Larson 2000.

Study characteristics
Methods	Randomised controlled trial
Participants	16 full‐time neonatal intensive care unit (NICU) nurses. Number of neonates not mentioned Inclusion criteria: nurses were selected for inclusion in the study because they represented stable and consistent staff and because approximately 70% of direct patient contacts on that unit were provided by nurses. Setting: 1 NICU (47 beds) in a New York City children’s hospital Country: USA Health status: nurses working/babies in NICU Numbers: treatment (8); control (8) Age (mean ± SD) Treatment: not reported Control: not reported Sex (M/F) Treatment (M/F): not reported Control (M/F): not reported "Nurses were eligible to participate if they worked full time on day or night shift in the NICU, had no dermatologic conditions such as psoriasis or latex hypersensitivity, were not receiving topical or systemic steroids or antibiotics, were willing to be randomly assigned to one of 2 treatment groups and follow all study regimens, and had no holiday scheduled during the 4‐week study period". Exclusion criteria Not reported
Interventions	Treatment group Antiseptic detergent handwash (2% chlorhexidine gluconate) alone. Regimen: "a 2‐min scrub using a saturated surgicals sponge brush containing 25 mL of a 4% CHG‐containing detergent (Scrub Care, Exidine Saturated Surgical Scrub Brush, Allegiance Health Care, McGraw Park, IL) when coming on duty. Handwashing with a 2% CHG product (Scrub‐Care) throughout the working shift. Liberal use of CHG‐compatible lotion (Prima‐Kare Lotion, Steris, St Louis, MO) during working hours (activity of CHG is neutralised by most lotions and therefore must be used only with specially formulated nonionic moisturising products). No restrictions or modifications of skin hygiene practices at home. Non‐latex gloves only" Control group Detergent soap and alcohol hand rinse (60% alcohol and emollients) Regimen: "a short (15 sec) wash with mild, non‐antimicrobial liquid detergent soap (Kindest Kare BodyWash and Shampoo, Steris, St Louis, MO) followed by a 10 sec application of a 60% isopropanol preparation containing emollients (Cal‐Stat, Steris, St Louis, MO) when coming on duty (no scrub). Use of the mild, non‐antimicrobial soap at work and at home to remove soil. A short application (10‐15 sec) of the alcoholic preparation throughout the working shift when hand degerming was indicated. Liberal and scheduled (4 times/day and as needed) use of an oil‐based skin emollient/moisturiser (Curel, Bausch & Lomb, Rochester, NY). No use of other antimicrobial skin products at home or work. Non‐latex gloves only"
Outcomes	Changes in the numbers of colony‐forming units (CFUs) on nurses’ hands Skin condition rating of nurses’ hands
Notes	This study was supported in part by Steris Corporation, St Louis, MO.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	16 nurses (8 per group) were randomly assigned by coin toss to 1 of 2 hand care regimens.
Allocation concealment (selection bias)	High risk	It was not reported if allocation was concealed; probably not done
Blinding of participants and personnel (performance bias) All outcomes	High risk	No blinding, and 1 of the outcomes (self‐rating hand skin assessment) was likely to be influenced by lack of blinding.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not stated whether outcome assessors were blinded to the intervention
Incomplete outcome data (attrition bias) All outcomes	Low risk	All participants were accounted for.
Selective reporting (reporting bias)	Low risk	All important outcomes were reported.
Other bias	Low risk	None was suspected.