Hand washing

In medicine we mean by hand sanitizer a method to reduce the number of pathogens on the skin of the hands with the aid of hand disinfectants. Objectives are the prevention of the transmission of pathogens ( especially bacteria and viruses) from one patient to the next and the busy own protection in health people.

• 7.1 for surgical hand disinfection
• 7.2 for hygienic hand disinfection
• 7.3 generally

Transient skin flora

The disinfection is used to reduce the transient skin flora. This refers to the temporary colonization with skin strange, possibly disease-causing ( pathogenic ) bacteria. Also, by washing, the transient skin flora are removed sufficiently comprehensive and for private use. In the field of patient care the claim is higher, so here disinfectants are necessary.

Resident skin flora

The resident skin's flora protects against disease-causing pathogens. Because they, too, is under attack by disinfectants, hand disinfectants also belongs to the systematic development of a skin protection.

Hygienic and surgical hand disinfection

Hygienic hand disinfection before and after each patient contact performed by the more thorough surgical hand disinfection, however, prior to surgery or invasive procedures.

The distinction between hygienic and surgical hand disinfection was introduced in 1905 by Carl Flügge. Hygienic hand disinfection eliminates haut foreign pathogens and reduces the number of skin's own agents. Surgical hand disinfection is the extensive elimination of the skin's natural pathogens that lucidum are present in the cornea to the stratum in decreasing number, where sweat and sebaceous glands usually are virtually germ -free.

The historically significant contribution in medicine delivered Ignaz Semmelweis (1818-1865), a Hungarian- Austrian physician. He recognized the cause of puerperal fever, and led in 1847 as the first- hygiene rules for doctors, midwives and hospital staff. Its provisions included the instruction to disinfect their hands with chlorinated lime before and after each patient contact. He was able to reduce the number of in-hospital deaths significantly. Only in 1861, his book The etiology, the concept and the prophylaxis of childbed fever.

The idea, instead of the previous washing of hands with various additives to develop a tool which should be rubbed into the hands, in 1965 Peter Kalmár, then an assistant doctor in the Surgical University Hospital Hamburg- Eppendorf. Thus, the method of hand disinfection should be more efficient, easier and faster done. The realization of this idea led to the development of alcoholic Einreibeverfahrens for hygienic and surgical hand disinfection. Kalmár was also the initiator of the fundamental change in the method of surgical hand disinfection. Because of the experience and of dermatological knowledge, it became deeply for the now generally accepted procedure one to omit the then usual and partly skin-damaging aggressive pre-washing with water, soap and brush or to separate in time the occasionally required cosmetic hand washes the disinfection process.

Hygienic hand disinfection

Hygienic hand disinfection is the most important measure for the prevention of nosocomial infections. It protects the patient and the medical and nursing staff.

Semmelweis had originally introduced by means of chloride of lime. Today, to prevent the hands transfer in the treatment and care of patients in hospital pathogens ( Nosocomial infection) approved, gentle on skin disinfectants. For hand disinfection with alcoholic preparations about 3 ml (2 to 3 strokes from wall dispensers ) are added to the dry palm of the hand and rubbed. Soak for at least 30 seconds. The agents act by destroying the single- hulls. The distribution of hand disinfectant is divided into six steps that will ensure that between the fingers, the finger and the nail folds are mitbenetzt:

• Rub palms together
• Rub the palm of the hand top of the other hand with fingers spread
• Rub the palms together, fingers spread
• Rubbing the surface of the fingers in the palm of the other hand
• Rubbing each other's thumb in his clenched fist
• Rubbing the fingertips in the palm of the other hand

The minimum contact time of 30 seconds ( eg, Pseudomonas ) is not sufficient for the inactivation of some resistant pathogens. Case of contamination with hepatitis B virus specific hand sanitizer must be used, their effectiveness against hepatitis B viruses show relevant reports.

Jewelery and wedding rings, watches and bracelets, nail polish, long nails not only provide nesting sites for pathogens, but impair the effectiveness of hand sanitizer, because the liquid does not reach the skin underneath jewelery and artificial fingernails.

Relevant provisions are in the accident prevention regulations of the trade associations (§ 22, § 6 UVV), or in the care standards of the institution. Here information for avoiding errors in dealing with the disinfectant dispensers for example, refer to.

Surgical hand disinfection

Surgical hand disinfection finds its use before any surgical procedure. Target is the extensive pathogen freedom. In addition to the surgeon all need to pull on the operating table, standing and working people of this disinfectant action. On the clean hands before an operation is only the disinfectant. Due to the surgical hand disinfection by rubbing alcoholic preparations in dry hands the transient flora is so greatly reduced that a germ proliferation and transmission is inhibited. Mechanical cleaning of hands with soap and water washing and nail toilet should be made to protect the skin over time regardless of the use of the disinfectant. This method results in significantly higher reduction rates than the hygienic hand washing with antimicrobial washing preparations or as the soap wash and providing greater security. In addition, a distribution of microorganisms in the environment such as takes place when washing your hands, prevented. In the hands and forearms an alcoholic hand disinfectant in several portions ( at least 2 × 5 mL) is distributed and rubbed for a period of at least 3, preferably 5 minutes. It is initially worked up to the elbow and in the end only rubbed his hands. Before tightening the gloves hands must be dry. In operations that take longer than three hours, or injuries of surgical gloves in connection with change of scrubs a new short hand disinfection ( gloves, etc. ) necessary to the on in the meantime from the deeper layers of the stratum corneum or by contamination kill the skin surface reached pathogens.

Hand disinfection in general everyday life

Disinfectants that are used in the medical field are not recommended in the budget because they also kill harmless bacteria that the body needs to train his defense. The washing of hands with gentle soap, especially when dirty, after going to the toilet, after contact with doors and doorknobs in public institutions and after contact with animals or sick people, is enough. Exceptions are made when a family member is ill or suffers from a weakened immune system.

Requirement of skin care

The repeated hand disinfection, the skin is attacked and degreased by alcohol. Therefore, hand sanitizer frequently contain lipid-layer components. Additional skin care is recommended and is called in the accident prevention regulations.