Hands

Kampf G, Voss A, Widmer AF.
Surgical hand disinfection between tradition and progress
Hyg Med 2006; 31 [7+8]: 316–321

Summary

With the beginning of surgical hand antisepsis in 1894 the practical procedure has changed again and again based on scientific evidence. The wash period was reduced from 7 minutes and may be omitted completely in the future because it has no measurable benefit but adds a clear risk, namely skin irritation. The disinfection period was, depending on the hand rub, also reduced from 5 to 3 and now to 1.5 minutes because the efficacy of the different application times was found to be equal. The shorter application time will further reduce potential risks such as the low absorption of alcohol and possible skin irritation. The efficacy for surgical hand disinfection is tested in Europe according to EN 12791. This method is accepted without restrictions by the Federal Institute for Medicinal Products and Medical Devices (BfArM) as well as many infection control societies (e.g. DGKH or VAH). According to the test method only the hands are treated and and only finger tips are sampled. There is currently only evidence with a short application that treating only the hands yields an equivalent efficacy than treating hands and forearms. Observational studies in surigal theaters provide a mixed picture on the factual duration of treatment. With alcohol-based hand rubs, however, the mean duration of treatment has been in the range of the recommended time. Compliance will increase if there is an advantage for the staff e.g. saving time. The shorter application time is in line with the recommendation “hand hygiene” issued by the commission for hospital hygiene at the RKI and has also been approved by the BfArM and various infection control societies. A clinical evaluation of the data is still pending. The new evidence, however, provides significant advantages by saving time without loosing antimicrobial efficacy. So far there is no documented disadvantage associated with a shorter application time.

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Anja Deecke