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Caliman Sato M, Izu Nakamura Pietro EC, Marques da Costa Alves L, Kramer A, da Silva Santos PS. Candida auris: a novel emerging nosocomial pathogen - properties, epidemiological situation and infection control. GMS HYGIENE AND INFECTION CONTROL 2023; 18:Doc18. [PMID: 37693850 PMCID: PMC10486814 DOI: 10.3205/dgkh000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Immunosuppression and critical illnesses in combination with ecological imbalance open the door for novel opportunistic fungal infections, as in case of Candida (C). auris. C. auris has emerged globally as a multidrug-resistant yeast, causing infections and outbreaks in health care facilities. This narrative review discusses the properties of the yeast, the development of the epidemiological situation, the nosocomial spread and causes for nosocomial outbreaks triggered by C. auris in the hospital environment, and summarizes international recommendations for infection control, supplemented by suggestions on diagnostic, screening and antibiotic stewardship.
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Affiliation(s)
- Marcelo Caliman Sato
- Center for Lasers and Applications, Instituto de Pesquisas Energéticas e Nucleares (IPEN-CNEN), São Paulo, Brazil
| | | | | | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
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Viljoen H, Schoeman JP, Fosgate GT, Boucher C. Comparative antimicrobial efficacy of 4 surgical hand-preparation procedures prior to application of an alcohol-based hand rub in veterinary students. Vet Surg 2022; 51:447-454. [PMID: 35192206 DOI: 10.1111/vsu.13783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 01/23/2022] [Accepted: 01/30/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the influence of skin preparations before application of an alcohol-based hand rub (ABHR) on bacterial counts before and after elective surgery. STUDY DESIGN Clinical prospective study. SAMPLE POPULATION Veterinary students (n = 103) performing ovariohysterectomies on 140 dogs. METHODS Participants were randomly assigned to 1 initial surgical preparation on the day of surgery: A - hand preparation with medicated solution (4% w/v chlorhexidine bigluconate followed by an ABHR; B - application of a medication solution (benzalkonium chloride 0.1%-1% and polymeric biguanide hydrochloride 0.01%-0.1%) followed by an ABHR; C - nonmedicated pH-neutral soap hand wash followed by ABHR, and D - direct application of an ABHR. Samples were taken by pressing the distal finger tips to an agar plate before the hand preparation, after the hand preparation (n = 3), after ABHR application, and 120 minutes later. Colony-forming units (CFUs) for samples were determined. Total log CFU and CFU log10 reduction were calculated and used for comparison with P < .05. RESULTS Two hours after surgery commenced, the participants of groups that performed a hand preparation had lower total CFUs than those that did not perform a hand preparation (P = .001). In particular, the number of CFUs was lower when ABHR was performed after application of pHN compared to direct ABHR (P = .001). CONCLUSION In this population, performing a hand preparation with pHN prior to applying an ABHR had better antimicrobial effect for the duration of surgery than not performing a hand preparation. CLINICAL SIGNIFICANCE Surgeons should wash their hands prior to ABHR before starting their first surgery of the day, even when hands appear clean.
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Affiliation(s)
- Hermien Viljoen
- Department of Companion Animal, Clinical Studies, Faculty of Veterinary, Science, University of Pretoria, Pretoria, South Africa
| | - Johan P Schoeman
- Department of Companion Animal, Clinical Studies, Faculty of Veterinary, Science, University of Pretoria, Pretoria, South Africa
| | - Geoffrey T Fosgate
- Epidemiology Section, Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Charles Boucher
- Department of Companion Animal, Clinical Studies, Faculty of Veterinary, Science, University of Pretoria, Pretoria, South Africa
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Nguyen TM. Should water in an operating theater be economized? The "water saving" project. J Visc Surg 2020; 157:269-270. [PMID: 32014441 DOI: 10.1016/j.jviscsurg.2020.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- T M Nguyen
- Département of Anaesthesiology, Seclin Carvin Hospital center, 59113 Seclin, France.
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Abdel-Sayed P, Tornay D, Hirt-Burri N, de Buys Roessingh A, Raffoul W, Applegate LA. Implications of chlorhexidine use in burn units for wound healing. Burns 2020; 46:1150-1156. [PMID: 31911075 DOI: 10.1016/j.burns.2019.12.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/05/2019] [Accepted: 12/15/2019] [Indexed: 12/22/2022]
Abstract
Chlorhexidine is known to be a potent antiseptic with evidence of a beneficial role in burn care. Nevertheless, several in vitro studies have reported cytotoxicity on cultured cells, while in vivo and clinical data seem to show more controversial results. In the frame of this work, we aimed to evaluate the use of chlorhexidine in burn units worldwide be sending a survey to professionals of the field. We associated survey results to those perspectives reported in the literature to update recommendations for the use of chlorhexidine in specific protocols for burn management. The survey results showed that there is no clear consensus on the use of chlorhexidine regarding the concentrations, the type of excipient and the cleansing after application. Literature searches showed evidence that the skin of premature infants appears to be more sensitive to chlorhexidine that adult skin, with more reported cases of adverse effects. It was also determined that aqueous formulations of chlorhexidine do not appear to be necessarily less efficient than with alcohol as an excipient, and that lower concentrations are as efficient as higher concentrations. In view of this study, we have adjusted our protocols for the use of aqueous formulations at low concentrations and investigated further the role of washing after application in order to standardize the indication of chlorhexidine and minimize the probability of adverse effects.
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Affiliation(s)
- Philippe Abdel-Sayed
- Regenerative Therapy Unit, Lausanne University Hospital, Switzerland; Service of Plastic, Reconstructive & Hand Surgery, Lausanne University Hospital, Switzerland
| | - Dorian Tornay
- Regenerative Therapy Unit, Lausanne University Hospital, Switzerland
| | - Nathalie Hirt-Burri
- Regenerative Therapy Unit, Lausanne University Hospital, Switzerland; Service of Plastic, Reconstructive & Hand Surgery, Lausanne University Hospital, Switzerland
| | | | - Wassim Raffoul
- Service of Plastic, Reconstructive & Hand Surgery, Lausanne University Hospital, Switzerland
| | - Lee Ann Applegate
- Regenerative Therapy Unit, Lausanne University Hospital, Switzerland; Service of Plastic, Reconstructive & Hand Surgery, Lausanne University Hospital, Switzerland.
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Biermann NM, McClure JT, Sanchez J, Saab M, Doyle AJ. Prospective, randomised clinical trial of four different presurgical hand antiseptic techniques in equine surgery. Equine Vet J 2019; 51:600-605. [DOI: 10.1111/evj.13060] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 12/09/2018] [Indexed: 11/26/2022]
Affiliation(s)
- N. M. Biermann
- Atlantic Veterinary College University of Prince Edward Island Charlottetown Prince Edward Island Canada
| | - J. T. McClure
- Atlantic Veterinary College University of Prince Edward Island Charlottetown Prince Edward Island Canada
| | - J. Sanchez
- Atlantic Veterinary College University of Prince Edward Island Charlottetown Prince Edward Island Canada
| | - M. Saab
- Atlantic Veterinary College University of Prince Edward Island Charlottetown Prince Edward Island Canada
| | - A. J. Doyle
- Atlantic Veterinary College University of Prince Edward Island Charlottetown Prince Edward Island Canada
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Paula H, Hübner NO, Assadian O, Bransmöller K, Baguhl R, Löffler H, Kramer A. Effect of hand lotion on the effectiveness of hygienic hand antisepsis: Implications for practicing hand hygiene. Am J Infect Control 2017; 45:835-838. [PMID: 28768592 DOI: 10.1016/j.ajic.2017.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/24/2017] [Accepted: 05/24/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Skin protection products should be used after washing hands with soap, during breaks, after work, and during leisure time. Aside from their beneficial effects, skin care products may also interact with alcohol-based hand disinfectants by reducing their efficacy. The aim of this study was to investigate the effect of a hand lotion on the effectiveness of hygienic hand antisepsis using an alcohol-based handrub. METHODS The effect of a protective hand lotion against an isopropyl alcohol-based handrub was investigated in 20 healthy volunteers according to the European standard test procedure EN 1500 in the following combinations: handwashing and application of hand lotion, only application of hand lotion, and no washing and no hand lotion (control), each for 5 minutes or 1 hour before hand antisepsis. The difference in microbiologic before-and-after values were expressed as log reduction factor. RESULTS The effectiveness of hand antisepsis was not significantly affected in any of the groups using the tested hand lotion. CONCLUSIONS Hand antisepsis may be delayed for 5 minutes after hand lotion application. Shorter time intervals might be possible but were not tested.
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Affiliation(s)
- Helga Paula
- Department of Hospital Epidemiology & Infection Control, Medical University of Vienna, Vienna, Austria.
| | - Nils-Olaf Hübner
- Institute for Hygiene and Environmental Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Ojan Assadian
- Department of Hospital Epidemiology & Infection Control, Medical University of Vienna, Vienna, Austria; Institute for Skin Integrity and Infection Prevention, School of Human & Health Sciences, University of Huddersfield, United Kingdom
| | - Katja Bransmöller
- Institute for Hygiene and Environmental Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Romy Baguhl
- Institute for Hygiene and Environmental Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Harald Löffler
- SLK-Kliniken GmbH, Am Gesundbrunnen 20-26, Heilbronn, Germany
| | - Axel Kramer
- Institute for Hygiene and Environmental Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
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Kampf G, Kramer A, Suchomel M. Lack of sustained efficacy for alcohol-based surgical hand rubs containing ‘residual active ingredients’ according to EN 12791. J Hosp Infect 2017; 95:163-168. [DOI: 10.1016/j.jhin.2016.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/04/2016] [Indexed: 10/20/2022]
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Verwilghen D. The World Health Organization's Clean Hands Save Lives: A concept applicable to equine medicine as Clean Hands Save Horses. EQUINE VET EDUC 2016. [DOI: 10.1111/eve.12680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- D. Verwilghen
- Section of Medicine and Surgery; Department of Large Animals Sciences; University of Copenhagen; Denmark
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Zandiyeh M, Roshanaei G. Effectiveness of three surgical alcohol-based hand rubs on skin flora. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2015; 20:221-5. [PMID: 25878700 PMCID: PMC4387647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 09/07/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND It is proved that surgical hand disinfectant contains alcohol, and has favorable properties such as strong and rapid antibacterial effect, ease of application, and suitable effect on skin. Therefore, nowadays use of them has been gradually replacing traditional surgical hand scrub with antibacterial soap. Hence, several domestic and imported products are available to the healthcare facilities in Iran. This study was done in order to determine the antibacterial effect of Decosept, Sterillium, and Septicidine on skin flora. MATERIALS AND METHODS This clinical trial was carried out on 20 volunteers. Subjects disinfected their hands with three test products. At first, subjects washed their hands with soap. Then pre-value sample was taken from the finger tips in Tryptic Soy Broth (TSB). After that, the hands were disinfected with one of the surgical hand rubs with as much volume as necessary to keep the hands wet, at the recommended application time. Immediate post-value sample was taken from one hand and the other hand was gloved for 3 h. After removing the surgical glove, 3 h post-value sample (sustained effect) was taken from the hand. RESULTS All products remarkably decreased the colony forming units (CFU) immediately (P < 0.0001) and 3 h (P < 0.0001) after disinfection. Analysis of variance (ANOVA) revealed significant differences among immediate post-values (P < 0.005). Septicidine was significantly the least effective than the others, whereas 3 h effect of the three products was similar (P = 0.630, ANOVA). CONCLUSIONS Our results confirm the effectiveness of the three alcohol-based hand rubs. Considering the short application time, less volume used, and more antibacterial effect, however, Sterillium seems to be a better choice.
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Affiliation(s)
- Mitra Zandiyeh
- Department of Operating Room, School of Para Medicine, Hamadan University of Medical Sciences, Hamadan, Iran,Address for correspondence: Mrs. Mitra Zandiyeh, Department of Operating Room, School of Para Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. E-mail:
| | - Ghodratollah Roshanaei
- Department of Biostatics and Epidemiology, Modeling of Noncommunicable Disease Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Harnoss JC, Brune L, Ansorg J, Heidecke CD, Assadian O, Kramer A. Practice of skin protection and skin care among German surgeons and influence on the efficacy of surgical hand disinfection and surgical glove perforation. BMC Infect Dis 2014; 14:315. [PMID: 24912541 PMCID: PMC4229856 DOI: 10.1186/1471-2334-14-315] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 05/28/2014] [Indexed: 11/24/2022] Open
Abstract
Background Surgical hand rub and healthy skin are basic requirements to prevent surgical site infections. Nevertheless, there is little knowledge about the current practice of skin protection and/or skin care products (SP/SC) using among surgeons as well as a lack of data pertaining to the influence of SP/SC on the antimicrobial efficacy of surgical hand rub. Methods A 10 weeks-survey among German surgeons as well as an experimental crossover study involving 26 participants were conducted. The immediate and sustainable efficacy (IE/SE) of surgical hand rub and participants’ hand moisture were measured after an 8-day usage of SP/SC, as well as the influence on micro-perforations on surgical gloves. Results The questionnaire was available to 16,000 German surgeons. Thereof, 1,771 surgeons accessed the questionnaire, representing a total participation rate of 11%. As 19% (n = 338) of questionnaires were incomplete, a total of 1,433 completed questionnaires were available for further analysis. More than 75% of the participants stated not to use any SP/SC, yet, almost 50% suffered from skin irritation or discomfort. Only 5% used SP/SC at the beginning of their shift. 10% refused to use SP/SC because of concerns that SP/SC may reduce the antimicrobial efficacy of surgical hand rub. After usage of SP/SC over 8-days, skin moisture was significantly higher (P < 0.001), whereas no significant influence on the antimicrobial efficacy of surgical hand rub was observed (IE: P = 0.135; SP: P = 0.681). Micro-perforations were detected in 8/52 surgical gloves (15%), with no statistical significant difference between SP/SC users (n = 2/26; 8%) and non-users (n = 6/26; 23%; P = 0.249). Conclusions Following the results of this largest questionnaire base survey among German surgeons on skin care, there is a need to educate and inform surgeons on the correct application and the concept of SP/SC strategies. In the present study, the combination of selected SP/SC products and one alcohol-based hand rub formulation did not show a negative interaction with surgical hand rub or surgical glove perforation. However, it is advisable to ascertain the compatibility of SP/SC products with the used hand disinfectant prior to purchase.
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Affiliation(s)
| | | | | | | | - Ojan Assadian
- Clinical Institute for Hospital Hygiene and Infection Control, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria.
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Abstract
Surgical site infection (SSI) can affect the quality of care and increase the morbidity and mortality rate in after-surgical procedure. The use of an antiseptic skin preparation agent before the procedure can reduce the pathogens in the skin surface around the incision. Indicating the type of skin antiseptic preparation could prevent the infection and contamination of the wound. The most commonly used types of skin preparations are chlorhexidine and povidone iodine. However, the antiseptic solutions of both agents are strengthened with alcohol to prevent postoperative wound infection. The aim of this paper is to identify the best antiseptic agent in terms of skin preparation by evaluating the evidence in the literature. The factors associated with choosing the antiseptic skin agent, such as patients' allergies, skin condition and environmental risk, are also taken into account. This review suggests that cholorhexdine with alcohol may be the most effective in terms of reducing SSI.
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Patrick M, Van Wicklin SA. Implementing AORN Recommended Practices for Hand Hygiene. AORN J 2012; 95:492-507. [DOI: 10.1016/j.aorn.2012.01.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 01/19/2012] [Indexed: 11/29/2022]
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Verwilghen D, Grulke S, Kampf G. Presurgical hand antisepsis: concepts and current habits of veterinary surgeons. Vet Surg 2012; 40:515-21. [PMID: 21736594 DOI: 10.1111/j.1532-950x.2011.00846.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess current habits for surgical hand preparation among veterinary surgical specialists and to compare data with current guidelines for hand asepsis techniques. STUDY DESIGN Survey of veterinary surgical specialists. SAMPLE POPULATION Diplomates of the American (ACVS) and European Colleges of Veterinary Surgeons (ECVS). METHODS An internet-based survey of hand preparation methods before surgical procedures was conducted of 1300 listed ACVS and ECVS Diplomates. RESULTS A 42.6% response rate was obtained. Approximately, 80% of respondents use disinfecting soaps as a primary method for hand antisepsis. Of those, 81% use chlorhexidine-based scrubs and 7% use a neutral soap followed by a hydroalcoholic solution. CONCLUSIONS Contrary to current recommendations of the World Health Organization and scientific evidence supporting use of hydro-alcoholic rubs for presurgical hand preparation, veterinary surgical specialists still use surgical scrub solutions containing disinfecting soaps.
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Affiliation(s)
- Denis Verwilghen
- Department of Clinical Sciences of Companion Animals and Equids, Faculty of Veterinary Medicine of Liege, Liege, Belgium.
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A 1-minute hand wash does not impair the efficacy of a propanol-based hand rub in two consecutive surgical hand disinfection procedures. Eur J Clin Microbiol Infect Dis 2009; 28:1357-62. [DOI: 10.1007/s10096-009-0792-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 07/15/2009] [Indexed: 10/20/2022]
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Suchomel M, Gnant G, Weinlich M, Rotter M. Surgical hand disinfection using alcohol: the effects of alcohol type, mode and duration of application. J Hosp Infect 2009; 71:228-33. [PMID: 19144448 DOI: 10.1016/j.jhin.2008.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 11/10/2008] [Indexed: 10/21/2022]
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Kramer A, Hübner N, Below H, Heidecke CD, Assadian O. Improving adherence to surgical hand preparation. J Hosp Infect 2009; 70 Suppl 1:35-43. [PMID: 18994680 DOI: 10.1016/s0195-6701(08)60009-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
At present, no universal agreement on detailed practice for surgical hand preparation exists. In order to fill this gap, in 2002 a Franco-German recommendation for surgical hand preparation was published as a first step towards a generally accepted European recommendation. Based on an assessment of the actual literature, a protocol for surgical hand preparation is discussed with the aim to recommend evidence-based standard procedures including prerequisites, washing and disinfection phase, and its practical implementation. In contrast to hygienic hand disinfection, for surgical hand preparation compliance is not an issue, since it mostly is regarded as a ceremony which is carried out without exception. Nevertheless, the following factors influence acceptance and efficacy: skin tolerance, ease of use, duration of procedure, and recommended time), potential for impaired efficacy due to incorrect performance of the procedure, possibility of systemic risks and irritating potential by applied preparations, religious restrictions, ecological aspects, costs and safety. Here, we report our experience with the introduction of a new hand preparation regime in all surgical disciplines in our university hospital based on the above factors. The following statements were evaluated: 1) The immediate efficacy of an alcohol-based hand disinfectant is impaired by a preceding hand wash for up to 10 minutes. Therefore hands should not be routinely washed before the disinfection period unless there is a good reason for it such as visible soiling. 2) A shortened application time (1.5 minutes) is equal to 3 min in terms of efficacy. 3) Hands should be air dried before gloves are put on, otherwise the perforation rate of gloves will increase. 4) The efficacy of alcohol-based disinfectants is significantly higher when hands are allowed to dry for 1 minute after the washing phase and before the disinfection phase. To clarify the above questions before the establishment of the modified technique, the surgical team was invited to a meeting. As a result, the heads of surgical departments supported the new technique and decided to change their practice.
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Affiliation(s)
- A Kramer
- Institute of Hygiene and Environmental Medicine, Ernst Moritz Arndt University Greifswald
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Kampf G. Surgical scrubbing: we can clean up our carbon footprints even better by disinfecting our hands. J Hosp Infect 2009; 71:91-2; author reply 92-3. [DOI: 10.1016/j.jhin.2008.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 09/24/2008] [Indexed: 10/21/2022]
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Kampf G, Ostermeyer C, Kohlmann T. Bacterial population kinetics on hands during 2 consecutive surgical hand disinfection procedures. Am J Infect Control 2008; 36:369-74. [PMID: 18538704 DOI: 10.1016/j.ajic.2007.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 09/26/2007] [Accepted: 09/27/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although consecutive surgical hand disinfections is common clinical practice, the effect on the bacterial density on hands has not been studied for all commonly used hand rubs. We studied the effect of 2 consecutive applications of hand rubs on resident bacterial hand flora. METHODS A propanol-based hand rub (PBHR; Sterillium) and the reference alcohol (60% n-propanol) were tested in a Latin-square design according to EN 12791. The first application of the PBHR was always for 1.5 minutes; the second application was for 1.5, 1, or 0.5 minutes. The reference alcohol was always applied for 3 minutes. Pre-values and post-values were obtained in accordance with EN 12791. RESULTS The first reference disinfection reduced the bacterial density by 2.87 log(10) (immediate efficacy) and 2.27 log(10) (after 3 hours). The PBHR yielded a similar reduction. Immediately after the second reference disinfection, bacterial density was reduced by 0.45 log(10). Application of the PBHR yielded greater reductions of 0.71 log(10) (after 0.5 minute), 0.79 log(10) (after 1 minute), and 1.12 log(10) (after 1.5 minutes). The difference between all treatments was not significant (P = .089; Friedman test). After 3 hours, bacterial density was further decreased by 1.11 log(10) (reference disinfection), 1.89 log(10) (PBHR, 1 minute), 1.67 log(10) (PBHR, 1.5 minutes), and 1.08 log(10) (PBHR, 0.5 minute). The difference between all treatments was significant (P = .005), but none of the short treatments with the PBHR was significantly less effective than the reference treatment (P > .05; Wilcoxon-Wilcox test). CONCLUSIONS Overall, a simple 1.5-minute application of a well-formulated PBHR for surgical hand disinfection keeps the bacterial density as low as possible ("irreducible minimum") even in 2 consecutive surgical procedures of 3 hours.
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Affiliation(s)
- Günter Kampf
- Department of Scientific Affairs, BODE Chemie GmbH & Co KG, Hamburg, Germany.
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Abstract
BACKGROUND Alcohol-based hand rubs are used worldwide to prevent transmission of nosocomial pathogens. OBJECTIVES To investigate skin irritation caused by alcohols alone and in combination with detergent washing. METHODS Single and repetitive patch testing with 60-100% alcohols [ethanol, 1-propanol, 2-propanol (synonyms: isopropyl alcohol, isopropanol)], a positive control [0.5% sodium lauryl sulphate (SLS)] and negative controls (empty chamber and water) were performed. Wash tests were performed with 80% ethanol and 0.5% SLS on the forearms with each agent alone and with both agents in a tandem design. Skin hydration, erythema and barrier disruption [measured as transepidermal water loss (TEWL)] were evaluated (always 15 volunteers). RESULTS We found no significant change in skin barrier or erythema induced by the alcohols in the patch tests, whereas skin hydration decreased significantly. Application of alcohols to previously irritated skin did not show a stronger skin barrier disruption than application of SLS alone. Wash tests demonstrated that alcohol application caused significantly less skin irritation than washing with a detergent (TEWL, P < 0.001; skin hydration, P < 0.05; erythema, P < 0.05). Even on previously irritated skin, ethanol did not enhance irritation. By contrast, a protective effect of ethanol used after skin washing was observed (TEWL, P < 0.05; skin hydration, P < 0.05; erythema, P < 0.05). CONCLUSIONS Alcohol-based hand rubs cause less skin irritation than hand washing and are therefore preferred for hand hygiene from the dermatological point of view. An alcohol-based hand rub may even decrease rather than increase skin irritation after a hand wash due to a mechanical partial elimination of the detergent.
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Affiliation(s)
- H Löffler
- Department of Dermatology, University of California, San Francisco, CA, USA.
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Rotter ML, Kampf G, Suchomel M, Kundi M. Long-term effect of a 1.5 minute surgical hand rub with a propanol-based product on the resident hand flora. J Hosp Infect 2007; 66:84-5. [PMID: 17428577 DOI: 10.1016/j.jhin.2007.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 02/20/2007] [Indexed: 11/19/2022]
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