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

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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