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Günter Kampf - One of the best experts on this subject based on the ideXlab platform.
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Lack of antimicrobial efficacy of mecetronium etilsulfate in propanol-based Hand rubs for surgical Hand Disinfection.
The Journal of hospital infection, 2017Co-Authors: Günter KampfAbstract:The aim of this study was to determine if mecetronium etilsulfate (MES) contributes to overall efficacy in surgical Hand Disinfection. Three blinded Hand rubs (45% iso-propanol, 30% n-propanol) were applied for 1.5 min and compared with the EN 12791 reference procedure (crossover design). One commercial Hand rub contained 0.2% MES, and the two other Hand rubs were identical apart from 0.2% MES. None of the formulations had a log10 reduction after 3 h that was significantly better compared with the reference procedure [mean 1.72 (standard deviation 1.15)]. The antimicrobial contribution of MES in Hand rubs is questionable.
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small volumes of n propanol 60 applied for 3 minutes may be ineffective for surgical Hand Disinfection
Antimicrobial Resistance and Infection Control, 2014Co-Authors: Günter Kampf, Christiane OstermeyerAbstract:Background: There is a trend in some countries to recommend the use of surgical Hand disinfectants at volumes as low as 4 ml per application. Aim: To determine whether the volume applied and Hand size influence the efficacy of surgical Hand Disinfection. Methods: Thirteen experiments, according to EN 12791, resulting in 269 datasets from 75 subjects were analyzed. Hands were first washed for one minute with soap. The pre-values were obtained by rubbing the finger tips in tryptic soy broth for one minute. Each subject treated his/her Hands with n-propanol (60%, v/v), with as many portions as necessary to keep the Hands wet for three minutes (6–12 ml). Bacterial post-values were taken from one Hand (immediate effect); the other Hand was gloved for three hours (sizes 7–9). The second post-value was taken when the glove was removed (3 h effect). Results: The mean immediate log10 reduction of CFU was 2.56±1.12. The glove size had no significant effect on the efficacy of Disinfection (p=0.182; ANOVA). However, a volume of 6 ml was significantly less effective than 9 ml for glove sizes of 7.5–8 (p<0.05; Tukey post hoc analysis). The mean log10 reduction after 3 h was 2.12±1.24. A volume of 6 ml was again significantly less effective than 12 ml for glove size 7 and than 9 ml for glove sizes 7.5–8 (p<0.05). Conclusions: The application of small volumes of surgical Hand disinfectant when using the EN 12791 reference procedure is likely to yield poor efficacy results, regardless of Hand size.
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Small volumes of n-propanol (60%) applied for 3 minutes may be ineffective for surgical Hand Disinfection.
Antimicrobial resistance and infection control, 2014Co-Authors: Günter Kampf, Christiane OstermeyerAbstract:Background: There is a trend in some countries to recommend the use of surgical Hand disinfectants at volumes as low as 4 ml per application. Aim: To determine whether the volume applied and Hand size influence the efficacy of surgical Hand Disinfection. Methods: Thirteen experiments, according to EN 12791, resulting in 269 datasets from 75 subjects were analyzed. Hands were first washed for one minute with soap. The pre-values were obtained by rubbing the finger tips in tryptic soy broth for one minute. Each subject treated his/her Hands with n-propanol (60%, v/v), with as many portions as necessary to keep the Hands wet for three minutes (6–12 ml). Bacterial post-values were taken from one Hand (immediate effect); the other Hand was gloved for three hours (sizes 7–9). The second post-value was taken when the glove was removed (3 h effect). Results: The mean immediate log10 reduction of CFU was 2.56±1.12. The glove size had no significant effect on the efficacy of Disinfection (p=0.182; ANOVA). However, a volume of 6 ml was significantly less effective than 9 ml for glove sizes of 7.5–8 (p
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Less and less-influence of volume on Hand coverage and bactericidal efficacy in Hand Disinfection.
BMC infectious diseases, 2013Co-Authors: Günter Kampf, Sven Eggerstedt, Sigunde Ruselack, Nicolas Nowak, Muhammad BashirAbstract:Some manufacturers recommend using 1.1 mL per application of alcohol-based Handrubs for effective Hand Disinfection. However, whether this volume is sufficient to cover both Hands, as recommended by the World Health Organization, and fulfills current efficacy standards is unknown. This study aimed to determine Hand coverage for three Handrubs (two gels based on 70% v/v and 85% w/w ethanol and a foam based on 70% v/v ethanol) applied at various volumes. Products were tested at product volumes of 1.1 mL, 2 mL, 2.4 mL as well as 1 and 2 pump dispenser pushes; the foam product was tested in addition at foam volumes of 1.1 mL, 2 mL, and 2.4 mL. Products were supplemented with a fluorescent dye and 15 participants applied products using responsible application techniques without any specific steps but the aim of completely covering both Hands. Coverage quality was determined under ultraviolet light by two blinded investigators. Efficacy of the three Handrubs was determined according to ASTM E 1174-06 and ASTM E 2755-10. For each experiment, the Hands of 12 participants were contaminated with Serratia marcescens and the products applied as recommended (1.1 mL for 70% v/v ethanol products; 2 mL for the 85% w/w ethanol product). Log10-reduction was calculated. Volumes < 2 mL yielded high rates of incomplete coverage (67%–87%) whereas volumes ≥ 2 mL gave lower rates (13%–53%). Differences in coverage were significant between the five volumes tested for all Handrubs (p < 0.001; two-way ANOVA) but not between the three Handrubs themselves (p = 0.796). Application of 1.1 mL of 70% v/v ethanol rubs reduced contamination by 1.85 log10 or 1.60 log10 (ASTM E 1174-06); this failed the US FDA efficacy requirement of at least 2 log10. Application of 2 mL of the 85% w/w ethanol rub reduced contamination by 2.06 log10 (ASTM E 1174-06), fulfilling the US FDA efficacy requirement. Similar results were obtained according to ASTM E 2755-10. Our data indicated that Handrubs based on 70% ethanol (v/v) with a recommended volume of 1.1 mL per application do not ensure complete coverage of both Hands and do not achieve current ASTM efficacy standards.
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world health organization recommended Hand rub formulations do not meet european efficacy requirements for surgical Hand Disinfection in five minutes
Journal of Hospital Infection, 2011Co-Authors: Günter Kampf, C OstermeyerAbstract:The World Health Organization (WHO) has recommended two Hand-rub formulations for local production based on 80% ethanol or 75% isopropanol (both v/v). We have looked at their efficacy according to EN 12791. Twenty-six subjects treated their Hands with the reference procedure (n-propanol, 60%) for 3 min or with one of the two formulations for 1.5, 3 or 5 min (Latin square design). Post-values (immediate effect) were taken from one Hand, the other Hand was gloved for 3 h. After the glove had been taken off, the second post-value was taken (3 h effect). The mean log(10) reduction of each Hand rub at all three application times was compared to Hodges and Lehmann's reference procedure for non-inferiority. In the first block the reference procedure reduced bacterial load by 2.43 log(10) (immediate effect) and 2.22 log(10) (3 h effect). The efficacy of the ethanol-based formulation (e.g. immediate efficacy of 1.41 log(10) at 5 min) was inferior to the reference procedure at all application times [lower 95% confidence interval (CI): less than -0.75]. In the second block the reference procedure reduced bacterial load by 2.72 log(10) (immediate effect) and 2.26 log(10) (3 h effect). The efficacy of the isopropanol-based formulation (e.g. immediate efficacy of 2.05 log(10) at 5 min) was also inferior to the reference procedure at all application times (lower 95% CI: less than -0.75). Both WHO-recommended Hand-rub formulations failed to meet the EN 12791 efficacy requirements for surgical Hand Disinfection within 5 min. A higher concentration of the active ingredients may improve the efficacy.
Christiane Ostermeyer - One of the best experts on this subject based on the ideXlab platform.
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Small volumes of n-propanol (60%) applied for 3 minutes may be ineffective for surgical Hand Disinfection.
Antimicrobial resistance and infection control, 2014Co-Authors: Günter Kampf, Christiane OstermeyerAbstract:Background: There is a trend in some countries to recommend the use of surgical Hand disinfectants at volumes as low as 4 ml per application. Aim: To determine whether the volume applied and Hand size influence the efficacy of surgical Hand Disinfection. Methods: Thirteen experiments, according to EN 12791, resulting in 269 datasets from 75 subjects were analyzed. Hands were first washed for one minute with soap. The pre-values were obtained by rubbing the finger tips in tryptic soy broth for one minute. Each subject treated his/her Hands with n-propanol (60%, v/v), with as many portions as necessary to keep the Hands wet for three minutes (6–12 ml). Bacterial post-values were taken from one Hand (immediate effect); the other Hand was gloved for three hours (sizes 7–9). The second post-value was taken when the glove was removed (3 h effect). Results: The mean immediate log10 reduction of CFU was 2.56±1.12. The glove size had no significant effect on the efficacy of Disinfection (p=0.182; ANOVA). However, a volume of 6 ml was significantly less effective than 9 ml for glove sizes of 7.5–8 (p
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small volumes of n propanol 60 applied for 3 minutes may be ineffective for surgical Hand Disinfection
Antimicrobial Resistance and Infection Control, 2014Co-Authors: Günter Kampf, Christiane OstermeyerAbstract:Background: There is a trend in some countries to recommend the use of surgical Hand disinfectants at volumes as low as 4 ml per application. Aim: To determine whether the volume applied and Hand size influence the efficacy of surgical Hand Disinfection. Methods: Thirteen experiments, according to EN 12791, resulting in 269 datasets from 75 subjects were analyzed. Hands were first washed for one minute with soap. The pre-values were obtained by rubbing the finger tips in tryptic soy broth for one minute. Each subject treated his/her Hands with n-propanol (60%, v/v), with as many portions as necessary to keep the Hands wet for three minutes (6–12 ml). Bacterial post-values were taken from one Hand (immediate effect); the other Hand was gloved for three hours (sizes 7–9). The second post-value was taken when the glove was removed (3 h effect). Results: The mean immediate log10 reduction of CFU was 2.56±1.12. The glove size had no significant effect on the efficacy of Disinfection (p=0.182; ANOVA). However, a volume of 6 ml was significantly less effective than 9 ml for glove sizes of 7.5–8 (p<0.05; Tukey post hoc analysis). The mean log10 reduction after 3 h was 2.12±1.24. A volume of 6 ml was again significantly less effective than 12 ml for glove size 7 and than 9 ml for glove sizes 7.5–8 (p<0.05). Conclusions: The application of small volumes of surgical Hand disinfectant when using the EN 12791 reference procedure is likely to yield poor efficacy results, regardless of Hand size.
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Bacterial population kinetics on Hands during 2 consecutive surgical Hand Disinfection procedures
American journal of infection control, 2008Co-Authors: Günter Kampf, Christiane Ostermeyer, Thomas KohlmannAbstract: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 log10 (immediate efficacy) and 2.27 log10 (after 3 hours). The PBHR yielded a similar reduction. Immediately after the second reference Disinfection, bacterial density was reduced by 0.45 log10. Application of the PBHR yielded greater reductions of 0.71 log10 (after 0.5 minute), 0.79 log10 (after 1 minute), and 1.12 log10 (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 log10 (reference Disinfection), 1.89 log10 (PBHR, 1 minute), 1.67 log10 (PBHR, 1.5 minutes), and 1.08 log10 (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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Efficacy of two distinct ethanol-based Hand rubs for surgical Hand Disinfection – a controlled trial according to prEN 12791
BMC infectious diseases, 2005Co-Authors: Günter Kampf, Christiane OstermeyerAbstract:Background Aim of the study was to determine the efficacy of two distinct ethanol-based Hand rubs for surgical Hand Disinfection in a controlled cross-over trial according to prEN 12791.
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efficacy of two distinct ethanol based Hand rubs for surgical Hand Disinfection a controlled trial according to pren 12791
BMC Infectious Diseases, 2005Co-Authors: Günter Kampf, Christiane OstermeyerAbstract:Background Aim of the study was to determine the efficacy of two distinct ethanol-based Hand rubs for surgical Hand Disinfection in a controlled cross-over trial according to prEN 12791.
C Ostermeyer - One of the best experts on this subject based on the ideXlab platform.
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world health organization recommended Hand rub formulations do not meet european efficacy requirements for surgical Hand Disinfection in five minutes
Journal of Hospital Infection, 2011Co-Authors: Günter Kampf, C OstermeyerAbstract:The World Health Organization (WHO) has recommended two Hand-rub formulations for local production based on 80% ethanol or 75% isopropanol (both v/v). We have looked at their efficacy according to EN 12791. Twenty-six subjects treated their Hands with the reference procedure (n-propanol, 60%) for 3 min or with one of the two formulations for 1.5, 3 or 5 min (Latin square design). Post-values (immediate effect) were taken from one Hand, the other Hand was gloved for 3 h. After the glove had been taken off, the second post-value was taken (3 h effect). The mean log(10) reduction of each Hand rub at all three application times was compared to Hodges and Lehmann's reference procedure for non-inferiority. In the first block the reference procedure reduced bacterial load by 2.43 log(10) (immediate effect) and 2.22 log(10) (3 h effect). The efficacy of the ethanol-based formulation (e.g. immediate efficacy of 1.41 log(10) at 5 min) was inferior to the reference procedure at all application times [lower 95% confidence interval (CI): less than -0.75]. In the second block the reference procedure reduced bacterial load by 2.72 log(10) (immediate effect) and 2.26 log(10) (3 h effect). The efficacy of the isopropanol-based formulation (e.g. immediate efficacy of 2.05 log(10) at 5 min) was also inferior to the reference procedure at all application times (lower 95% CI: less than -0.75). Both WHO-recommended Hand-rub formulations failed to meet the EN 12791 efficacy requirements for surgical Hand Disinfection within 5 min. A higher concentration of the active ingredients may improve the efficacy.
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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
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2009Co-Authors: Günter Kampf, C OstermeyerAbstract:We studied the effect of a 1-min Hand wash on the bacterial Hand flora in two consecutive surgical Hand Disinfection procedures. A propanol-based Hand rub (PBHR; Sterillium®) and n-propanol (60%, v/v) were tested in a Latin-square design according to EN 12791 in four variations. The reference alcohol was always applied for 3 min after a 1-min Hand wash (variation 1). The PBHR was applied for 1.5 min (first application) or 0.5 min (second application). Variation 2 included a 1-min Hand wash before both applications, variation 3 included the Hand wash before application 1, in variation 4 Hands were not washed at all before application. Pre- and post-values were obtained according to EN 12791. The reference Disinfection reduced bacteria by 2.99 log10 (immediate efficacy) and 2.22 log10 after 3 h. The second reference Disinfection reduced bacteria by 0.95 log10 (immediate efficacy) and 0.68 log10 after 3 h. The PBHR always yielded an equivalent reduction with and without a preceding Hand wash (p > 0.05; Friedman test). A 1-min Hand wash before application of the PBHR did not significantly change its efficacy for surgical Hand Disinfection in two consecutive surgical procedures of 3 h.
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surgical Hand Disinfection with a propanol based Hand rub equivalence of shorter application times
Journal of Hospital Infection, 2005Co-Authors: Günter Kampf, C Ostermeyer, P HeegAbstract:Summary The aim of this study was to determine the efficacy of a propanol-based Hand rub at application times shorter than 3 min. The bacterial pre-value was obtained from the finger tips (prEN 12791). Subjects treated their Hands with the reference procedure (n-propanol, 60%) for 3 min or the product (crossover design). Sterillium™ was applied for 3, 2, 1.5 and 1 min. Four other preparations were tested for 1 min. Post-values (immediate effect) were taken from one Hand, and the other Hand was gloved for 3 h. After the gloves were removed, the second post-value was taken (sustained effect). Sterillium was more effective than the reference procedure at 3, 2 and 1.5 min (immediate and sustained effect). The immediate effect after 1 min was significantly lower [mean log10 reduction factor (RF): 1.91±0.90 vs. 2.52±0.95; P=0.001], whereas the sustained effect was not (mean RF: 1.81±1.06 vs. 2.05±1.14; P=0.204). All other preparations failed the efficacy requirement at 1 min for both the immediate and sustained effect. Using 2×3 mL Sterillium for a total of 1.5 min for surgical Hand Disinfection was at least as effective as the 3-min reference Disinfection.
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Efficacy of alcohol-based gels compared with simple Hand wash and hygienic Hand Disinfection
Journal of Hospital Infection, 2004Co-Authors: Günter Kampf, C OstermeyerAbstract:A recent research letter on the limited efficacy of alcohol-based Hand gels has alerted the global infection control community and raised the question of the true significance of data obtained according to EN 1500. It has been described that a 1 min simple Hand wash reduces artificial contamination of Hands by a log(10) reduction factor of 2.8 and a 1 min reference Hand Disinfection with 2-propanol (60%, v/v) by a factor of 4.6 steps. The EN 1500 gel data show that the 30 s efficacy of most gels is closer to a simple Hand wash than to the reference Hand Disinfection. The 30 s efficacy of most alcohol-based liquid products and one gel, however, is almost identical to the reference Hand Disinfection. In many European countries alcohol-based liquid products have been established as a standard practice in hygienic Hand Disinfection for decades. Replacement of these products with most available gels would be a step backward in terms of efficacy and has still to be seen critically from the efficacy point of view.
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Inter-laboratory reproducibility of the Hand Disinfection reference procedure of EN 1500
The Journal of hospital infection, 2003Co-Authors: Günter Kampf, C OstermeyerAbstract:Abstract Recent tests carried out using EN 1500 have suggested that most alcohol-based Hand gels are significantly less effective than the reference alcohol [2-propanol, 60% (v/v)] whereas liquid alcohol-based Hand rubs are not. However concerns about the accuracy and reproducibility of the test have been raised. We therefore analysed 41 experiments performed in four different laboratories using EN 1500 Hand Disinfection procedures with the reference alcohol, to analyse inter-laboratory reproducibility of the test. The mean reduction factors (difference of the log 10 of the pre-value and the post-value) from the four laboratories did not reveal a significant difference ( P =0.059; analysis of variance), although the difference of the mean pre and post-values was highly significant ( P
Axel Kramer - One of the best experts on this subject based on the ideXlab platform.
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Determination of antiseptic efficacy of rubs on the forearm and consequences for surgical Hand Disinfection
The Journal of hospital infection, 2011Co-Authors: N.-o. Hübner, N.b. Kellner, L.i. Partecke, Torsten Koburger, Claus-dieter Heidecke, Thomas Kohlmann, Axel KramerAbstract:While Hands are acknowledged to be the most important source of pathogens from the skin of the surgical team, the transmission of pathogens from the forearms may also be relevant. Preoperative Hand Disinfection is recommended, but evidence-based standards for the forearms are lacking. As neither the European standard EN 12791 nor the American guidelines ASTM 1115 are applicable to the forearms, a new test method based on the European standard EN 12791 and the German Society for Hygiene and Microbiology (DGHM) method for testing for the efficacy of skin antiseptics was developed to address the forearms. The antiseptic efficacy of a commercially available alcohol-based Hand rub [76.7% (w/w) ethanol] was assessed on the upper arm after 15s, 2.5 min, and 30 min, and on the lower arm after 2.5 min, 30 min, and 3 h. On the upper arm, application of the product followed the DGHM standard procedure. On the forearm, the product was applied by the participants themselves with the right Hand over the left forearm and vice versa as performed during preoperative Hand Disinfection. Sampling and culture were performed according to the DGHM method for skin antisepsis on the upper arm. Twenty-two volunteers were investigated. The efficacy of the antiseptic treatment on the forearm was not significantly lower than on the upper arm for any of the areas tested (P > 0.05). Reduction factors for all tested areas and times were quite similar, with confidence intervals ranging between 1.43 and 2.31 log₁₀. We suggest that an application time of 10s may be sufficient for the treatment of the forearm as part of preoperative Hand Disinfection, provided that an appropriate product is used.
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Quantity of ethanol absorption after excessive Hand Disinfection using three commercially available Hand rubs is minimal and below toxic levels for humans
BMC Infectious Diseases, 2007Co-Authors: Axel Kramer, Nora Bieber, Nils-olaf Huebner, Harald Below, Cyril D Toma, Guenter Kampf, Ojan AssadianAbstract:BackgroundDespite the increasing promotion of alcohol-based Hand rubs and the worldwide use of ethanol-based Hand rubs in hospitals only few studies have specifically addressed the issue of ethanol absorption when repeatedly applied to human skin. The aim of this study was to assess if ethanol absorption occurs during hygienic and surgical Hand Disinfection using three different alcohol-based Hand-rubs, and to quantify absorption levels in humans.MethodsTwelve volunteers applied three Hand-rubs containing 95% (Hand-rub A), 85% (Hand-rub B) and 55% ethanol (Hand-rub C; all w/w). For hygienic Hand Disinfection, 4 mL were applied 20 times for 30 s, with 1 minute break between applications. For surgical Hand Disinfection, 20 mL of each Hand rub was applied to Hands and arms up to the level of the elbow 10 times for 3 minutes, with a break of 5 minutes between applications. Blood concentrations of ethanol and acetaldehyde were determined immediately prior and up to 90 minutes after application using head space gas chromatography.ResultsThe median of absorbed ethanol after hygienic Hand Disinfection was 1365 mg (A), 630 mg (B), and 358 mg (C). The proportion of absorbed ethanol was 2.3% (A), 1.1% (B), and 0.9% (C). After surgical Hand Disinfection, the median of absorbed ethanol was 1067 mg (A), 1542 mg (B), and 477 mg (C). The proportion of absorbed ethanol was 0.7% (A), 1.1% (B), and 0.5% (C). The highest median acetaldehyde concentration after 20 hygienic Hand Disinfections was 0.57 mg/L (Hand-rub C, after 30 min), after 10 surgical Hand Disinfections 3.99 mg/L (Hand-rub A, after 20 minutes).ConclusionThe overall dermal and pulmonary absorption of ethanol was below toxic levels in humans and allows the conclusion that the use of the evaluated ethanol-based Hand-rubs is safe.
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Quantity of ethanol absorption after excessive Hand Disinfection using three commercially available Hand rubs is minimal and below toxic levels for humans.
BMC infectious diseases, 2007Co-Authors: Axel Kramer, Nora Bieber, Nils-olaf Huebner, Harald Below, Cyril D Toma, Guenter Kampf, Ojan AssadianAbstract:Background Despite the increasing promotion of alcohol-based Hand rubs and the worldwide use of ethanol-based Hand rubs in hospitals only few studies have specifically addressed the issue of ethanol absorption when repeatedly applied to human skin. The aim of this study was to assess if ethanol absorption occurs during hygienic and surgical Hand Disinfection using three different alcohol-based Hand-rubs, and to quantify absorption levels in humans.
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Optimizing surgical Hand Disinfection
Zentralblatt fur Chirurgie, 2006Co-Authors: G. Kampf, Axel Kramer, M. Rotter, A. WidmerAbstract:For more than 110 years Hands of surgeons have been treated before a surgical procedure in order to reduce the bacterial density. The kind and duration of treatment, however, has changed significantly over time. Recent scientific evidence suggests a few changes with the aim to optimize both the efficacy and the dermal tolerance. Aim of this article is the presentation and discussion of new insights in surgical Hand Disinfection. A Hand wash should be performed before the first Disinfection of a day, ideally at least 10 min before the beginning of the Disinfection as it has been shown that a 1 min Hand wash significantly increases skin hydration for up to 10 min. The application time may be as short as 1.5 min depending on the type of Hand rub. Hands and forearms should be kept wet with the Hand rub for the recommended application time in any case. A specific rub-in procedure according to EN 12791 has been found to be suitable in order to avoid untreated skin areas. The alcohol-based Hand rub should have a proven excellent dermal tolerance in order to ensure appropriate compliance. Considering these elements in clinical practice can have a significant impact to optimize the high quality of surgical Hand Disinfection for prevention of surgical site infections.
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Effect of a 1 min Hand wash on the bactericidal efficacy of consecutive surgical Hand Disinfection with standard alcohols and on skin hydration
International journal of hygiene and environmental health, 2006Co-Authors: Nils-olaf Hübner, Harald Löffler, Günter Kampf, Axel KramerAbstract:Abstract Background In most surgical theatres, a 1 min or even longer Hand wash is routine as part of the pre-operative Hand Disinfection. But its benefit has recently been seen critically. Methods We have therefore investigated the effect of a 1 min Hand wash on skin hydration and on the efficacy of consecutive surgical Hand rubbing with three standard alcohols (60% propan-1-ol, 60% propan-2-ol, 80% ethanol; all v/v) on the resident Hand flora. Three types of treatment were performed: (i) a 1 min pre-wash before surgical Hand Disinfection, (ii) no pre-wash before surgical Hand Disinfection and (iii) no pre-wash but use of a brush for 1 min during Disinfection procedure. The efficacy of the alcohols was determined according to prEN 12791 with the same 20 volunteers in paired groups. To assess the effect of the Hand wash on skin hydration, 10 volunteers washed their Hands with sapo kalinus for 1 min and dried Hands with a paper towel. Skin hydration was measured with a corneometer before the Hand wash and subsequently up to 10 min thereafter both on the palm and dorsum of Hands. We also tested the reduction of bacterial spores by a 15 s Hand wash according to EN 1499 after artificial contamination of Hands of 14 volunteers with spores of B. stearothermophilus. Results Propan-1-ol (60%) was most effective with a mean log10 reduction of 2.11, followed by ethanol (80%) with a mean log10 reduction of 1.76 and propan-2-ol (60%) with a mean log10 reduction of 0.57 (all immediate effect without Hand wash). The efficacy of the alcohols was neither significantly improved nor impaired by a preceding 1 min Hand wash, but there is a trend towards better efficacy on dry Hands. Using a brush for 1 min during Disinfection resulted in a better efficacy with all alcohols. An anaylsis of variance revealed that the immediate effect of ethanol ( p = 0.013 ) and propan-2-ol ( p = 0.001 ) is significantly influenced by the variation of treatments which is mainly explained by the effect of brushing during Disinfection. But no significant difference between treatment variations was found in the sustained effect with any of the alcohols. Skin hydration increased significantly by a 1 min Hand wash for up to 10 min despite drying Hands with a paper towel. A 15 s Hand wash reduced the number of bacterial spores significantly from log10 3.84 to log10 1.99 ( p = 0.001 ). Conclusions There is no benefit of a Hand wash as part of surgical Hand Disinfection except that a short Hand wash of 15 s can effectively reduce spores. The best time for this short Hand wash is at the beginning of work in hospital, but at the latest in the sluice of the operating theatre about 10 min before applying an alcohol-based Hand rub to give the skin enough time to dry.
Ulrica Nilsson - One of the best experts on this subject based on the ideXlab platform.
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Exploring bacterial growth and recolonization after preoperative Hand Disinfection and surgery between operating room nurses and non-health care workers: a pilot study
BMC Infectious Diseases, 2018Co-Authors: Camilla Wistrand, Karin Falk-brynhildsen, Bo Söderquist, Ulrica NilssonAbstract:BackgroundTo prevent cross infection the surgical team perform preoperative Hand Disinfection before dressed in surgical gowns and gloves. Preoperative Hand Disinfection does not make Hands sterile and the surgical glove cuff end has been regarded as a weak link, since it is not a liquid-proof interface. The aims were to investigate if there were differences in bacterial growth and recolonization of Hands between operating room nurses and non-health care workers as well as to investigate if bacterial growth existed at the surgical glove cuff end during surgery.MethodsThis pilot project was conducted as an exploratory comparative clinical trial. Bacterial cultures were taken from the glove and gown interface and at three sites of the Hands of 12 operating room nurses and 13 non-health care workers controls directly after preoperative Hand Disinfection and again after wearing surgical gloves and gowns. Colony forming units were analysed with Mann-Whitney U test and Wilcoxon Sign Ranks test comparing repeated measurements. Categorical variables were evaluated with chi-square test or Fisher’s exact test.ResultsOperating room nurses compared to non-health care workers had significant higher bacterial growth at two of three culture sites after surgical Hand Disinfection. Both groups had higher recolonization at one of the three culture sites after wearing surgical gloves. There were no differences between the groups in total colony forming units, that is, all sampling sites. Five out of 12 of the operating room nurses had bacterial growth at the glove cuff end and of those, four had the same bacteria at the glove cuff end as found in the cultures from the Hands. Bacteria isolated from the glove cuff were P. acnes, S. warneri, S. epidermidis and Micrococcus species, the CFU/mL ranged from 10 to 40.ConclusionsThere were differences in bacterial growth and re-colonization between the groups but this was inconclusive. However, bacterial growth exists at the glove cuff and gown interface, further investigation in larger study is needed, to build on these promising, but preliminary, findings.Trial registrationTrial registration was performed prospectively at Research web (FOU in Sweden, 117,971) 14/01/2013, and retrospectively at ClinicalTrials.gov (NCT02359708). 01/27/2015.
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Exploring bacterial growth and recolonization after preoperative Hand Disinfection and surgery between operating room nurses and non-health care workers: a pilot study
BMC infectious diseases, 2018Co-Authors: Camilla Wistrand, Karin Falk-brynhildsen, Bo Söderquist, Ulrica NilssonAbstract:To prevent cross infection the surgical team perform preoperative Hand Disinfection before dressed in surgical gowns and gloves. Preoperative Hand Disinfection does not make Hands sterile and the surgical glove cuff end has been regarded as a weak link, since it is not a liquid-proof interface. The aims were to investigate if there were differences in bacterial growth and recolonization of Hands between operating room nurses and non-health care workers as well as to investigate if bacterial growth existed at the surgical glove cuff end during surgery. This pilot project was conducted as an exploratory comparative clinical trial. Bacterial cultures were taken from the glove and gown interface and at three sites of the Hands of 12 operating room nurses and 13 non-health care workers controls directly after preoperative Hand Disinfection and again after wearing surgical gloves and gowns. Colony forming units were analysed with Mann-Whitney U test and Wilcoxon Sign Ranks test comparing repeated measurements. Categorical variables were evaluated with chi-square test or Fisher’s exact test. Operating room nurses compared to non-health care workers had significant higher bacterial growth at two of three culture sites after surgical Hand Disinfection. Both groups had higher recolonization at one of the three culture sites after wearing surgical gloves. There were no differences between the groups in total colony forming units, that is, all sampling sites. Five out of 12 of the operating room nurses had bacterial growth at the glove cuff end and of those, four had the same bacteria at the glove cuff end as found in the cultures from the Hands. Bacteria isolated from the glove cuff were P. acnes, S. warneri, S. epidermidis and Micrococcus species, the CFU/mL ranged from 10 to 40. There were differences in bacterial growth and re-colonization between the groups but this was inconclusive. However, bacterial growth exists at the glove cuff and gown interface, further investigation in larger study is needed, to build on these promising, but preliminary, findings. Trial registration was performed prospectively at Research web (FOU in Sweden, 117,971) 14/01/2013, and retrospectively at ClinicalTrials.gov ( NCT02359708 ). 01/27/2015.
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Bacterial growth and recolonization after preoperative Hand Disinfection and surgery : a pilot study
2017Co-Authors: Camilla Wistrand, Karin Falk-brynhildsen, Bo Söderquist, Ulrica NilssonAbstract:Bacterial growth and recolonization after preoperative Hand Disinfection and surgery : a pilot study
