gms | German Medical Science

While for millennia handwashing has been practiced not only in an attempt to remove physical contamination but also to rid oneself of guilt and evil, it was only some 200 years ago that, thanks to the insights of physicians such as Alexander Gordon, Oliver Wendell Holmes and Ignaz Philipp Semmelweis and to Semmelweis’ ability to draw the right conclusions, that people became aware of the fact that diseases could be spread via the hands and, vice versa, that this pathway could be interrupted through hand hygiene.

Today, hand hygiene is seen as the most important measure to protect against the spread of nosocomial infections, but is it being practiced such that it does justice to its assigned role? Evidence of shortcomings here came to light in the middle of the past century, giving rise to scientific research, which in turn meant a sharp increase over the past 50 years in the body of knowledge relating to effective methods for removal from the hands or killing and inactivation of pathogens which were not even discovered 200 years ago and of which many more are still not known. This has been made possible above all thanks to the development of in vitro und in vivo laboratory test methods for evaluation of the effect of hand hygiene methods.

The German Society of Hygiene and Microbiology (DGHM) published already back in 1958 the first “Guidelines for Testing Chemical Disinfectants” [1] and included only those hand disinfection products on its “List of Tested Chemical Disinfectants Found To Be Effective” (e.g. [2]) that had been tested as per the methods cited in the guidelines. Somewhat later the American Society of Testing and Materials (today: ASTM International) published the first test protocols for hand disinfection products [3], which in 1974 were adopted by the US Food and Drug Agency as “Guidelines” in a “Tentative Final Monograph” (TFM) and in 1994, having revised it to incorporate new insights, it was published once again [4]. Besides, ASTM International has also published other standards of relevance to hand disinfectants:

• E 2276 (Bacteria-Eliminating Effectiveness of Hygiene Handwash and Handrub Agents Using the Fingerpads of Adult Subjects),
• E 1838 (Virus-Eliminating Effectiveness of Liquid Hygienic Handwash and Handrub Agents Using the Fingerpads of Adult Volunteers),
• E 2011 (Handwashing Formulations for Virus-Eliminating Activity Using the Entire Hand) und
• E 1115 (Evaluation of Surgical Hand Scrub Formulations).

Where the user is concerned, guidelines for hand disinfection containing information on indication and implementation are of course more important than methods dealing with efficacy testing of products. Such guidelines are therefore being compiled increasingly more commonly within the hospitals by the infection control teams set up during the 1970s. Formal, written guidelines were ultimately also published by several relevant healthcare institutions, scientific societies and associations. These include for example those of the Centers for Disease Control (CDC 1975 [5], 1986 [6] and 2002 [7]), of the Association for Professionals in Infection Control (APIC 1988 [8] und 1995 [9]) or of the Hospital Infection Control Practices Advisory Committee (HICPAC 1995 [10], 1996 [11]).

The WHO Guidelines for Hand Hygiene in Healthcare Settings, formulated under the direction of Didier Pittet, within the framework of the WHO World Alliance for Patient Safety, proved to be the most successful of the attempts undertaken at global level to enhance hand hygiene. These guidelines contain detailed information and recommendations on hand hygiene, while also taking account of facilities available in developing countries. Publication of this important document is expected in 2005/2006.

The most remarkable changes to hand hygiene strategies in recent years were no doubt the efforts aimed at improving compliance among medical personnel and the increasing international acceptance of hand disinfection by using alcohols in the form of rubs; whether this will be with lotions or gels remains to be seen.

Figure 1 [Fig. 1]

Specialist for Hygiene and Microbiology.

Chairman of the Clinical Institute for Hygiene and Medical Microbiology of the University of Vienna.

After successfully ending his study of Medicine at the University of Vienna in 1965 Manfred Rotter became assistant doctor at the Hygiene Institute there. He gets a further Diploma in Bacteriology at the London University and habilitated at the University of Vienna for the subject of Hygiene and Microbiology in 1976.

In 1984 and 1987 he took on a visiting professorship in South Africa and became Head of the Clinical Department for Clinical Microbiology of the Hygiene Institute at the Vienna General Hospital, one of the biggest in Europe, in 1991. Additionally he was appointed Chairman of the Clinical Institute for Hygiene and Medicinal Microbiology of the University of Vienna in 1995.

Professor Rotter is a worldwide acknowledged specialist in the area of alcoholic hand disinfection. More than 400 publications and numerous scientific honours do not only document his expertise but also the absolute acknowledgment thereof. Tongue in cheek – but nevertheless meant seriously – he is often being called „the direct successor of Semmelweis“.