PROCEDURES FOR HAND HYGIENE IN GERMAN-SPE AKING COUNTRIES

According to the field of application, strategies for the prevention o f the transfer of microbial skin nora from the hands must consider the various categories of flora: transient, resident or stemming from inf ected lesions on the hands (infection flora). Depending on the species and virulence of the microorganism and of the susceptibility of the i nfection target, transient flora may or may not be of pathogenic impor tance. in contrast, resident skin flora is usually regarded as pathoge nic only under certain circumstances such as in surgery, especially wi th transplantation of foreign bodies and in highly susceptible hosts. Microorganisms stemming from infected lesions are of proven pathogenic ity. In the non-surgical field, only the transient and infection flora from the hands play a role. Such lesions are an absolute contraindica tion for patient-care, preparation of pharmaceuticals or foodstuff. In some procedures, the transmission of transient flora can be prevented by use of the non-touch technique (''instruments instead of fingers'' ) or by the intelligent use of protective gloves. Hands already contam inated may be rendered safe by procedures for the elimination of trans ients such as handwashing, hygienic handwash and hygienic hand rub (in the order of increasing efficacy). Among all useable chemicals, ethan ol, isopropanol and n-propanol (in the order of increasing efficacy) a re the strongest and fastest agents. Furthermore, the duration of trea tment (between 30 and 60s) significantly influences the achievable red uction of microbial release. According to the new European standards ( CEN) for testing chemical disinfectants and antiseptics, products for hygienic handwash must be significantly more efficacious than unmedica ted soap, on artificially contaminated hands. In contrast, products fo r the hygienic hand rub must not be significantly less efficacious tha n a reference disinfection including isopropanol 60% vol rubbed onto t he hands of the same volunteers during 1 min. By this, the average red uction of microbial release amounts to 4.2 to 4.4 Ig, in our hands. Th e effectiveness of procedures for the hygienic handwash is usually sig nificantly lower than that of alcoholic rubs. Therefore, in hospitals, they can be used only in certain indications such as patientcare in r everse isolation, preparation of pharmaceuticals or foodstuff. In the surgical field, where not only transient but also resident flora is a cause of postoperative infection, the microbial release from the hands of the surgical team into the surgical wound must be prevented by usi ng surgical gloves. Because of frequent glove lesions, a surgical hand disinfection is usually performed before donning gloves to keep a pos sible inoculumn as small as possible. Also in this field of applicatio n, alcoholic rubs proved to be significantly more effective than washi ng hands with antiseptic detergents. There exists a strong positive co rrelation of the reduction of microbial release and the duration of ha nd treatment, between 1 and 5 min. The European test standards (CEN) r equire products for surgical hand disinfection to be at least as effic acious as a reference disinfection of clean hands, which are constantl y rubbed and kept wet with n-propanol 60% vol during 3 min. By this, t he achievable average reduction of the microbial release ranges betwee n 2.0 and 2.4 Ig. In contrast, antiseptic washing procedures with prep arations containing povidone-iodine, chrorhexidine gluconate or triclo san reduce the bacterial release within 2-5 min only by 0.5 to 1.2 Ig. Some of them exert a bacteriostatic sustaining effect which is not fo und with alcoholic preparations. This, however, is not necessary with the latter as the initial bacerial reduction is that strong that resti tution of the skin flora takes > 3 hours. Alcoholic preparations are a t least as tolerable for the skin as antiseptic detergents, if not bet ter, if they contain suitable emollients. Because dilution renders alc ohols ineffective they must be used only on dry hands. At the necessar y high concentrations, alcohols are flamable. Special storage conditio ns may, thus, be necessary.