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Author: Kampf G et al. Source: BMC Infect Dis. 2008, Oct 29; 8:149


Kampf G et al.

Influence of the rub-in-technique on required time and hand coverage in hygienic hand disinfection

Background: For hygienic hand disinfection, World Health Organization (WHO), Centers for Disease Control and Prevention (CDC) and Robert Koch-Institute (RKI) recommend a rub-in time that is long enough (mostly 30 seconds). However, several data indicate that hand disinfectants available on the market can achieve sufficient activity against bacteria according to EN 1500 within 15 seconds. The study verified, whether this short application time is enough to ensure good coverage of both hands.

Methods: The study comprised four sets of experiments and was conducted with 15 test persons and 20 healthcare workers to investigate the coverage of hands after the application of the hand disinfectant with various rub-in techniques and different exposure times. The percentage of completely covered hands and the average rub-in time was assessed. To determine gaps in coverage, the authors used fluorescent solution in combination with a UV light box. Examined rub-in procedures included the reference procedure with 5 repetitions of 6 special steps, which are used in accordance with EN 1500 to assess the efficacy of hand disinfectants for hygienic hand disinfection. Further sets of experiments included modifications of this reference method and the responsible application without specification of special steps.

One-time performance of the 6 steps required 17 seconds only, but leaded to gaps in coverage with all test persons. With every additional repetition of the 6 steps, the coverage became better, but required an application time of up to 37 seconds. The responsible rub-in technique yielded the best results in coverage and required between 25 and 28 seconds.

Conclusions: High-quality hand disinfection cannot be achieved within 15 seconds. It is recommended to maintain the 30-second exposure time. The known six rub-in steps based on the reference method in accordance with EN 1500 are not suitable for clinical practice. The authors advocate responsible application and emphasise the importance of training with UV light and individual feedback.

Source: BMC Infectious Diseases 2008, 8: 149.

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