How surgeons wash their hands

Hand hygiene - This is how it’s done right!

Hand hygiene is one of the most important measures in preventing infection in hospitals and care facilities. In everyday work, the hands of the staff are in constant contact with patients and objects - this is how pathogens can be transmitted. The correct use of hand disinfection as an integral part of the hygiene concept and workflow is all the more important. Here the most important rules for effective hand hygiene are refreshed again.

Of course, hand washing and disinfecting are primarily intended to prevent infections from spreading further. But the hygienic measures also have other goals:

  • Protection against the spread of skin contamination,
  • Removal and / or killing of temporary (transient) microorganisms,
  • Reduction of the permanently present (resident) skin flora,
  • Removal of dirt,
  • Protection and care of the hands.

Requirements for effective hygiene

  1. There should be no jewelry, watches, rings, or any other type of jewelry on the hands and forearms.
  2. Only well-cared for and intact skin can be safely disinfected. That is why skin protection and regular skin care are mandatory.
  3. Disinfectants should always be close to the user and be accessible to the staff at all times. Wall dispensers, bed frame brackets, smock bottles and other application systems ensure sufficient hygiene products in the work environment.

The right equipment at the washing area

The correct operation of a disinfectant dispenser must also be learned to ensure perfect hygiene. Contact with dispensers, washing lotions, disinfectant bottles and at the washing areas increases the risk of the transmission of pathogens. To prevent this from happening, contact should be avoided. Corresponding washing facilities must be operable without hand contact:

  • Easily accessible washing facility and dispenser.
  • Wash basins with cold and hot water (e.g. single-lever mixer taps).
  • One dispenser each for hand disinfection and washing lotion. Bars of soap are not allowed.
  • Additional dispensers or tubes for skin protection and skin care.
  • Operation of the taps and dispensers using feet, elbows or sensor technology.
  • The dispensers should be easy to clean and disinfect. Dispensers for washing lotions and skin care products must be emptied, disinfected and thoroughly cleaned before each filling. Particular attention should be paid to the dosing device. Disposable bottles are suitable for the use of washing lotions and disinfectants.
  • Towel dispenser with disposable towels.

Four measures to keep your hands clean in hospitals

1. Hygienic hand disinfection

The main aim of hygienic hand disinfection is to eliminate the transient skin flora. This measure prevents the transmission of microorganisms from one patient to another. Therefore, hygienic hand disinfection must be carried out correspondingly frequently:

  • before and after contact with patients,
  • before activities in a sterile environment,
  • after contact with potentially infectious materials,
  • after contact with the immediate patient environment.

With hygienic hand disinfection, the disinfectant is rubbed into all areas of the hand. It is particularly important to ensure that wrists, thumbs, fingertips and spaces between the fingers are permanently moistened with the disinfectant. The process is continued according to the exposure time recommended by the manufacturer.

Which disinfectant is the right one?

Users should inform themselves in advance about the effectiveness of suitable disinfectants. The IHO disinfectant list provides information about the virus effectiveness of preparations in the healthcare sector. RKI-listed products must be used for officially ordered decontamination.

2. Surgical hand disinfection

Surgical hand disinfection is intended to destroy the transient skin flora and reduce the resident skin flora. This measure is carried out before all surgical interventions. Although the surgeon's hands are put in sterile surgical gloves during the operation, surgical hand disinfection prevents the germs from being transmitted via the glove shaft. For effective hand disinfection, the fingernails must be cut short and round and there must be no nail bed damage. If necessary, there are disinfected plastic brushes especially for cleaning fingernails.

Surgical hand disinfection is used in four steps:

  1. Put the hand sanitizer into the dry, cleaned hand. The dispenser is operated with the elbow.
  2. Rub hands and forearms up to the elbows with disinfectant. Make sure that the entire palms of the hands are moistened with disinfectant.
  3. Rub hands and forearms with disinfectant for the manufacturer's recommended exposure time and keep them moist.
  4. Keep hands above elbow level during and after rubbing. The hands must be dry before putting on the surgical gloves.

Wash your hands first or disinfect them first?

In routine cases, the traditional washing phase before surgical hand disinfection can be dispensed with. Hand washing is generally no longer necessary if the hands are optically clean. The reason: washing your hands reduces the effect of alcoholic disinfectants and therefore has the opposite effect. Before starting work, however, it is still mandatory to wash your hands, as the alcohols in the disinfectants are insufficiently effective against bacterial spores.

Hand washing is the washing of hands with water and washing lotion. Before and after work, hand washing is sufficient as a hygiene measure. But in most situations in everyday hospital life, hygienic hand disinfection with an alcoholic disinfectant is preferable to hand washing. However, hand washing is sufficient in the following cases:

  • before starting work and after finishing work,
  • if the hands are noticeably dirty,
  • if the hands are exposed to spore-forming agents,
  • after going to the toilet,
  • sweaty or sticky hands.

The application of hand washing takes place in five steps:

  1. Wet your hands with lukewarm water.
  2. Remove the washing lotion using a dispenser or dosing pump and foam it up with water.
  3. Clean under fingernails with a soft brush - if necessary.
  4. Rinse hands carefully to remove any remaining wash lotion.
  5. Thoroughly dry wet hands with a single-use towel.

The following points should be avoided during the washing process:

  • Use of hot water: removes the skin's own greasy film.
  • Intensive treatment with the brush: damages the epidermal layers of the skin.
  • Use of soap: destroys the skin's natural protective acid mantle.
  • Excessively long washing.
  • Inadequate rinsing off of the washing lotion.
  • Use of disposable towels that are too hard.
  • Insufficient drying after washing.

Wash your hands first or disinfect them first?
If a combination of the two processes is necessary - for example in the event of potential contamination with Clostridium difficile spores - hand washing should always be carried out after disinfection. Except for heavily soiled hands - then these must first be freed from the coarse dirt by hand washing so that the disinfection takes effect. In the case of spot contamination, the Robert Koch Institute (RKI) recommends pre-treatment with a paper towel, cellulose or similar soaked in hand disinfectant before the hygienic hand disinfection takes place.

4. Skin care & skin protection

Skin care is important to keep the skin healthy and to ensure that the disinfectant works optimally. The best times to care for your skin are before you start work, during breaks, and after work. More often if necessary, because healthy skin is the basis for effective hand hygiene. The degree of care required also depends on the skin type and the time of year.

The aim of skin protection is to prevent contact between pollutants and the skin. These hygiene measures also include protective gloves. Skin protection is used before starting work, before or during activities that are stressful to the skin, before wearing gloves for long periods of time and after breaks.

The application of skin care or skin protection takes place in three steps:

  1. To ensure that everything goes well from a hygienic point of view, the care product should be taken from a wall dispenser, by means of a dosing pump or from a tube.
  2. For skin care or skin protection, apply the product to the back of the hands of clean, dry hands.
  3. First apply cream to the outside of the hand, then to the inside. Don't forget the spaces between the fingers and nail beds.

The hygienic use of disposable medical gloves

Protective gloves must be worn in the event of foreseeable contact with pathogens or body excretions. Hygienic hand disinfection must be carried out before and after each putting on of gloves, as gloves do not offer reliable protection against contamination. A gloved hand should only be disinfected in exceptional cases, for example to avoid frequent glove changes. However, the following requirements must be met for this:

  • proof that the gloves can be disinfected,
  • no previous risk of perforation,
  • no contamination with blood etc.,
  • no increased likelihood of contamination with viruses or multi-resistant pathogens.

Development and avoidance of skin irritations

There is a general suspicion that alcohol-based hand sanitisers are harmful to the skin and cause dry hands. But this concern is unfounded. Although skin oils are dissolved during disinfection, they are also rubbed back into the skin at the same time. The ingredients in alcoholic disinfectants can contain lipid-replenishing substances and partially replace missing skin oils.

It looks different when washing your hands. Long and frequent washing destroys the protective function of the horny layer. As a result, the skin's own fats are dissolved and washed away. In addition, there is no antimicrobial effect. In the long term, this can lead to cracked or flaky skin, which offers ideal niches for microorganisms and represents a hygiene risk. Correctly used skin protection and regular skin care can help against this.

These activities are harmful to the skin:

  • long and frequent hand washing,
  • Brushing or scrubbing skin,
  • prolonged wearing of gloves,
  • direct skin contact with irritating or corrosive products.