作者：Eurona Earl Tilley 齣處：WebMD醫學新聞 　　February 13, 2009 — 根據刊載於2月1日臨床感染性疾病期刊的研究結果 以肥皂和清水洗手以及用酒精乾洗手都可 在降低A型流感方麵 以肥皂和清水洗手優於酒精乾洗手 - 趣味新聞網

發表日期 2009-03-03T08:34:00+08:00

     本帖最後由 goodcat1111 於 2009-3-18 23:40 編輯

作者：Eurona Earl Tilley
齣處：WebMD醫學新聞

February 13, 2009 — 根據刊載於2月1日臨床感染性疾病期刊的研究結果，以肥皂和清水洗手以及用酒精乾洗手都可以有效降低人類手上的A型流感病毒。手部衛生對於降低健康照護工作者、病患與照護者的流感與禽流感傳播很重要。

澳洲墨爾本大學醫學係、Monash大學流行病與預防醫學係、奧斯汀健康中心感染癥部門的M. Lindsay Grayson醫師等人寫道，雖然人與人之間的流感傳播主要是因為空氣微粒，但病患手部與照護者手部的傳染也相當重要；適當的手部清潔實務可以降低傳染風險，但很少有活體資料來確認目前運用之手部清潔規範的抗病毒效果；再者，未清潔之人類手上流感病毒的長期生存能力如何仍不清楚。

研究者評估20名接種過流感疫苗之健康照護工作者使用五種手部清潔規範的情形，手部清潔規範包括三種酒精性乾洗手製劑(61.5%的乙醇膠、70%乙醇加0.5% chlorhexidine的溶液、70% isopropanol 加0.5% chlorhexidine的溶液)，肥皂與清水洗手，以及未使用手部清潔技術的對照組。

為瞭試圖模擬惡化案例的臨床場景，於研究對象的右手掌上倒入高濃度、活的A型流感病毒(H1N1病毒株)，之後於空氣中等待兩分鍾風乾。於進行手部清除規範前後，使用病毒培養以及即時反轉錄聚閤酶連鎖反應(PCR)評估H1N1濃度。此外，一小組參與者(n = 8)被評估他們手上病毒隨著時間的自然生存能力。這些參與者中，未使用手部清潔技術，他們的手在倒上前述的病毒後60分鍾纔評估H1N1濃度。

有趣的是，研究結果發現，在風乾兩分鍾之後，有30%的參與者偵測不到病毒，不過，評估手上H1N1病毒隨著時間自然生存能力這一組，在60分鍾之後，病毒濃度並未繼續下降。在文獻中，Grayson醫師等人解釋，人類的手也許本來就是不利於H1N1的敵意環境，一開始的風乾動作與手部皮膚上的天然油脂或許就有抗病毒效果。

那些在風乾兩分鍾之後於手部偵測齣H1N1的研究對象中，使用三種酒精性乾洗手以及肥皂和清水洗手都能有效降低他們手上的病毒濃度。不過，肥皂和清水洗手在統計上較優於酒精性乾洗手(P < .001)。但實際差彆是，在健康照護工作者的手上，肥皂和清水洗手與酒精性乾洗手之間的病毒濃度差異隻有1-100 copies/μL。

作者結論錶示，我們相信，隻要適當進行手部清潔，我們的發現對於公共衛生有重要影響，因為使用非藥皂和清水簡單的洗手就可以相當有效地減少手上的流感病毒，因此，可以有效預防流感傳播。對於忙碌的健康照護工作者(HCWs)來說，手部清潔頻率相當高的人，使用酒精性乾洗手似乎是個適閤的替代方法。

Soap and Water Hand Washing Superior to Alcohol-Based Rubs in Reducing Presence of Influenza A

By Eurona Earl Tilley
Medscape Medical News

February 13, 2009 — Soap and water hand washing and alcohol-based rubs are effective reducing the presence of influenza A virus on human hands, according to the results of a study published in the February 1 issue of Clinical Infectious Diseases. Hand hygiene may play an important role in reducing the transmission of pandemic and avian influenza among healthcare workers, patients, and caregivers.

"Although person-to-person transmission of influenza virus is due primarily to aerosol spread, transmission on the hands of patients and their caregivers is also potentially important," write M. Lindsay Grayson, MBBS, MD, MSC, FRACP, FAFPHM, from the Infectious Diseases Department, Austin Health, the Department of Epidemiology and Preventive Medicine, Monash University, and the Department of Medicine, University of Melbourne, Australia, and colleagues. "Appropriate hand-hygiene practices should reduce transmission risk, but there are few in vivo data to confirm the antiviral efficacy of currently available HH protocols. Furthermore, the long-term viability of influenza virus on unwashed human hands remains unclear."

The researchers evaluated the use of 5 hand hygiene protocols on 20 healthcare workers who had previously undergone vaccination with the influenza virus. The hand hygiene protocols included 3 alcohol-based hand rubs (61.5% ethanol gel, 70% ethanol plus 0.5% chlorhexidine solution, and 70% isopropanol plus 0.5% chlorhexidine solution), soap and water hand washing, as well as a control protocol which contained no hand hygiene technique.

In an attempt to mimic a worse-case clinical scenario, a high contaminating concentration of live influenza A virus (H1N1 strain) was poured into the right palm of study participants and then allowed to air dry for 2 minutes. The concentration of H1N1 was evaluated by viral culture and real-time reverse-transcriptase polymerase chain reaction (PCR) both before and after the use of the hand hygiene protocols. In addition, a subset of the participants (n = 8) were assessed for the natural viability of the virus over time in their hands. Among these participants, hand hygiene techniques were not used and their hands remained contaminated for 60 minutes before being evaluated for the concentration of H1N1.

Interestingly, the results of the study revealed that the virus was undetectable in 30% of the participants following the 2-minute air drying period. Nevertheless, no further reductions in the viral concentration occurred following the additional 60-minute waiting period among the subset of participants used to assess the natural viability of H1N1. In the article, Dr. Grayson and colleagues explain that “human hands may be a naturally hostile environment for H1N1 and that the initial act of drying and possibly the presence of natural skin oils on the hands may also have an antiviral effect.”

Among those participants with detectable H1N1 after the 2-minute drying period, the 3 alcohol-based hand rubs as well as soap and water hand washing were effective in reducing the viral concentration on participants' hands. However, soap and water hand washing was shown to be statistically superior (P < .001) to the alcohol-based hand rubs. The actual difference, though, in viral concentration on the healthcare worker’s hands with soap and water hand washing vs the alcohol-based hand rubs was only 1-100 copies/μL.

"We believe that our findings have potentially important public health implications, because simple hand washing with unmedicated soap and water appears to be highly effective in removing influenza virus from hands and is, therefore, likely to be effective in preventing transmission of influenza, as long as [hand hygiene] is undertaken appropriately," the authors conclude. "For busy HCWs for whom the number of [hand hygiene] opportunities is likely to be very high, the use of [alcohol-based hand rubs] would seem to be a very suitable alternative."

Clin Infect Dis. 2009;48:285–291.

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