing is a key measure for the prevention of crossed nosocomial infection, but this measure is not always observed. We study whether fast disinfection with an alcohol solution is better than handwashing and whether it can enhance observance. Materials and methods: The effects of several alcohol solutions on native and acquired microbiota are compared with classic handwashing in ‘in vitro’ and ‘in vivo’ (health volunteers) quantitative tests. A field assay was subsequently performed in severely ill patient intensive care units (ICUs) (Burn and other ICUs), using a semiquantitative method to compare the effects of disinfection with standard handwashing (n =102) with N-duopropenide alcohol application (n =264). Results and discussion: In both designs — health volunteers and hospital ward teams — we found significant differences between handwashing and N-duopropenide application. Handwashing barely modified the native or acquired microbiota (only 0.1 to 2 log 10 reduction) and did not eliminate Staphylococcus aureus and Gram-negative bacteria (from 34 to 23%: P 0.05). However, N-duopropenide reduced the acquired microbiota by 5 log 10 and the native hand microbiota by more than 2 log 10 , as well as significantly reducing S. aureus and Gram-negative bacteria (33 – 1.3%; P 0.01). © 2001 Elsevier Science Ltd and ISBI. All rights reserved. Keywords: N-Duopropenide-alcohol; Hygienic hand disinfection; Burn ICU www.elsevier.com/locate/burns 1. Introduction Although routine hand disinfection is a key measure in the prevention of nosocomial infection, observance of this measure only occurs on less than 40% of oppor- tunities, even in units with critically ill patients [1]. The reasons for this lack of observance include poor bath- room placement, lack of time, forgetfulness or rejection of the usual recommendations or negligence. Health education, usually given by the Preventive Medicine Unit, can improve observance of these measures, but the efficacy of the educational programs is only tempo- rary. Another problem is that even people who do disinfected their hands wash for too short a time and do not reach the recommended 15–30 s, usually spend- ing only 8–10 s, including water rinsing [2,3]. The Centers for Disease Control (CDC) [4] has proposed that hand disinfection should take at least 10 s, fol- lowed by hand rinsing with tap water, and this recom- mendation may have led some people to reduce the duration of the handwashing even more. The CDC recommendations regarding antiseptics with a residual effect, like chlorhexidine, are being replaced by hand- washing of the same duration but with normal soap, which is less efficient in so far as eliminating native and acquired microbiota, and can negatively influence the control of nosocomial infections, particularly in suscep- tible patients. These facts have led to a search for alternative prod- ucts with a significant residual effect that can improve * Corresponding author. Present address: Department of Preven- tive Medicine. School of Medicine, Auto ´ noma University of Madrid, C/ Arzobispo Morcillo 4, 28029 Madrid, Spain. Fax: +34-1- 3975353. E-mail address: rafael.herruzo@uam.es (R. Herruzo-Cabrera). 0305-4179/01/$20.00 © 2001 Elsevier Science Ltd and ISBI. All rights reserved. PII:S0305-4179(01)00013-4