Context The intentional use of Bacillus anthracis transmitted
via the US mail in October-November 2001 resulted in 22 people developing
inhalation or cutaneous anthrax. Glove use with handwashing prior to and after
contact with potential contaminated environmental surfaces and cutaneous lesions
has been recommended. However, only limited data are available on the susceptibility
of B anthracis to antiseptics.
Objective To evaluate the efficacy of several hand antiseptics (interventions)
and soap and water (control) against Bacillus atrophaeus, a surrogate of B anthracis.
Design, Setting, and Participants Challenge study conducted among healthy adult volunteers, using the
Standard Test Method for Evaluation of the Effectiveness of Health Care Professional
Handwash Formulations (American Society for Testing and Materials E 1174-94)
to determine the efficacy of various hand hygiene products at wash times of
10, 30, and 60 seconds. Volunteers were excluded if they had eczema, psoriasis,
or other chronic skin conditions; nonintact skin; or allergies to any study
agent. Study agents were a waterless rub containing 61% ethyl alcohol, a 2%
chlorhexidine gluconate preparation, and an antibacterial microfiber towel
that releases hypochlorite. A nonantimicrobial soap was used as a control.
Main Outcome Measure Reduction of B atrophaeus spores (log10 CFU/mL) on contaminated hands.
Results Washes of 10, 30, and 60 seconds with either soap and water or 2% chlorhexidine
gluconate eliminated 1.5 to 2.0 log10 CFUs/mL of B atrophaeus spores at wash 3. Mean reductions (95% confidence intervals)
with 10-, 30-, and 60-second washes with soap and water were 2.4 (2.2-2.5),
2.3 (2.2-2.4), and 2.1 (1.9-2.4) log10 CFUs/mL, respectively; and
with 2% chlorhexidine gluconate, 2.1 (2.0-2.3), 1.8 (1.5-2.0), and 1.7 (1.5-1.9)
log10 CFUs/mL, respectively. Handwashing with chlorine-containing
towels was increasingly effective as the wipe time increased; reductions at
10, 30, and 60 seconds were 1.3 (1.1-1.5), 1.6 (1.2-2.0), and 2.2 (2.1-2.2)
log10 CFUs/mL, respectively. A waterless rub containing 61% ethyl
alcohol was ineffective in eliminating B atrophaeus spores
at all times tested (0 [−0.1 to 0.1], −0.2 [−0.3 to −0.1],
and 0 [−0.2 to 0.2] log10 CFUs/mL).
Conclusions In this evaluation of hand hygiene agents, handwashing with soap and
water, 2% chlorhexidine gluconate, or chlorine-containing towels reduced the
amount of B atrophaeus spore contamination, whereas
use of a waterless rub containing ethyl alcohol was not effective in removing