Hand Hygiene: Are Indigenous Medicine Based Medicated Hand Washing Products Effective?

Background: In the Indian market a variety of medicated hand washing products based on indigenous medicine (MHWPs) are available but not much reliable data is available regarding their efficacy in Hygienic Hand Disinfection (HHD). Similarly not much is known about the efficacy of LI, which is commonly used in our hospital and also in many other hospitals. In the present study we evaluated and compared the efficacies of three such products AY, JE and ME and LI against a plain soap (PL) and an alcohol based preparation (ST).

Objective: To evaluate the efficacy of three indigenous medicine based hand washing products and a commonly used bar soap in Indian hospitals in hygienic hand disinfection.

Methods: Experiments were conducted on 12 volunteers using Escherichia coli ATCC 25922 and a clinical isolate of coagulase negative Staphylococcus (CNS) as test organisms. Test products were coded as AY, JE, ME and LI and control preparations used were an alcohol-based preparation (ST) and plain soap (PL). The efficacy of the test products was assessed using the hygienic hand disinfection test essentially as described by Ayliffe, Babb & Quoraishi. Quantitative cultures were done as described by Miles and Misra. Average of counts from left and right hands was calculated and the difference in log10 of the counts for pre- and post-disinfection conditions, i.e., log10 reduction factor (RF) was determined. Average of RF values of all the volunteers for each product was determined for each test-organism and these mean RFs of all the test-products and control preparations were then compared statistically using student-t test. The relationship between the numbers of bacteria applied and recovered indicates the effectiveness of the product used. The results obtained with each product were compared amongst themselves and with the control preparations.

Results: The tests for efficacy revealed that alcohol based hand-wash preparation was significantly more efficacious than other products (p value<0.05) and that there was no significant difference in the efficacy of the test-products and plain soap when compared after 30 seconds application time (p value>0.05), The study also showed that most of the products were significantly more effective against Escherichia coli than against coagulase-negative Staphylococcus (p value <0.05).

Conclusions: Results indicate that like plain soap, the test products including LI were exerting their effect mainly due to mechanical and detergent action and the presence of disinfectant action due to the agents present, if any, is questionable when applied for 30 seconds. It seems that for most ward procedures a plain soap would suffice and the choice of agent is usually un-important provided it is used correctly and at the appropriate time, but in some circumstances, the more efficacious agent i.e. alcohol may be preferred, e.g., in ICUs or during outbreaks of infection.