Kramer A, Hübner N, Below H, Heidecke C-D, Assadian O
Institute of Hygiene and Environmental Medicine, Ernst Moritz Arndt University Greifswald.
J Hosp Infect. 2008 Oct;70 Suppl 1:35-43. doi: 10.1016/S0195-6701(08)60009-2.
At present, no universal agreement on detailed practice for surgical hand preparation exists. In order to fill this gap, in 2002 a Franco-German recommendation for surgical hand preparation was published as a first step towards a generally accepted European recommendation. Based on an assessment of the actual literature, a protocol for surgical hand preparation is discussed with the aim to recommend evidence-based standard procedures including prerequisites, washing and disinfection phase, and its practical implementation. In contrast to hygienic hand disinfection, for surgical hand preparation compliance is not an issue, since it mostly is regarded as a ceremony which is carried out without exception. Nevertheless, the following factors influence acceptance and efficacy: skin tolerance, ease of use, duration of procedure, and recommended time), potential for impaired efficacy due to incorrect performance of the procedure, possibility of systemic risks and irritating potential by applied preparations, religious restrictions, ecological aspects, costs and safety. Here, we report our experience with the introduction of a new hand preparation regime in all surgical disciplines in our university hospital based on the above factors. The following statements were evaluated: 1) The immediate efficacy of an alcohol-based hand disinfectant is impaired by a preceding hand wash for up to 10 minutes. Therefore hands should not be routinely washed before the disinfection period unless there is a good reason for it such as visible soiling. 2) A shortened application time (1.5 minutes) is equal to 3 min in terms of efficacy. 3) Hands should be air dried before gloves are put on, otherwise the perforation rate of gloves will increase. 4) The efficacy of alcohol-based disinfectants is significantly higher when hands are allowed to dry for 1 minute after the washing phase and before the disinfection phase. To clarify the above questions before the establishment of the modified technique, the surgical team was invited to a meeting. As a result, the heads of surgical departments supported the new technique and decided to change their practice.
目前，对于外科洗手准备的详细操作尚无普遍共识。为填补这一空白，2002年发布了一份法德两国关于外科洗手准备的建议，作为迈向被广泛接受的欧洲建议的第一步。基于对实际文献的评估，讨论了外科洗手准备方案，目的是推荐基于证据的标准程序，包括前提条件、洗手和消毒阶段及其实际实施。与卫生手消毒不同，对于外科洗手准备，依从性不是问题，因为它大多被视为一项必须毫无例外执行的程序。然而，以下因素会影响接受度和效果：皮肤耐受性、易用性、操作持续时间和推荐时间），因操作不当导致效果受损的可能性、所用制剂引发全身风险和刺激的可能性、宗教限制、生态因素、成本和安全性。在此，我们报告基于上述因素在我校医院所有外科科室引入新的洗手准备方案的经验。对以下陈述进行了评估：1）在进行酒精基手消毒剂消毒前洗手长达10分钟会削弱其即时效果。因此，除非有充分理由，如明显污染，否则在消毒阶段前不应常规洗手。2）缩短应用时间（1.5分钟）在效果上等同于3分钟。3）戴手套前双手应风干，否则手套穿孔率会增加。4）在洗手阶段后和消毒阶段前让双手干燥1分钟，酒精基消毒剂的效果会显著提高。在确立改良技术之前，为阐明上述问题，邀请外科团队参加了一次会议。结果，外科各科室主任支持新技术并决定改变他们的操作方法。
