When nurses reported for enrollment, the study nurse rolled a die, and those with odd numbers were assigned to the soap group, and those with even numbers were assigned to the alcoholic–hand-gel group.
When nurses reported for enrollment, the study nurse rolled a die, and those
with odd numbers were assigned to the soap group, and those with even numbers were assigned to the alcoholic–hand-gel group.
Stratification was used to assure that a comparable number of nurses were assigned to the soap group or the alcoholic–hand-gel group on each ward.
Nurses in the soap group washed their hands with nonmedicated soap (Soft N Sure, Steris Corp, St Louis, MO) between care of most patients.
A few patients on study wards were on Contact Precautions, and nurses were asked
to wash with an antiseptic liquid soap containing 2% chlorhexidine gluconate (Steris) after caring for these patients.
The alcoholic hand gel used in the trial was Purell Instant Hand Sanitizer (Gojo Industries, Akron, OH).
This product contains 62% ethyl alcohol, <10% isopropanol, and
emollients.
Dispensers were installed in patient cubicles in the ICU and outside each patient room on the other wards where the trial took place.
Nurses using the alcoholic hand gel were asked to use the gel between most patient-care contacts but were allowed to wash with the nonmedicated soap and water in the event that their hands became contaminated with dirt or proteinaceous material, or to remove buildup of emollients on their hands.
Nurses in both the soap group and the alcoholic-gel group were asked to refrain from using any hand creams or lotions during the trial periods.
Nurses who developed severe irritation or dryness before the completion of the trial were allowed to use lotion, and this was recorded on evaluation forms.
Phase 1 lasted approximately 2 weeks.
Phase 1 was followed by a 2-week rest period, during which all nurses used the standard soap-and-water regimen (nonmedicated soap, except when caring for the few patients on Contact Precautions) and were allowed to use hand lotion or cream.
During phase 2, which lasted 2 weeks, nurses who were initially in the soap group
switched to the alcoholic–hand-gel group, and vice versa. Both groups also were asked to refra
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