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Hands

Hygienic Hand Disinfection

Kampf G., Pitten F.-A., Heeg P.,
Christiansen B.
Efficacy of two alcohol-based antiseptic agents on the forehead at shorter application times
BMC Microbiology 2007, 7:85doi:10.1186/1471-2180-7-85

Content
For most of the antiseptic agents in Central Europe an application time of 10 minutes is recommended on skin with many sebaceous glands. This is one of the first studies to determine a shorter but likewise effective application time (10, 2.5 and 2 minutes) for different formulations. The efficacy requirements were fulfilled at 2.5 minutes application time on the skin of the forehead by the colourless and coloured antiseptic agents.

A German translation of this article can be requested from Anja Deecke.
Please send an e-mail message.

 

Kramer A, Bernig T, Kampf G.
Clinical double-blind trial on the dermal tolerance and user acceptability of six alcohol-based hand antiseptics for hygienic hand antisepsis.
J Hosp Infect. 2002; 51: 114-120.

Content of the study
In a clinical randomized double-blind study six alcohol-based hand disinfectants have been tested for their skin tolerability. From an objective point of view, all preparations possessed a good compatibility. From a subjective point of view, Sterillium® was evaluated significantly better in terms of skin moisture ever and replenishing characteristics.

A German translation of this study was published in: Krankenhaushygiene + Infektionsverhütung, 2003; 25: 245-251.

 

Kramer A, Rudolph P, Kampf G, Pittet D.
Limited efficacy of alcohol-based hand gels.
The Lancet 2002; 359: 1489-1490.

Content of the study
Most alcohol-based gels (e.g. Purell) do not meet the European efficacy requirements in accordance with EN 1500 as do comparable liquid products (e.g. Sterillium®). Hence, these gels are not suitable for hygienic hand disinfection in health care practise.

 

Kampf G, Rudolf M, Labadie JC, Barrett SP.
Spectrum of antimicrobial activity and user acceptability of the hand antiseptic Sterillium® Gel.
J Hosp Infect. 2002; 52: 141-147.

Content of the study
Sterillium® Gel* is the first alcohol-based gel, which is comparable to alcohol-based liquid preparations in terms of efficacy. Additionally, it has a distinctive effect on a number of viruses.

* not available in Germany

 

Kampf G, Ostermeyer C.
Intra-laboratory reproducibility of the hand hygiene reference procedures of EN 1499 (hygienic hand wash) and EN 1500 (hygienic hand disinfection)
J Hosp Infect. 2002; 52: 219-224.

Content of the study
In Europe, the efficacy of hand hygiene preparations is determined in accordance with EN 1499 (hygienic hand washing) and EN 1500 (hygienic hand disinfection). A total of 35 trials with 15 test persons each were analyzed, and confirmed an excellent reproducibility of these methods. Thus, it is proven that the European test methods are suitable for the determination of in-vivo efficacy.

 

Surgical Hand Disinfection

Labadie JC, Kampf G, Lejeune B, Exner M, Cottron O, Girard R, Orlick M, Goetz ML, Darbord JC, Kramer A.
Recommendation for surgical hand antisepsis – requirements, implementation and need for research. A proposal by representatives of the SFHH, DGHM and DGKH for a European discussion.
J Hosp Infect. 2002; 51: 312-315.

Content
Societies for hygiene developed a draft for a European recommendation with regard to surgical hand disinfection. Alcohol-based preparations are to be used preferably. In principle, washings prior to disinfection can be neglected.

A German translation of this article was published in: Hygiene + Medizin, 2002; 27: 166-168.

 

Girard R, Réat C, Carboni N, Bouket J-L.
L´antisepsie chirurgicale des mains peut-elle remplacer en routine le lavage chirugical des mains? Essai en bloc d´orthopédie réglée.
Hygiènes 1996; 12 : 34-38.

Content of the study
In an orthopedic operation room, 31 employees used Sterillium® for surgical hand disinfection. After more than two weeks, significantly fewer skin irritations occurred than with the previously used antimicrobial wash lotions.

Pitten F-A, Rudolph P, Below H, Kramer A.
Assessment of the activity of antiperspirants added to surgical hand antiseptics: methodological aspects and first observations.
J Hosp Infect. 2001; 29-32.

Content of the study
As the microorganisms resident on the hand attain to the skin via perspiratory glands, a preparation’s antiperspirant effect is not only of cosmetic interest for surgical hand antisepsis. For the first time, a sweat reducing effect of the ingredient Mecetronium etilsulfate in Sterillium® has been proven.

 

Compliance

Kampf G (Ed.)
Hand hygiene in health care.
Springer Verlag Berlin Heidelberg New York 2003, ISBN 3-540-44200-6; € 59,95.

Content of the book
With this textbook, which has been conceived as standard work, Dr. Günter Kampf (editor) and an international team of authors have a share in increasing compliance in hand hygiene. Being scientifically substantiated and practice-oriented at the same time, this book deals with current hand hygiene aspects, e.g. epidemiological relevance of hands, toxicology and tolerability of active ingredients, compliance, international norms and recommendations, financial benefit.

 

Kampf G.
State-of-the-art hand hygiene in community medicine.
Int J Hyg Environ Health. 2003 Oct; 206 (6): 465-472.

Content
Hand hygiene becomes more and more important even in outpatient medical care – last but not least because of the spread of methicillin-resistant Staphylococcus aureus (MRSA). This article deals with alcohol-based hand disinfection as state-of-the-art hand hygiene in consideration of dermatological aspects.

Kampf G, Höfer M, Wendt C.
Efficacy of hand antiseptics against vancomycin-resistant enterococci in vitro.
J Hosp Infect. 1999; 42: 143-150.

Contents of the study
A quantitative suspension trial tested various hand disinfection preparations for their efficacy against 7 different vancomycin-resistant enterococci (VRE) strains. Sterillium® demonstrated an excellent efficacy against VRE with reduction factors of > 7, already after 15 seconds.

 

Kampf G, Jarosch R, Rüden H.
Limited effectiveness of chlorhexidine based hand antiseptics against methicillin-resistant Staphylococcus aureus (MRSA).
J Hosp Infect. 1998; 38: 297-303.

Content of the study
A quantitative suspension trial tested various hand disinfection preparations for their efficacy against 3 different methicillin-resistant Staphylococcus aureus (MRSA) strains. Preparations based on chlorhexidine were significantly less effective than alcohol-based preparations. In addition, MRSA proved to be much harder to inactivate with chlorhexidine than methicillin-sensitive S. aureus.

 

Maury E, Alzieu M, Baudell Jl, Haram N, Barbut F, Guidet B, Offenstadt G.
Availability of an alcohol solution can improve hand antisepsis compliance in an intensive care unit.
Am. J. Respir. Crit. Care Med. 2000; 162: 324-327.

Content of the study
In an internal intensive care unit Sterillium® was introduced for hand disinfection. The compliance was observed over a period of 5 weeks. Compliance could be increased significantly (from 42.4% to 60.9%). Skin compatibility with repeated application was described as good.

Pittet D.
Improving compliance with hand hygiene in hospitals.
Infect. Control Hosp. Epidemiol. 2000; 21: 381-386.

Content of the study
Compliance with hand hygiene is a multi-factorial and complex incident. Many interventions to increase compliance failed. However, if the reasons for non-compliance are known, purposeful interventions can be realized.

 

Pittet D, Hugonnet S, Harbarth S, Monronga P, Sauvan V, Touveneau S, Perneger TV.
Effectiveness of a hospital-wide program to improve compliance with hand hygiene.
Lancet 2000; 356: 1307-1312.

Content of the study
By the means of introducing an alcohol-based hand disinfectant and a campaign promoting hand disinfection, a significant reduction of the prevalence of nosocomial infections could be proven (from 16.9% to 9.9%) in the University Hospital of Geneva over a period of 6 years. In the same period, the incidence rate of MRSA could also be significantly reduced.

 

Voss A, Widmer AF.
No time for hand washing!? Hand washing versus alcohol-based rub: can we afford 100% compliance?
Infect. Control Hosp. Epidemiol. 1997; 18: 205-208.

Content of the study
Theoretical calculations prove that much less time has to be spent for hygienic hand disinfection with alcohol-based solutions. In other words: in the same available time, one can disinfect hands more often and thus contribute to an increased compliance.

Efficacy

Kampf G, Hollingsworth A.
Validity of the four European test strains of prEN 12054 for the determination of comprehensive bactericidal activity of an alcohol-based hand rub.
J Hosp Infect. 2003 Nov; 55 (3): 226-31.

Content
In accordance with the European prEN 12054 norm, a hand disinfectant’s bactericidal activity is determined by the means of 4 test organisms: Staphylococcus aureus, Enterococcus hirae, Escherichia coli and Pseudomonas aeruginosa. The hand disinfectant has to achieve a decrease of 5 log10 units within 30 seconds. In order to investigate the significance of these test organisms, the hand disinfectant ‘Sterillium®’ has been tested requirements in compliance with the U.S. Food and Drug Administration (FDA), which comprises all clinically relevant bacteria strains: 13 gram-positive and 18 gram-negative bacteria strains (ATCC strains), 14 clinically relevant problem bacteria as well as clinical isolates of each species were used as test organisms. It has been confirmed that the bactericidal activity of a propanol-based hand disinfectant against the prEN 12054 test organisms allows the inference on a comprehensive bactericidal effect.

Pietsch H.
Hand antiseptics: rubs versus scrubs, alcohol-based solutions versus alcohol-based gels.
J Hosp Infect. 2001; 33 – 36.

Content of the study
Alcohol-based hand disinfectants like Sterillium® have various advantages: they are significantly more effective than conventional alcohol-based gels, their skin tolerability with repeated application is significantly better than with chlorhexidine-containing wash lotions, their antimicrobial effect (when used for surgical hand antisepsis) is significantly better than chlorhexidine-containing liquid soaps.

 

Sauermann G, Proske O, Keyhani R, Leneveu M-C, Pietsch H, Rohde B.
Skin tolerance of Sterillium and Hibiscrub in a comparative clinical trial.
Hyg. Med. 1995; 20: 184-189.

Content of the study
In a prospective, randomized cross-over study, 60 test persons either used Hibiscrub or Sterillium® 8 times per day for 14 weeks. Skin tolerability of both procedures was determined with different methods. In general, Sterillium® was significantly better tolerated than Hibiscrub.

 

 

Instruments

 

Following studies and publications can be requested as reprints at Dagmar Martini

 

In German available only

Bloß R.
Influence of disinfection agents on instrument cleaning.
Talk at DGKH Congress 04-10-2002.

Content
For instrument reprocessing, the influence of different disinfection agents on protein adhesion has been reviewed by the means of standardized blood fixation and standardized test pieces. It has been shown that products containing aldehydes or peracetic acid have a fixing effect on proteins. Even with a subsequent alkaline cleaning, residues can only be removed partly. Hence, an in-depth pre-cleaning is necessary, particularly when aldehyde- or peracetic acid-containing disinfectants are used.

 

Martiny H.
Water exposure through microorganisms.
Krankenhaus Arzt 1996; 69 (4): 195-197.

Content
Even with an excellently carried out disinfection, a subsequent rinsing can cause re-contamination. What are the reasons?

 

Martiny H.
Water: high quality is the basic requirement, part II.
Krankenhaus Arzt 1996; 69: 244-245

Content
Besides hardness constituents, water also contains other ions, which partly exert influence on the instrument reprocessing.

 

Sarunski D, Niknam S.
Helicobacter pylori: risk of contamination through endoscopes?
ENDO-PRAXIS 2000; 1.

Content
In connection with helicobacter pylori infections, inadequately reprocessed endoscopes are also in the discussion as a possible source of contamination. It is for sure that only appropriate reprocessing procedures and extensively tested products can prevent a possible transmission of microorganisms.

 

Albrecht H.
Infection potential of contrast media residues; novel efficacy system for duodenoscopes is superior to enzymatic cleaners.
ENDO-PRAXIS 2000; 2: 18-19.

Content
Crystallized x-ray contrast media constitutes a good culture medium for microorganisms, as these residues cannot be dissolved and removed by common cleaning agents and disinfectants. A new product development provides a solution.

 

 

Surface

Rutala WA, Weber DJ.
Surface disinfection: should we do it?
J Hosp Infect. 2002 Aug; 48 Suppl A: 64-68.

Content
This paper reviews the epidemiological and microbiological data regarding the use of disinfectants on non-critical surfaces. As a consequence, surface cleaning and disinfection near patients should be routinely carried out on the basis of a risk analysis and an evaluation of the level of knowledge as well as after patient discharge. In addition, the hygienists regard disinfection of floors in patient areas as reasonable to control nosocomial infections.