***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The effectiveness of an alcoholic solution compared with the st and ard hygienic h and washing procedure during regular work in clinical wards and intensive care units of a large public university hospital in Barcelona was assessed . METHODS A prospect i ve , r and omized clinical trial with crossover design , paired data , and blind evaluation was done . Eligible health care workers ( HCWs ) included permanent and temporary HCWs of wards and intensive care units . From each category , a r and om sample of persons was selected . HCWs were r and omly assigned to regular h and washing ( liquid soap and water ) or h and washing with the alcoholic solution by using a crossover design . The number of colony-forming units on agar plates from h and s printing in 3 different sample s was counted . RESULTS A total of 47 HCWs were included . The average reduction in the number of colony-forming units from sample s before h and washing to sample s after h and washing was 49.6 % for soap and water and 88.2 % for the alcoholic solution . When both methods were compared , the average number of colony-forming units recovered after the procedure showed a statistically significant difference in favor of the alcoholic solution ( P < .001 ) . The alcoholic solution was well tolerated by HCWs . Overall acceptance rate was classified as " good " by 72 % of HCWs after 2 weeks use . Of all HCWs included , 9.3 % stated that the use of the alcoholic solution  worsened minor pre-existing skin conditions . CONCLUSIONS Although the regular use of hygienic soap and water h and washing procedures is the gold st and ard , the use of alcoholic solutions is effective and safe and deserves more attention , especially in situations in which the h and washing compliance rate is hampered by architectural problems ( lack of sinks ) or nursing work overload Two methods for artificial contamination of h and s and two sampling techniques to recover the test organisms were compared for their effects on the results of two post-contamination h and treatments : a h and rub with two portions of 3 ml of 2-propanol 60 % v/v for 1 min , and a h and wash with liquid soap 20 % w/v for 1 min followed by a 15 s rinse . The two contamination methods involved a short immersion of the h and s ( up to the middle of the mid-h and ) in a suspension of the test organism followed by either air-drying ( 3 min ) or drying by rubbing the h and s ' vigorously against each other ( 3 min ) in a st and ardized way . The two sampling techniques consisted of rubbing the fingertips in either 10 ml trypticase soy broth ( TSB ) against the bottom of a Petri dish ; or 100 ml TSB against glass beads contained in a bowl . Sixteen volunteers were r and omly allotted to four blocks of four . They carried out the four possible combinations of two treatments and two contamination methods in a series of four tests arranged in a Latin-square design . In addition , the two sampling techniques were compared with each other concurrently by sampling of the right and left h and each with a different one of the two techniques . The alcoholic h and rub reduced the release of test organisms significantly ( 2P less than 0.005 ) more effectively , by 1.1 - 1.3 x log10 , than did the h and wash with liquid soap , regardless of the contamination or sampling method . Whereas the two recovery techniques yielded virtually identical results in corresponding situations , the method of artificial contamination affected the mean reduction factors , strongly . ( ABSTRACT TRUNCATED AT 250 WORDS Objective To compare skin condition and skin microbiology among intensive care unit personnel using one of two r and omly assigned h and hygiene regimens : a 2 % chlorhexidine gluconate (CHG)-containing traditional antiseptic wash and a waterless h and rub containing 61 % ethanol with emollients ( ALC ) . Design Prospect i ve , r and omized clinical trial . Setting Two critical care units ( medical and surgical ) in a large , metropolitan academic health center in Manhattan . SubjectsFifty staff members ( physicians , nurses , housekeepers , respiratory therapists ) working full time in the intensive care unit . Interventions One of two h and hygiene regimens r and omly assigned for four consecutive weeks . Measurements and Main Results The two outcomes were skin condition ( measured by two tools : H and Skin Assessment form and Visual Skin Scaling form ) and skin microbiology . Sample s were obtained at baseline , on day 1 , and at the end of wks 2 and 4 . Participants in the ALC group had significant improvements in the H and Skin Assessment scores at wk 4 ( p = 0.04 ) and in Visual Skin Scaling scores at wks 3 ( p = 0.01 ) and 4 ( p = 0.0005 ) . There were no significant differences in numbers of colony-forming units between participants in the CHG or ALC group at any time period . The ALC regimen required significantly less time than the CHG regimen ( mean : 12.7 secs and 21.1 secs , respectively;p = 0.000 ) and result ed in a 50 % reduction in material costs . Conclusions Changes in h and hygiene practice s in acute care setting s from the traditional antiseptic wash to use of plain , mild soap and an alcohol-based product should be considered . Further research is needed to examine the association between use of antiseptic products for h and hygiene of staff and reductions in nosocomial infection rates among patients Alcohol-based gels have been introduced recently in many hospitals worldwide for h and antisepsis . We investigated the antimicrobial efficacy of ten gels and four rinses  according to European st and ards ( EN 1500 ) . No gel met the EN 1500 requirements within 30 s of application , whereas all h and rinses did . The tested h and gels should be considered a retro grade step for h and hygiene because the application time in clinical practice is often shorter than 30 s ; they should not replace alcohol-based liquid h and disinfectants currently used in hospitals or be implemented as first choice agents Outbreaks of gram-negative colonization ( generally by antibiotic-resistant enterobacteria ) are common in newborn intensive care units ( NICUs ) , and control methods are not always effective . We studied the effectiveness of an alcohol solution of N-duopropenide ( NDP ) in vivo ( germicidal effect on flora of teams in the NICU and the pediatric intensive care unit vs h and washing with nonantiseptic soap ) and its effect on the control of a multiresistant ( MR ) Klebsiella pneumoniae outbreak  in our NICU that had persisted for 13 months , despite the use of classic control measures . For educational purpose s , we also performed 4 prevalence studies of microbial h and flora in NICU staff ( two before and two after introducing NDP ) . The alcohol solution of NDP was highly germicidal in vivo , destroying microorganisms better than classic h and washing on the h and s of 69 health care staff of our NICU and PICU . The flora in both units was reduced from an average of 63 % to an average of 95 % . Application of this disinfectant to the h and s of health care workers after h and ling newborns helped to eliminate the MR Klebsiella strain in our NICU , ( relative risk compared with the period preceding use of the disinfectant : 8.6 , with 95 % confidence intervals , 4.8 - 145.5 ) . Four prevalence studies of h and microbial contamination , before and after NDP introduction in the NICU , showed a significant reduction of enterobacteriaceae , mainly MR K pneumoniae , in health care workers . In conclusion , NDP in alcohol was very effective in vivo . It proved to be a useful complementary measure to h and washing and reduced exogenous microorganism transmission in a unit with a heavy patient-care workload OBJECTIVES To establish the concentration of isopropanol that exerts the same immediate and sustained effects as n-propanol 60 % v/v in surgical scrubbing , and to assess the performance of the test method proposed as the European st and ard in parallel experiments . DESIGN Isopropanol at concentrations of 70 % , 80 % , and 90 % v/v was tested in comparison with n-propanol 60 % , the proposed reference preparation , in the draft method proposed by the European st and ard . A Latin square design was used with four balanced blocks of five volunteers each in four experimental runs that were spaced by intervals of 1 week each . Volunteers were allotted r and omly to one of the four blocks . Independently , the volunteers ' right and left h and s also were r and omized into two groups for the assessment of either immediate or sustained effects . SETTING Two laboratories supervised by two investigators , one from Vienna , Austria , and one from London , The United Kingdom . METHOD The release of skin flora from the fingertips of clean h and s was assessed before and after treatment by immediate sampling from one h and and by sampling of the other , gloved h and after 3 hours . The mean log10 reductions ( RF ) of bacterial release achieved by rubbing the alcoholic preparations for 3 minutes onto the h and s were established . RESULTS For both experiments , the immediate effects of isopropanol 70 % ( RF , 2.0 and 2.1 , respectively ) were significantly smaller than those of the reference n-propanol 60 % ( RF , 2.4 and 2.6 , respectively ) . This also was found with the sustained effects ( RF , 0.7 and 1.1 vs 1.0 and 1.6 , respectively ) . At 90 % , isopropanol equalled the immediate effect of n-propanol 60 % , whereas at 80 % it proved slightly ( although not significantly ) less active . There were no significant differences in the results of both investigators . The sustained effects of isopropanol 80 % and 90 % were both larger than the reference in Vienna but were found smaller by the London investigator ; none of the differences were significant . Mean RFs were significantly different between Vienna and London with n-propanol 60 % and isopropanol 70 % , but not with isopropanol at 80 % or 90 % . CONCLUSIONS At 90 % , isopropanol is as effective as n-propanol 60 % , which was proposed by the European Committee for St and ardization as a reference in testing products for surgical h and disinfection . It could , therefore , serve as an alternative if the proposed agent is undesirable for any reason . In parallel experiments by two investigators , the proposed test method proved well workable ; the results were very similar and the conclusions identical 
    Output:
    
Alcohol-based h and rub  removes microorganisms from h and s of personnel more effectively , requires less time , and irritates h and s less often than traditional h and washing with nonmedicated soap or other antiseptic agents and water .
The combination of 61 % ethanol and 1 % chlorhexidine gluconate ( CHG ) is even more effective in producing residual antibacterial properties on the skin .
Furthermore , the availability of bedside alcohol-based solutions increased compliance with h and hygiene among HCWs .
CONCLUSION Rubbing h and s with alcohol-based agents has been proved to be effective in the reduction of microorganisms from h and s. Alcohols are effective for preoperative cleaning of the h and s of surgical personnel .
Addition of CHG to alcohol-based solution can produce residual antibacterial properties on the skin .
The use of alcohol-based solutions containing emollients causes less skin irritation and dryness and requires less time than washing h and s with soap or other disinfectants .
The promotion of bedside , alcohol-based h and rubs contributes to the increase in compliance with h and hygiene by HCWs