Peter Kalmár

from Wikipedia, the free encyclopedia
Peter Kalmár

Peter Kalmár (born August 11, 1934 in Budapest ) is a German heart surgeon from Hungary. He was a pioneer in the field of hand disinfection.

Life

Kalmár was admitted to medical school in Budapest in 1952 . In 1956 he fled Hungary ; the escape ended in Hamburg , where he finished his studies. In 1958 he was promoted to Dr. med. doctorate ("Contribution to the mode of action of harmine and bulbocapnine ") and worked as an assistant doctor first in several Hamburg hospitals, from 1962 in Rheinhausen . In 1964 he returned to Hamburg and got an assistant position in the clinic of Ludwig Zukschwerdt with Georg-Wilhelm Rodewald in the University Clinic Hamburg-Eppendorf (UKE), where he was used in a thoracic, cardiac and vascular surgery ward. In 1968 he was appointed senior physician in cardiac surgery . In 1969, he completed his habilitation and received the license to teach cardiovascular surgery and experimental cardiology . In 1973 he was appointed adjunct professor. In 1974 he was offered a professorship for cardiovascular surgery at the University of Bonn . During the ultimately unsuccessful appointment negotiations, the hospital operator in Hamburg made an offer to stay. In 1987 he took over the management of heart surgery at the UKE. In 1993 he was a member of a surgical team at the UKE that carried out the first double heart and liver transplant in Germany. Kalmár retired in 1998 and worked until 2014 as a freelancer in the consulting company for quality assurance and health economics Lohfert & Lohfert AG, Hamburg.

Alcoholic rub for hand disinfection

Although the necessity of hand disinfection was only recognized at the end of the 19th century since Semmelweis and Lister, the practice of hygienic and surgical hand disinfection remained complex, sometimes inadequate and occasionally skin-damaging until the 1960s.

The distinction between hygienic and surgical hand disinfection was introduced by Carl Flügge in 1905 : hygienic hand disinfection removes germs foreign to the skin and reduces the number of skin's own germs. Surgical hand disinfection is the extensive elimination of the skin's own germs, which are present in decreasing numbers in the cornea up to the stratum lucidum, whereby the sweat and sebum glands are normally almost germ-free. Hygienic hand disinfection took place, if at all, only in the form of the usual hand washing and drying or by using dilute disinfectant solutions. Disposable material was not yet known at that time, so that the hands were dried with towels, the z. T. were only changed once a day. For surgical disinfection before operations , the surgeons first washed their hands with soap and a brush under running water for five minutes. Thereafter, this washing was continued by applying copious amounts of high-proof alcohol to the hands and forearms. Finally, they dried themselves off with sterile towels. Alternative methods could not prevail due to gaps in effectiveness or incompatibilities.

The reason for the development of the rub-in process was the experience u. a. during the weekly chief physician's visit. During these visits, all senior and resident doctors visited the patients together with the head of the clinic. If there were patients with ulcers in the rooms, the wound usually had to be examined and the bandage changed. Disposable gloves, as they are common today, did not exist back then. However, given the fast pace of the chief rounds and the tightness of the hospital room, it was not possible for every doctor to wash their hands after the examination. Instead, a bowl was set up in the hallway in front of the room, in which there was a diluted solution containing formalin , which was previously considered to be disinfectant . The doctors dipped their hands in the disinfectant, dried them with a towel, and turned to the next patient.

In 1965, out of interest, Kalmár took a sample from the no longer fresh solution and gave it for microbiological examination. The then senior physician Naumann examined the sample. He came to the alarming result that the solution also contained various pathogenic bacteria , so the diluted agent obviously did not develop the expected effect. Kalmár concluded from the findings and his observations in daily practice that, instead of the laborious washing of hands to prevent the transmission of bacteria after contact with patients, a disinfectant had to be developed that could easily be found in the hands quickly and with little effort rubbed in, which looked safe and promised good acceptance due to its skin-care properties.

Through the mediation of Kalmár's superior, the cardiac and thoracic surgeon Georg Rodewald, the chief physician of the anesthesia department , Horaz, was asked to talk to his brother-in-law, Eberhard Bode, owner of the bacillol factory Dr. Bode & Co. in Hamburg, today Bode Chemie . Bode commissioned his colleague Rolf H. Steinhagen, who had already made contact with cardiac surgery in the UKE in connection with the introduction of surface disinfection, to sit down with Kalmár to find a solution to his idea.

After studying the literature, Kalmár and Steinhagen came to the conclusion that alcohol should continue to be regarded as the only effective means for the broad-based disinfection of the hands. The high-percentage alcohol previously used in surgical hand disinfection, however, had several disadvantages: on the one hand, the high potential for skin irritation and, on the other hand, the low depth effect due to the rapid evaporation. Kalmar drew the conclusion from this that alcohol had to be used diluted and combined with skin-caring components, such as lipid-replenishing substances. In addition, in order to ensure a longer-lasting effect, even with operations lasting three to four hours, the cornea should be soaked into the deeper corneal layers to prevent resident germs from reaching the surface from the deeper corneal layers. Therefore, the alcohol has to be modified so that it can diffuse into the skin. Dermatologists recommended invert soaps to be considered. It was decided to use fatty alcohols.

The determination of the alcohol combination with an optimal effectiveness was determined with bacteriological series examinations. In addition, Kalmár and Steinhagen tested the invert soaps in question in terms of their skin behavior in their own tests. The preparation was formulated after these experiments. The individual components were put together - the first hand disinfectant for the rub-in process was born. After the bacteriological tests carried out by Meyer-Rohn in the UKE's dermatology clinic, the preparation was approved for use in 1965. In the same year the bacillol factory Dr. Bode & Co. introduced the new pharmaceutical specialty as a liquid hand disinfectant based on alcohol for hygienic and, after the excellent long-term effectiveness proven by Kalmar in cardiac surgery, also for surgical hand disinfection as a rub-in preparation in Germany and shortly afterwards also in Austria. A number of follow-up preparations with minor variations in composition were developed by the other companies active in the manufacture and sale of disinfectants and brought onto the market.

Surgical hand disinfection without washing

The test and control results in the operating theater with the preparation Sterillium on the artificially contaminated and the native hand, even over 4 hours, were achieved without the previously usual pre-washing with soap and brush under running water.

In the narrow space of the washroom in Eppendorfer Herzchirurgie with an operating room for two operating tables, there was a very annoying tightness in the morning when two operating teams were preparing for operations at the same time and disinfected their hands. On one of the working days, during hand disinfection, the question arose as to why the usual water-soap pre-wash was used if the rub-in process produced better hygienic results than anything previously used, even without this preliminary. In the discussion that followed, Kalmar recommended that in future the general hygiene of the hands be carried out outside the operating unit and, as part of hand disinfection, only rub the alcohol-based rub into the hands and forearms for 5 minutes. Rodewald, the director of the unit, immediately agreed to this proposal. From that day on, hands in the operating unit were rinsed with water only after the procedures. This suddenly saved time and space.

In the early 1980s, several publications appeared that reported allergic reactions in the hands in connection with the use of various alcoholic rubs . A former senior physician, who had been the head of a specialist department in southern Germany for several years, called Kalmár in Hamburg and asked for advice, as his hands showed inflammatory changes in the skin after being disinfected with the rub-in preparation. He said that something had been changed in the composition of the disinfectant, which could explain the new skin intolerance. In-depth checks by the manufacturer did not reveal any changes to the recipe or the manufacturing process. In further discussions with the surgeon concerned, it turned out that he had had to use the usual combination procedure of surgical hand disinfection in the clinic there for one to two years, in which the hands had to be washed with water, soap and a brush for several minutes before the actual disinfection . In accordance with the literature on the harmful effects of too frequent or too aggressive washing, it was suspected that it was not the preparation but the combination with washing that was ultimately responsible for the intolerance symptoms.

This view corresponds to the current guideline of the Working Group of the Scientific Medical Societies on hand disinfection and hand hygiene.

Awards

Publications

  • with J. Meyer-Rohn: Experiences with a new hand disinfectant . Der Chirurg 39 (1968), pp. 231-236.
  • Surgical hand disinfection with alcoholic rub-in preparations . Swiss Med 7 (1985), pp. 57-59.

literature

Web links

Individual evidence

  1. ↑ Hamburg surgeons transplant heart and liver simultaneously for the first time , welt.de, May 14, 2018
  2. ^ RH Steinhagen: Development stages of hand disinfection . In: Eckert / Rodewald, Hygiene and Asepsis in der Chirurgie, pp. 55–61, here: p. 57. See also: Special print from: Volker Schumpelick, Niels M. Bleese, Ulrich Mommsen (ed.): Chirurgie. Textbook for students. Stuttgart undated, p. 51
  3. ↑ Disinfectant Sterillium Prof. Peter Kalmár: "I am the inventor of the germ killer" . In: mopo.de . June 6, 2015.
  4. ↑ AWMF - guidelines for hand disinfection and hand hygiene. Retrieved March 2, 2011 .
personal data
SURNAME Kalmár, Peter
ALTERNATIVE NAMES Kalmár, Peter Pal (full name)
BRIEF DESCRIPTION German heart surgeon
DATE OF BIRTH August 11, 1934
PLACE OF BIRTH Budapest