Health care workers’ hand contamination levels and antibacterial efficacy of different hand hygiene methods used in a Vietnamese hospital

Handwashing with soap or another antisepsis disinfectant solution is a common practice in Vietnam, but the availability and quality of tap water is unpredictable. We assessed the risk for hand contamination and compared the efficacy of 5 hand hygiene methods in a tertiary Vietnamese hospital. Five fingertip imprints of the dominant hand of 134 health care workers (HCWs) were sampled to establish the average bacterial count before and after hand hygiene action using (1) alcohol-based handrub (ABHR), (2) plain soap and water handwashing with filtered and unfiltered water, or (3) 4% chlorhexidine gluconate hand antisepsis with filtered and unfiltered water. Average bacterial contamination of hands before hand hygiene was 1.65 log(10). Acinetobacter baumannii, Klebsiella pneumoniae, and Staphylococcus aureus were the most commonly isolated bacterial pathogens. The highest average count before hand hygiene was recovered from HCWs without direct patient contact (2.10 ± 0.11 log(10)). Bacterial counts were markedly reduced after hand hygiene with ABHR (1.4 log(10); P < .0001) and 4% chlorhexidine gluconate with filtered water (0.8 log(10); P < .0001). Use of unfiltered water was associated with minimal non-significant bacterial reduction. HCWs carry high levels of bacteria on their dominant hand, even without direct patient contact. ABHR as an additional step may overcome the effect of high bacterial counts in unfiltered water when soap and water handwashing is indicated.