Open Access Highly Accessed Research article

Practice of skin protection and skin care among German surgeons and influence on the efficacy of surgical hand disinfection and surgical glove perforation

Julian C Harnoss1, Laura Brune2, Jörg Ansorg3, Claus-Dieter Heidecke4, Ojan Assadian5* and Axel Kramer2

Author Affiliations

1 Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg 69120, Germany

2 Institute for Hygiene and Environmental Medicine, Universitätsmedizin Greifswald, Greifswald 17475, Germany

3 Professional Board of German Surgeons, Berlin 10117, Germany

4 Department of Surgery, Universitätsmedizin Greifswald, Greifswald 17489, Germany

5 Clinical Institute for Hospital Hygiene and Infection Control, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria

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BMC Infectious Diseases 2014, 14:315  doi:10.1186/1471-2334-14-315

Published: 10 June 2014



Surgical hand rub and healthy skin are basic requirements to prevent surgical site infections. Nevertheless, there is little knowledge about the current practice of skin protection and/or skin care products (SP/SC) using among surgeons as well as a lack of data pertaining to the influence of SP/SC on the antimicrobial efficacy of surgical hand rub.


A 10 weeks-survey among German surgeons as well as an experimental crossover study involving 26 participants were conducted. The immediate and sustainable efficacy (IE/SE) of surgical hand rub and participants’ hand moisture were measured after an 8-day usage of SP/SC, as well as the influence on micro-perforations on surgical gloves.


The questionnaire was available to 16,000 German surgeons. Thereof, 1,771 surgeons accessed the questionnaire, representing a total participation rate of 11%. As 19% (n = 338) of questionnaires were incomplete, a total of 1,433 completed questionnaires were available for further analysis. More than 75% of the participants stated not to use any SP/SC, yet, almost 50% suffered from skin irritation or discomfort. Only 5% used SP/SC at the beginning of their shift. 10% refused to use SP/SC because of concerns that SP/SC may reduce the antimicrobial efficacy of surgical hand rub.

After usage of SP/SC over 8-days, skin moisture was significantly higher (P < 0.001), whereas no significant influence on the antimicrobial efficacy of surgical hand rub was observed (IE: P = 0.135; SP: P = 0.681). Micro-perforations were detected in 8/52 surgical gloves (15%), with no statistical significant difference between SP/SC users (n = 2/26; 8%) and non-users (n = 6/26; 23%; P = 0.249).


Following the results of this largest questionnaire base survey among German surgeons on skin care, there is a need to educate and inform surgeons on the correct application and the concept of SP/SC strategies. In the present study, the combination of selected SP/SC products and one alcohol-based hand rub formulation did not show a negative interaction with surgical hand rub or surgical glove perforation. However, it is advisable to ascertain the compatibility of SP/SC products with the used hand disinfectant prior to purchase.

Hand disinfection; Surgical hand rub; Skin protection; Skin care; Compliance surgeon; Interaction; Alcohol-based hand rub; Micro-perforation; Surgical glove