State-of-the-art hand hygiene in community medicine.
by
Kampf G.
Bode Chemie GmbH,
Melanchthonstr.
27, D-22525 Hamburg, Germany. Int J Hyg Environ Health. 2003Oct;206(6):465-72.
ABSTRACT
Hand hygiene becomes more important in community medicine not only
since antibiotic resistant bacteria such as MRSA spread within the
community. Hands may be colonized with transient microorganism in up to
75%. Among those transient pathogens S. aureus, C. difficile or the
hepatitis C virus may be found. During patient care the number of
microorganisms on the hands steadily increases. In addition hands may
be contaminated with different kinds of germs even if only "clean"
activities are carried out. Gloves may be worn but do not provide
complete protection from contamination due to leaks. Therefore hands
should always be treated after gloves are taken off. State-of-the-art
treatment of hands is the hygienic hand disinfection with alcohol-based
hand rubs. They are more effective, quicker to carry out, better
tolerated by the skin, with a positive effect on compliance, and cost
effective in comparison to antiseptic soaps based on chlorhexidine or
triclosan and in comparison to normal non-medicated soaps. Healthy skin
easily tolerates alcohol-based products from the beginning on. Only
health care workers with an underlying irritative contact dermatitis
which is often caused by bar or liquid antiseptic soaps may have
difficulties to use alcohol-based products initially. In such a case
treatment of the underlying skin condition is the way to go and not
staying with a preparation which has caused the dermatitis. All this
knowledge is now reflected in current guidelines on hand hygiene.
Beside liquids alcohol-based gels can be used if they have an
antimicrobial activity equal to alcohol-based liquid preparations. Hand
hygiene remains the single most important tool to avoid cross
transmission of microorganisms between patients. This state-of-the-art
hand hygiene should also be emphasized more in community medicine. This
review may help to go the first step into this direction.