Hand disinfection
In medicine, hand disinfection is a process for reducing the number of pathogens on the skin of the hands with the help of hand disinfectants . This basic hygiene measure largely prevents pathogens (especially bacteria and viruses ) from being transmitted to other people via the hands. In patient care, this method reduces the risk of infection, especially for cross infections ; it also serves to protect the people working there.
Effect on the skin flora
Compared to hand washing, hand disinfection is the more effective measure to switch off or reduce microbial colonization - transient and resident skin flora - on the hands. It is also more gentle on the skin than washing.
Transient skin flora
The transient skin flora consists of germs that temporarily settle on the skin. These may include pathogens that cause disease . By washing hands transient skin flora is largely removed, but this is not sufficiently considered in the patient care. Proper use of a hand disinfectant, on the other hand, can deactivate or kill pathogens and thus offers more security against the transmission of germs.
Resident skin flora
The resident flora (local flora ) is part of the physiological nature of the skin. Various microorganisms contained therein maintain normal skin functions through their metabolic products and inhibit the growth of non-resident germs. However, the germs of the resident skin flora can also trigger infections, for example on non-intact skin and inside the body, if they were introduced through invasive interventions. Therefore, the resident skin flora must also be reduced by means of suitable disinfection processes before certain activities .
Hygienic and surgical hand disinfection
The hygienic hand disinfection is carried out before and after each patient contact, the more thorough surgical hand disinfection , however prior to surgery or invasive procedures. The hygienic hand disinfection eliminates the foreign pathogens and reduces the number of the skin's own pathogens. Surgical hand disinfection is the extensive elimination of the skin's own pathogens, which are present in decreasing numbers in the cornea up to the stratum lucidum, whereby the sweat and sebum glands are usually almost sterile.
Historical background
The historically decisive contribution to medicine was made by Ignaz Semmelweis (1818–1865), a Hungarian-Austrian doctor. He recognized the cause of childbed fever and was the first to introduce hygiene regulations for doctors, midwives and hospital staff in 1847 . His instructions also included the instruction to disinfect hands with chlorinated lime before and after each patient contact. This enabled him to significantly reduce the number of in-hospital deaths. It was not until 1861 that his book The Etiology, the Concept and Prophylaxis of Child Bed Fever was published . The distinction between hygienic and surgical hand disinfection was introduced by Carl Flügge in 1905 .
In 1965, Peter Kalmár , then an assistant doctor at the University Surgical Clinic in Hamburg-Eppendorf, came up with the idea of developing a product that should only be rubbed into the hands instead of the previous washing of hands with various additives . This should make the hand disinfection process more efficient, easier and faster. The realization of this idea led to the development of the alcoholic rub-in process for hygienic and surgical hand disinfection. Kalmár was also the initiator of the fundamental change in the procedure of surgical hand disinfection. Based on the experience he had gained and the level of dermatological knowledge he had, he strongly advocated the now generally accepted procedure of omitting the then common and sometimes skin-damaging pre-washing with water, soap and brush or separating the occasional hand washing from the disinfection process.
Hygienic hand disinfection
The hygienic hand disinfection is the most important measure for prevention of hospital infections . It protects the patient and the medical staff. In many hospitals and care facilities, visitors can use hand disinfection devices in the entrance area or on the wards to contribute to patient safety. It is also recommended to inform patients about hand hygiene measures and to guide them in these.
At the time, Semmelweis used chlorinated lime to disinfect hands. Today, approved disinfectants that are kind to the skin are supposed to prevent the transfer of infectious agents during the treatment and care of patients in hospital and possibly trigger a nosocomial infection. The usual means work by destroying the single-cell shells. Special hand disinfectants are required against non-enveloped viruses; z. B. In the case of contamination with hepatitis B viruses, the effectiveness of the agent against these viruses must be proven by appropriate expert reports. In the case of spore formers (e.g. Clostridium difficile), the hands must also be washed for disinfection.
When disinfecting hands with alcoholic preparations, approx. 3 ml (2 to 3 puffs from wall dispensers) are put into the dry palm and rubbed in. The exposure time is specified by the manufacturer, it is usually at least 30 seconds. A longer exposure time is necessary to inactivate certain pathogens (e.g. Pseudomonas ).
Requirements for effective hand disinfection
Before disinfection, the hands and wrists must be free of coarse dirt and without jewelry or wedding rings, wristwatches , bracelets or bracelets. The fingernails should be cut short. Arm and finger jewelry and long as well as painted or artificial fingernails are nesting places for pathogens and impair the effectiveness of hand disinfection. They are therefore prohibited for activities that require hand disinfection. For reasons of personal protection, there is an exception for wearing ring dosimeters , which must, however, be disinfected after each use. In addition, the WHO and the Commission for Hospital Hygiene and Infection Prevention recommend working clothes with short sleeves for all occupational groups with patient contact.
method
The hand disinfectant is applied to the dry palms of the hands - at least the amount specified by the manufacturer, the hands must be wet - and rubbed in on both hands inside and outside for at least 30 seconds, in particular fingertips, thumbs, nail folds and wrists must be included; if contamination is suspected, also the forearms with the appropriate amount of disinfectant. The manufacturer's information on the exposure time must be observed.
There are precise instructions for hand disinfection, which provide a specific sequence of the individual steps; according to DIN EN 1500: 1997-10 for hygienic hand disinfection according to DIN EN 12791: 2005-10 for surgical hand disinfection. However, it has been proven that individual rub-in methods produce better results.
commitment
The Commission for Hospital Hygiene and Infection Prevention ( KRINKO ) describes in the current recommendation on hand hygiene in health care facilities in the so-called "five-moment concept" typical situations in which hygienic hand disinfection is appropriate for staff with patient contact:
- before patient contact
- before aseptic activities
- after contact with potentially infectious materials
- after patient contact
- after contact with surfaces in the immediate vicinity of the patient.
The "five moments" concept corresponds to the My five moments of hand hygiene model of the World Health Organization ( World Health Organization , WHO) and replaced with the publication of the recommendation on hospital hygiene in 2016 the numerous developmental indications of KRINKO recommendation in the guideline of the year 2000.
Further relevant regulations can be found in the accident prevention regulations of the professional associations (§ 22, § 6 UVV). The professional association for health and welfare services (BGW) names other situations, e.g. B.
- before starting work, for example in outpatient and inpatient care, in medical practices, in kitchens, in operating theaters
- before the preparation of invasive measures and after their follow-up
- before handling any food or medication
- after using the toilet
- after using disposable gloves.
In addition, the regulations of the respective institution apply.
According to the KRINKO recommendation, gloved hands may only be disinfected in exceptional cases while a patient is being cared for. The gloves used for this must be chemical-resistant in accordance with EN 374 and must not be visibly perforated and not be contaminated with blood, secretions or excretions.
Surgical hand disinfection
Surgical hand disinfection is used before all surgical interventions. The aim is to be largely free of pathogens by eliminating the transient and reducing the resident skin flora in order to reduce the risk of transmission in the event of a possible glove defect. In addition to the surgeon, all persons working in the sterile area must undergo this disinfection measure.
The previous washing of the hands with soap and water for one minute serves to reduce the spore load. It usually takes place when entering the hospital or practice. Brushing off the skin or fingernails during washing is only recommended for stubborn dirt. To protect the skin, at least ten minutes should elapse between washing and using the disinfectant, as the long washing increases the skin's moisture significantly and reduces the effectiveness of the disinfectant due to this dilution effect.
Only the disinfectant is used on clean and dry hands. Surgical hand disinfection by rubbing alcoholic preparations into dry hands and forearms over a period of up to five minutes reduces the transient flora so much that the spread of germs or transmission is prevented. In the beginning, you work up to the elbow and then just rub your hands in at the end. Hands must be dry before putting on gloves. The duration of the application, i.e. H. the wetting of the hands with the disinfectant depends on the declared exposure time of the manufacturer. Different preparations are available with exposure times between one and three minutes (as of May 2017).
During long operations, changing the gloves every 90 minutes without re-disinfecting your hands is recommended. For operations that last longer than three hours or for injuries to the surgical gloves, another brief disinfection of the hands is necessary in connection with the change of surgical clothing (gloves, etc.) in order to remove them from the deeper layers of the stratum corneum or through Kill pathogens that have come into contact with the skin surface.
Causes of incorrect or neglected hand disinfection
Hygienic hand disinfection is a standard measure for infection prophylaxis in patient care, but for various reasons it is not implemented frequently enough in an effective way. The factors that hinder the consistent implementation of suitable hygiene measures include understaffing, lack of training and experience, insufficient knowledge of the applicable recommendations and lack of motivation from superiors. The profession of doctor and belonging to the male gender also favor inadequate hand hygiene.
Hand disinfection in general everyday life
Hand disinfectants that are used in the medical field are not recommended in the household, as they also kill harmless germs that the body needs to train its defenses. Washing your hands with skin-friendly soap reduces the amount of germs by up to 99%, and is usually a sufficient hygiene measure in the event of soiling, after going to the toilet, after contact with doors or door handles in public facilities and after contact with animals or people . Exceptions exist if a family member is sick or has a weakened immune system.
Skin care requirement
Repeated hand disinfection attacks the skin and degreases it with alcohol. That is why hand disinfectants often contain moisturizing components. Additional skin care is recommended and is mentioned in the accident prevention regulations .
See also
Literature, media
For surgical hand disinfection
- Video of surgical hand disinfection ( Memento from August 12, 2007 in the Internet Archive )
For hygienic hand disinfection
- Th. Bernig: Comparison of the skin tolerance of six selected alcoholic hand disinfectants in a clinical double-blind trial based on the subjective acceptance and the determination of objective skin parameters . Diss Med Fak Univ Greifswald 1997.
- Klaus Koch: Nursery instead of logic. Hygiene behavior of doctors examined . South German Ztg., April 3, 2001, Germany p. V2 / 15.
General
- European Standard EN 1499 : Chemical disinfectants and antiseptics, disinfecting hand washing, test methods and requirements (phase 2 / step 2) 1998. Hygiene & Medizin 28th year 2003, booklet 4; 129-133
- A. Kramer et al. (Ed.): Clinical antiseptics . Springer, Berlin 1993.
- Günter Kampf: Hand hygiene in health care . Springer, Berlin 2004, ISBN 3-540-44200-6 . Online: limited preview in Google Book search
Web links
- KRINKO recommendation, published in the Federal Health Gazette, 2016 (PDF) (accessed April 1, 2017).
- S2 guideline : Hand disinfection and hand hygiene , AWMF register number 029/027 (online: full text + English version , as of August 27, 2016, valid until September 30, 2021).
- Operation Clean Hands: Video tutorial for medical staff in hospitals , accessed on September 1, 2014.
Individual evidence
- ^ RH Steinhagen: Development stages of hand disinfection, in: Eckert / Rodewald, Hygiene und Asepsis in der Chirurgie, pp. 55–61, here: p. 57. See also: Special print from: Volker Schumpelick, Niels M. Bleese, Ulrich Mommsen (Ed.): Surgery. Textbook for students. Stuttgart undated, p. 51.
- ↑ Sample presentation for the KRINKO recommendation (2016) Hand hygiene. P. 18 ; accessed on March 3, 2019.
- ↑ Recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. Retrieved March 3, 2019.
- ↑ Sample presentation for the KRINKO recommendation (2016) Hand hygiene, p. 9 ; accessed on March 13, 2019.
- ↑ Clinic group is taking out long-sleeved gowns for doctors. kma Online from February 1, 2016 ; accessed on March 7, 2019.
- ↑ hand hygiene on BGW-online ; accessed on March 3, 2019.
- ↑ M. Dülligen, A. Kirov, H. Unverricht: Hygiene and medical microbiology. Schattauer, Stuttgart 2013; P. 206
- ↑ S. Niknam: New KRINKO recommendation hand hygiene: Every moment counts , in Heilberufe , 2017, issue 2, volume 68, page 28 - page 31
- ↑ Sample presentation for the KRINKO recommendation (2016) Hand hygiene. Pp. 34-35 ; accessed on March 3, 2019.
- ↑ AWMF guidelines 2016 ; accessed on March 3, 2019
- ↑ Requirements of the Federal Health Gazette 2016.
- ↑ Epidemiological Bulletin No. 5, Robert Koch Institute 2005, p. 36 ; accessed on March 3, 2019.
- ↑ Hygiene tips for kids. Hand hygiene information. (No longer available online.) In: Institute for Hygiene and Public Health at the University of Bonn. March 1, 2015, archived from the original on February 22, 2019 ; accessed on May 15, 2020 .