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Using Alcohol for Hand Antisepsis: Dispelling Old Myths

John M. Boyce , MD
Infection Control and Hospital Epidemiology
Vol. 21, No. 7 (July 2000), pp. 438-441
DOI: 10.1086/501784
Stable URL: http://www.jstor.org/stable/10.1086/501784
Page Count: 4
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Using Alcohol for Hand Antisepsis: Dispelling Old Myths
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Abstract

EXCERPT I have taken the unusual step of requesting an editorial from an author of the article being discussed in order to offer an opportunity to place the issues addressed herein in a larger context. A dispute has simmered for more than a decade as to the appropriate role (if any) of waterless hand cleansers, with most American authorities skeptical and European authorities supportive. However, considerable evidence has accumulated in the past few years, as reviewed below by an American expert, and there may no longer be room for dispute—ED. Alcohol has been used as an antiseptic since ancient times. However, the first systematic in vitro studies of the germicidal activity of ethyl alcohol against pure cultures of bacteria were performed by Koch in the early 1880s.1 In the 1890s and early 1900s, alcohol was proposed for use as a skin antiseptic.1 Early investigators discovered that alcohols must be diluted with water for maximal antimicrobial activity and that preparations containing 50% to 70% alcohol were more effective than 95% alcohol.1,2 In 1922, studies in Germany demonstrated the efficacy of an isopropyl alcohol hand rub in reducing bacterial counts on contaminated hands.3 In 1935, isopropyl alcohol was added to the American Medical Association Council on Pharmacy and Chemistry’s list of new and nonofficial remedies, and disinfection of the skin was listed as one of its recommended uses.4 Using more quantitative methods, Price showed in the late 1930s that 65.5% alcohol was effective in reducing the number of bacteria on the skin.1 He subsequently recommended the use of a 3‐minute wash with 70% alcohol as a preoperative hand scrub and that 70% alcohol should be used for disinfecting contaminated hands.1

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