fcmedicineФундаментальная и клиническая медицинаFundamental and Clinical Medicine2500-07642542-0941КемГМУfcmedicine-119Research ArticleСтатьиГИГИЕНА РУК В МЕДИЦИНСКИХ ОРГАНИЗАЦИЯХHAND HYGIENE IN PATIENT CAREКампфГ. .KampfGÜNTERnoemail@neicon.ruМедицинский университет Грайсвальда, Институт гигиены и медицины окружающей средыРоссияUniversity Medicine Greifswald, Institute for Hygiene and Environmental MedicineRussian Federation201830122018346072Copyright © Кампф Г..., 20182018Кампф Г...Kampf G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://fcm.kemsmu.ru/jour/article/view/119

Гигиена рук - обязательный компонент снижения риска передачи возбудителей внутрибольничных инфекций в медицинских организациях. Всемирная организация здравоохранения (ВОЗ) инициировала проведение глобальной кампании по гигиене рук с целью снижения инфекций, связанных с оказанием медицинской помощи. В соответствии с пятью важнейшими элементами гигиены рук дезинфекция рук спиртсодержащими препаратами является средством выбора. Переносимость кожей этих препаратов обычно высока, если в них добавлены смягчающие компоненты. Мытье рук водой должно быть исключено, кроме ситуаций видимого загрязнения рук или контаминации их бактериальными спорами, например, C. difficile. Обычно используется жидкое мыло, при этом антимикробное мыло преимуществ не имеет. Предоперационная подготовка рук считается идеальной в случае использования спиртсодержащих антисептиков. Добавление биоцидных агентов с персистирующей антимикробной активностью не требуется, так как может повышать раздражение кожи, аллергические реакции и приводить к формированию резистентности к антимикробным средствам. Мытье рук хирургов с антимикробным мылом все больше и больше уходит в прошлое, так как обработка рук спиртсодержащими антисептиками значительно быстрее (1,5 мин) и бережнее для кожи рук. В соответствии с рекомендациями ВОЗ такой подход к гигиене рук поможет предотвратить инфекции, связанные с оказанием медицинской помощи, и снизить стрессовую нагрузку на кожу медицинских работников.

Hand hygiene is an essential element to reduce the transmission of nosocomial pathogens in healthcare facilities. The WHO has launched a global campaign on hand hygiene with the aim to reduce healthcare-associated infections. Hand disinfection using alcohol-based hand rubs is the treatment of choice for clean hands according to the five indications for hand hygiene. The dermal tolerance is usually good when emollients are part of the formulation. Hand washing should be an exception, e.g. when hands are visibly soiled or contaminated with bacterial spores such as C. difficile. Use of plain liquid soap is usually sufficient, antimicrobial soaps do not provide a relevant advantage over plain soaps. Preoperative treatment of hands is ideally done with alcohol-based hand rubs. Additional biocidal agents with a persistent antimicrobial activity are not necessary and may cause skin irritation, allergic reactions or biocidal tolerance. Surgical scrubbing with an-timicrobial soaps is more and more replaced by surgical hand rubbing which is faster (often 1.5 min application time) and more gentle to the skin. Following the WHO recommendations will help to prevent health-care-associated infections and to reduce the occupa-tional stress to the skin of healthcare workers.

гигиена рукмытье рукдезинфекция рукмытье рук хирурговдезинфекция рук хирурговhand hygienehand washhand disinfectionsurgical hand scrubbingsurgical hand rubbingReferencesPrice PB. The bacteriology of normal skin: a new quantitative test applied to a study of the bacterial ora and the disinfectant action of mechanical cleansing. J Infect Dis. 1938; 63 (3): 301-318Price PB. The bacteriology of normal skin: a new quantitative test applied to a study of the bacterial ora and the disinfectant action of mechanical cleansing. J Infect Dis. 1938; 63 (3): 301-318Rotter M. [Public health aspects of the hand]. Z Gesamte Hyg. 1990; 36 (2): 77-79Rotter M. [Public health aspects of the hand]. Z Gesamte Hyg. 1990; 36 (2): 77-79Montes LF, Wilborn WH. Location of bacterial skin ora. Br J Dermatol. 1969; 81 Suppl 1: 23-26. doi: 10.1111/j.1365-2133.1969.tb12829.xMontes LF, Wilborn WH. Location of bacterial skin ora. Br J Dermatol. 1969; 81 Suppl 1: 23-26. doi: 10.1111/j.1365-2133.1969.tb12829.xLark RL, VanderHyde K, Deeb GM, Dietrich S, Massey JP, Chenoweth C. An outbreak of coagulase-negative staphylococcal surgical-site infections following aortic valve replacement. Infect Control Hosp Epidemiol. 2001; 22 (10): 618-623. doi: 10.1086/501832Lark RL, VanderHyde K, Deeb GM, Dietrich S, Massey JP, Chenoweth C. An outbreak of coagulase-negative staphylococcal surgical-site infections following aortic valve replacement. Infect Control Hosp Epidemiol. 2001; 22 (10): 618-623. doi: 10.1086/501832Sullivan A, Edlund C, Nord CE. Effect of microbial agents on the ecological balance of human microora. Lancet Infect Dis. 2001; 1 (2):101-114. doi: 10.1016/S1473-3099(01)00066-4Sullivan A, Edlund C, Nord CE. Effect of microbial agents on the ecological balance of human microora. Lancet Infect Dis. 2001; 1 (2):101-114. doi: 10.1016/S1473-3099(01)00066-4Pittet D, Dharan S, Touveneau S, Sauvan V, Perneger TV. Bacterial contamination of the hands of hospital staff during routine patient care. Arch Intern Medi. 1999; 159 (8): 821-826. doi:10.1001/archinte.159.8.821Pittet D, Dharan S, Touveneau S, Sauvan V, Perneger TV. Bacterial contamination of the hands of hospital staff during routine patient care. Arch Intern Medi. 1999; 159 (8): 821-826. doi:10.1001/archinte.159.8.821McDonald LS, Bavaro MF, Hofmeister EP, Kroonen LT. Hand infections. J Hand Surg Am. 2011; 36 (8): 1403-1412. doi: 10.1016/j.jhsa.2011.05.035McDonald LS, Bavaro MF, Hofmeister EP, Kroonen LT. Hand infections. J Hand Surg Am. 2011; 36 (8): 1403-1412. doi: 10.1016/j.jhsa.2011.05.035Pittet D, Hugonnet S, Harbarth S, Monronga P, Sauvan V, Touveneau S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet. 2000; 356 (9238): 1307-1312. doi: 10.1016/S0140-6736(00)02814-2Pittet D, Hugonnet S, Harbarth S, Monronga P, Sauvan V, Touveneau S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet. 2000; 356 (9238): 1307-1312. doi: 10.1016/S0140-6736(00)02814-2Sax H, Allegranzi B, Uçkay I, Larson E, Boyce J, Pittet D. 'My ve moments for hand hygiene': a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect. 2007; 67 (1): 9-21. doi: 10.1016/j.jhin.2007.06.004Sax H, Allegranzi B, Uçkay I, Larson E, Boyce J, Pittet D. 'My ve moments for hand hygiene': a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect. 2007; 67 (1): 9-21. doi: 10.1016/j.jhin.2007.06.004Pittet D. Improving adherence to hand hygiene practice: a multidisciplinary approach. Emerg Infect Dis. 2001; 7 (2): 234-240. DOI: 10.3201/eid0702.700234Pittet D. Improving adherence to hand hygiene practice: a multidisciplinary approach. Emerg Infect Dis. 2001; 7 (2): 234-240. DOI: 10.3201/eid0702.700234Pittet D, Donaldson L. Clean Care is Safer Care: a worldwide priority. Lancet. 2005; 366 (9493): 1246-1247. doi: 10.1016/s0140-6736(05)67506-xPittet D, Donaldson L. Clean Care is Safer Care: a worldwide priority. Lancet. 2005; 366 (9493): 1246-1247. doi: 10.1016/s0140-6736(05)67506-xPittet D, Allegranzi B, Storr J, Donaldson L. 'Clean Care is Safer Care': the Global Patient Safety Challenge 2005-2006. Int J Infect Dis. 2006; 10 (6): 419-424. doi: 10.1016/j.ijid.2006.06.001Pittet D, Allegranzi B, Storr J, Donaldson L. 'Clean Care is Safer Care': the Global Patient Safety Challenge 2005-2006. Int J Infect Dis. 2006; 10 (6): 419-424. doi: 10.1016/j.ijid.2006.06.001Pittet D, Donaldson L. Clean care is safer care: the rst global challenge of the WHO World Alliance for Patient Safety. Am J Infect Control. 2005; 33 (8): 476-479. doi: 10.1016/j.ajic.2005.08.001Pittet D, Donaldson L. Clean care is safer care: the rst global challenge of the WHO World Alliance for Patient Safety. Am J Infect Control. 2005; 33 (8): 476-479. doi: 10.1016/j.ajic.2005.08.001WHO. Guide to implementation - a guide to the implementation of the WHO multimodal hand hygiene improvement strategy WHO; 2009 [cited 2016 16 May]. Available at: http://www.who.int/gpsc/5may/Guide_to_Implementation.pdf (accessed 11.11.2018)WHO. Guide to implementation - a guide to the implementation of the WHO multimodal hand hygiene improvement strategy WHO; 2009 [cited 2016 16 May]. Available at: http://www.who.int/gpsc/5may/Guide_to_Implementation.pdf (accessed 11.11.2018)WHO. WHO model list of essential medicines: WHO; 2015 [updated 06.05.2016]. Available at : http://www.who.int/medicines/publications/essentialmedicines/EML2015_8-May-15.pdf (accessed 11.11.2018)WHO. WHO model list of essential medicines: WHO; 2015 [updated 06.05.2016]. Available at : http://www.who.int/medicines/publications/essentialmedicines/EML2015_8-May-15.pdf (accessed 11.11.2018)WHO. Hand hygiene a key defence in Europe’s ght against antibiotic resistance : WHO; 2017 [updated 04.05.2017]. Available at: http://www.who.int/medicines/publications/essentialmedicines/EML2015_8-May-15.pdf. (accessed 11.11.2018)WHO. Hand hygiene a key defence in Europe’s ght against antibiotic resistance : WHO; 2017 [updated 04.05.2017]. Available at: http://www.who.int/medicines/publications/essentialmedicines/EML2015_8-May-15.pdf. (accessed 11.11.2018)Bettin K, Clabots C, Mathie P, Willard K, Gerding DN. Effectiveness of liquid soap vs. chlorhexidine gluconate for the removal of Clostridium difcile from bare hands and gloved hands. Infect Control Hosp Epidemiol. 1994; 15 (11): 697-702.Bettin K, Clabots C, Mathie P, Willard K, Gerding DN. Effectiveness of liquid soap vs. chlorhexidine gluconate for the removal of Clostridium difcile from bare hands and gloved hands. Infect Control Hosp Epidemiol. 1994; 15 (11): 697-702.Nerandzic MM, Rackaityte E, Jury LA, Eckart K, Donskey CJ. Novel strategies for enhanced removal of persistent Bacillus anthracis surrogates and Clostridium difcile spores from skin. PLoS One. 2013; 8 (7): e68706. doi: 10.1371/journal.pone.0068706Nerandzic MM, Rackaityte E, Jury LA, Eckart K, Donskey CJ. Novel strategies for enhanced removal of persistent Bacillus anthracis surrogates and Clostridium difcile spores from skin. PLoS One. 2013; 8 (7): e68706. doi: 10.1371/journal.pone.0068706Weber DJ, Sickbert-Bennett E, Gergen MF, Rutala WA. Efcacy of selected hand hygiene agents used to remove Bacillus atrophaeus (a surrogate of Bacillus anthracis) from contaminated hands. JAMA. 2003; 289 (10): 1274-1277. doi:10.1001/jama.289.10.1274Weber DJ, Sickbert-Bennett E, Gergen MF, Rutala WA. Efcacy of selected hand hygiene agents used to remove Bacillus atrophaeus (a surrogate of Bacillus anthracis) from contaminated hands. JAMA. 2003; 289 (10): 1274-1277. doi:10.1001/jama.289.10.1274Hübner N-O, Kampf G, Löfer H, Kramer A. Effect of a 1 minute hand wash on the bactericidal efcacy of consecutive surgical hand disinfection with standard alcohols and on skin hydration. Int J Hyg Environ Health. 2006; 209 (3): 285-291. doi: /10.1016/j.ijheh.2006.01.002Hübner N-O, Kampf G, Löfer H, Kramer A. Effect of a 1 minute hand wash on the bactericidal efcacy of consecutive surgical hand disinfection with standard alcohols and on skin hydration. Int J Hyg Environ Health. 2006; 209 (3): 285-291. doi: /10.1016/j.ijheh.2006.01.002Fujitani S, George WL, Morgan MA, Nichols S, Murthy AR. Implications for vancomycin-resistant Enterococcus colonization associated with Clostridium difcile infections. Am J Infect Control. 2011; 39 (3): 188-193. doi: 10.1016/j.ajic.2010.10.024Fujitani S, George WL, Morgan MA, Nichols S, Murthy AR. Implications for vancomycin-resistant Enterococcus colonization associated with Clostridium difcile infections. Am J Infect Control. 2011; 39 (3): 188-193. doi: 10.1016/j.ajic.2010.10.024Vervoort J, Gazin M, Kazma M, Kotlovsky T, Lammens C, Carmeli Y, et al. High rates of intestinal colonisation with uoroquinolone-resistant ESBL-harbouring Enterobacteriaceae in hospitalised patients with antibiotic-associated diarrhoea. Eur J Clin Microbiol Infect Dis. 2014; 33 (12): 2215-2221. doi: 10.1007/s10096-014-2193-9Vervoort J, Gazin M, Kazma M, Kotlovsky T, Lammens C, Carmeli Y, et al. High rates of intestinal colonisation with uoroquinolone-resistant ESBL-harbouring Enterobacteriaceae in hospitalised patients with antibiotic-associated diarrhoea. Eur J Clin Microbiol Infect Dis. 2014; 33 (12): 2215-2221. doi: 10.1007/s10096-014-2193-9Kabara JJ, Brady MB. Contamination of bar soaps under "in-use"conditions. 1984; 5 (4-5): 1-14. J Environ Pathol Toxicol Oncol. 1984; 5 (4-5): 1-14Kabara JJ, Brady MB. Contamination of bar soaps under "in-use"conditions. 1984; 5 (4-5): 1-14. J Environ Pathol Toxicol Oncol. 1984; 5 (4-5): 1-14Afolabi BA, Oduyebo OO, Ogunsola FT. Bacterial ora of commonly used soaps in three hospitals in Nigeria. East Afr med j. 2007; 84 (10): 489-495Afolabi BA, Oduyebo OO, Ogunsola FT. Bacterial ora of commonly used soaps in three hospitals in Nigeria. East Afr med j. 2007; 84 (10): 489-495Jensen DA, Danyluk MD, Harris LJ, Schaffner DW. Quantifying the effect of hand wash duration, soap use, ground beef debris, and drying methods on the removal of Enterobacter aerogenes on hands. J Food Prot. 2015; 78 (4): 685-690. doi: 10.4315/0362-028x.jfp-14-245Jensen DA, Danyluk MD, Harris LJ, Schaffner DW. Quantifying the effect of hand wash duration, soap use, ground beef debris, and drying methods on the removal of Enterobacter aerogenes on hands. J Food Prot. 2015; 78 (4): 685-690. doi: 10.4315/0362-028x.jfp-14-245Graf W, Kersch D, Scherzer G. [Microbial contamination of liquid-soap wall dispensers with one-way bottles]. Zentralbl Bakteriol Mikrobiol Hyg B. 1988; 186 (2): 166-179Graf W, Kersch D, Scherzer G. [Microbial contamination of liquid-soap wall dispensers with one-way bottles]. Zentralbl Bakteriol Mikrobiol Hyg B. 1988; 186 (2): 166-179Caetano JA, Lima MA, Di Ciero Miranda M, Serufo JC, Ponte PR. [Identication of bacterial contamination in liquid soap for hospital use]. Rev Esc Enferm USP. 2011; 45 (1): 153-160. doi: /10.1590/S0080-62342011000100021Caetano JA, Lima MA, Di Ciero Miranda M, Serufo JC, Ponte PR. [Identication of bacterial contamination in liquid soap for hospital use]. Rev Esc Enferm USP. 2011; 45 (1): 153-160. doi: /10.1590/S0080-62342011000100021Aktas E, Taspinar E, Alay D, Ogedey ED, Kulah C, Comert F. Extrinsic contamination of liquid soap with various gram-negative bacteria in a hospital in Turkey. Infect Control Hosp Epidemiol. 2010; 31 (11): 1199-1201. doi: 10.1086/657077Aktas E, Taspinar E, Alay D, Ogedey ED, Kulah C, Comert F. Extrinsic contamination of liquid soap with various gram-negative bacteria in a hospital in Turkey. Infect Control Hosp Epidemiol. 2010; 31 (11): 1199-1201. doi: 10.1086/657077Yapicioglu H, Gokmen TG, Yildizdas D, Koksal F, Ozlu F, Kale-Cekinmez E, et al. Pseudomonas aeruginosa infections due to electronic faucets in a neonatal intensive care unit. Journal of paediatrics and child health. 2012; 48 (5): 430-434. doi: 10.1111/j.1440-1754.2011.02248.xYapicioglu H, Gokmen TG, Yildizdas D, Koksal F, Ozlu F, Kale-Cekinmez E, et al. Pseudomonas aeruginosa infections due to electronic faucets in a neonatal intensive care unit. Journal of paediatrics and child health. 2012; 48 (5): 430-434. doi: 10.1111/j.1440-1754.2011.02248.xBlanc DS, Gomes Magalhaes B, Abdelbary M, Prod'hom G, Greub G, Wasserfallen JB, et al. Hand soap contamination by Pseudomonas aeruginosa in a tertiary care hospital: no evidence of impact on patients. J Hosp Infect. 2016; 93 (1): 63-67. doi: 10.1016/j.jhin.2016.02.010Blanc DS, Gomes Magalhaes B, Abdelbary M, Prod'hom G, Greub G, Wasserfallen JB, et al. Hand soap contamination by Pseudomonas aeruginosa in a tertiary care hospital: no evidence of impact on patients. J Hosp Infect. 2016; 93 (1): 63-67. doi: 10.1016/j.jhin.2016.02.010Biswal M, Prasad A, Dhaliwal N, Gupta AK, Taneja N. Increase in hospital purchase of hand hygiene products: The importance of focusing on the right product. Am J Infect Control. 2015; 43 (7): 765-766.doi:10.1016/j.ajic.2015.02.031Biswal M, Prasad A, Dhaliwal N, Gupta AK, Taneja N. Increase in hospital purchase of hand hygiene products: The importance of focusing on the right product. Am J Infect Control. 2015; 43 (7): 765-766.doi:10.1016/j.ajic.2015.02.031Sartor C, Jacomo V, Duvivier C, Tissot-Dupont H, Sambuc R, Drancourt M. Nosocomial Serratia marcescens infections associated with extrinsic contamination of a liquid nonmedicated soap. Infect Control Hosp Epidemiology. 2000; 21 (3): 196-199. DOI:10.1086/501743Sartor C, Jacomo V, Duvivier C, Tissot-Dupont H, Sambuc R, Drancourt M. Nosocomial Serratia marcescens infections associated with extrinsic contamination of a liquid nonmedicated soap. Infect Control Hosp Epidemiology. 2000; 21 (3): 196-199. DOI:10.1086/501743Kampf G. Die einfache Händewaschung. In: Kampf G, editor. Kompendium Händehygiene. Wiesbaden: mhp-Verlag; 2017. p. 78-91Kampf G. Die einfache Händewaschung. In: Kampf G, editor. Kompendium Händehygiene. Wiesbaden: mhp-Verlag; 2017. p. 78-91Larson EL, Eke PI, Wilder MP, Laughon BE. Quantity of soap as a variable in handwashing. Infect Control. 1987; 8 (9): 371-375Larson EL, Eke PI, Wilder MP, Laughon BE. Quantity of soap as a variable in handwashing. Infect Control. 1987; 8 (9): 371-375de Almeida e Borges LF, Silva BL, Gontijo Filho PP. Hand washing: changes in the skin ora. Am J Infect Control. 2007; 35 (6): 417-420. doi: 10.1016/j.ajic.2006.07.012de Almeida e Borges LF, Silva BL, Gontijo Filho PP. Hand washing: changes in the skin ora. Am J Infect Control. 2007; 35 (6): 417-420. doi: 10.1016/j.ajic.2006.07.012Babb JR, Davies JG, Ayliffe GA. A test procedure for evaluating surgical hand disinfection. J Hosp Infect. 1991; 18 (suppl B): 41-49. doi:10.1016/0195-6701(91)90262-7Babb JR, Davies JG, Ayliffe GA. A test procedure for evaluating surgical hand disinfection. J Hosp Infect. 1991; 18 (suppl B): 41-49. doi:10.1016/0195-6701(91)90262-7Cremieux A, Reverdy ME, Pons JL, Savage C, Chevalier J, Fleurette J, et al. Standardized method for evaluation of hand disinfection by surgical scrub formulations. Appl Environ Microbiol. 1989; 55 (11): 2944-2948Cremieux A, Reverdy ME, Pons JL, Savage C, Chevalier J, Fleurette J, et al. Standardized method for evaluation of hand disinfection by surgical scrub formulations. Appl Environ Microbiol. 1989; 55 (11): 2944-2948Heeg P, Oßwald N. Schwenzer: Wirksamkeitsvergleich von Desinfektionsverfahren zur chirurgischen Händedesinfektion unter experimentellen und klinischen Bedingungen. Hyg Med. 1986; 11: 107-110Heeg P, Oßwald N. Schwenzer: Wirksamkeitsvergleich von Desinfektionsverfahren zur chirurgischen Händedesinfektion unter experimentellen und klinischen Bedingungen. Hyg Med. 1986; 11: 107-110Larson EL, Butz AM, Gullette DL, Laughon BA. Alcohol for surgical scrubbing? Infect Control Hosp Epidemiol. 1990; 11 (3): 139-143Larson EL, Butz AM, Gullette DL, Laughon BA. Alcohol for surgical scrubbing? Infect Control Hosp Epidemiol. 1990; 11 (3): 139-143Lowbury EJ, Lilly HA. Disinfection of the hands of surgeons and nurses. Br Med J. 1960; 1 (5184): 1445-1450Lowbury EJ, Lilly HA. Disinfection of the hands of surgeons and nurses. Br Med J. 1960; 1 (5184): 1445-1450Rotter M, Koller W, Wewalka G. Eignung von Chlorhexidinglukonat- und PVP-Jod-haltigen Präparationen zur Händedesinfektion. Hygiene und Medizin. 1981; 6: 425-430Rotter M, Koller W, Wewalka G. Eignung von Chlorhexidinglukonat- und PVP-Jod-haltigen Präparationen zur Händedesinfektion. Hygiene und Medizin. 1981; 6: 425-430Larson E, Girard R, Pessoa-Silva CL, Boyce J, Donaldson L, Pittet D. Skin reactions related to hand hygiene and selection of hand hygiene products. Am J Infect Control. 2006;34 (10): 627-635. doi: 10.1016/j.ajic.2006.05.289Larson E, Girard R, Pessoa-Silva CL, Boyce J, Donaldson L, Pittet D. Skin reactions related to hand hygiene and selection of hand hygiene products. Am J Infect Control. 2006;34 (10): 627-635. doi: 10.1016/j.ajic.2006.05.289Callahan A, Baron E, Fekedulegn D, Kashon M, Yucesoy B, Johnson VJ, et al. Winter season, frequent hand washing, and irritant patch test reactions to detergents are associated with hand dermatitis in health care workers. Dermatitis. 2013; 24 (4): 170-175. doi: 10.1097/DER.0b013e318290c57fCallahan A, Baron E, Fekedulegn D, Kashon M, Yucesoy B, Johnson VJ, et al. Winter season, frequent hand washing, and irritant patch test reactions to detergents are associated with hand dermatitis in health care workers. Dermatitis. 2013; 24 (4): 170-175. doi: 10.1097/DER.0b013e318290c57fAtaman AD, Vatanoglu-Lutz EE, Yildirim G. Medicine in stamps-Ignaz Semmelweis and Puerperal Fever. J Turk Ger Gynecol Assoc. 2013; 14 (1): 35-39. doi: 10.5152/jtgga.2013.08Ataman AD, Vatanoglu-Lutz EE, Yildirim G. Medicine in stamps-Ignaz Semmelweis and Puerperal Fever. J Turk Ger Gynecol Assoc. 2013; 14 (1): 35-39. doi: 10.5152/jtgga.2013.08Anonym. WHO guidelines on hand hygiene in health care. First Global Patient Safety Challenge Clean Care is Safer Care. Geneva: WHO; 2009. Available at: http://www.who.int/gpsc/5may/tools/who_guidelineshandhygiene_summary.pdf (accessed 11.11.2018)Anonym. WHO guidelines on hand hygiene in health care. First Global Patient Safety Challenge Clean Care is Safer Care. Geneva: WHO; 2009. Available at: http://www.who.int/gpsc/5may/tools/who_guidelineshandhygiene_summary.pdf (accessed 11.11.2018)Kramer A, Rudolph P, Kampf G, Pittet D. Limited efcacy of alcohol-based hand gels. Lancet. 2002;359 (9316): 1489-1490. doi: 10.1016/S0140-6736(02)08426-XKramer A, Rudolph P, Kampf G, Pittet D. Limited efcacy of alcohol-based hand gels. Lancet. 2002;359 (9316): 1489-1490. doi: 10.1016/S0140-6736(02)08426-XSuchomel M, Kundi M, Pittet D, Weinlich M, Rotter ML. Testing of the World Health Organization recommended formulations in their application as hygienic hand rubs and proposals for increased efcacy. Am J Infect Control. 2011; 40 (4): 328-331Suchomel M, Kundi M, Pittet D, Weinlich M, Rotter ML. Testing of the World Health Organization recommended formulations in their application as hygienic hand rubs and proposals for increased efcacy. Am J Infect Control. 2011; 40 (4): 328-331EN 1500:2013. Chemical disinfectants and antiseptics. Hygienic hand disinfection. Test method and requirement (phase 2, step 2). Brussels: CEN - Comité Européen de Normalisation; 2013. 40 p.EN 1500:2013. Chemical disinfectants and antiseptics. Hygienic hand disinfection. Test method and requirement (phase 2, step 2). Brussels: CEN - Comité Européen de Normalisation; 2013. 40 p.Skodova M, Gimeno-Benitez A, Martinez-Redondo E, Moran-Cortes JF, Jimenez-Romano R, Gimeno-Ortiz A. Hand hygiene technique quality evaluation in nursing and medicine students of two academic courses. Revista latino-americana de enfermagem. 2015; 23 (4): 708-717. doi: 10.1590/0104-1169.0459.2607Skodova M, Gimeno-Benitez A, Martinez-Redondo E, Moran-Cortes JF, Jimenez-Romano R, Gimeno-Ortiz A. Hand hygiene technique quality evaluation in nursing and medicine students of two academic courses. Revista latino-americana de enfermagem. 2015; 23 (4): 708-717. doi: 10.1590/0104-1169.0459.2607Widmer AF, Dangel M. Alcohol-based handrub: evaluation of technique and microbiological efcacy with international infection control professionals. Infect Control Hosp Epidemiol. 2004; 25 (3): 207-209. DOI: 10.1086/502379Widmer AF, Dangel M. Alcohol-based handrub: evaluation of technique and microbiological efcacy with international infection control professionals. Infect Control Hosp Epidemiol. 2004; 25 (3): 207-209. DOI: 10.1086/502379Kampf G, Reichel M, Feil Y, Eggerstedt S, Kaulfers P-M. Inuence of rub-in technique on required application time and hand coverage in hygienic hand disinfection. BMC Infect Dis. 2008; 8: 149. doi: 10.1186/1471-2334-8-149Kampf G, Reichel M, Feil Y, Eggerstedt S, Kaulfers P-M. Inuence of rub-in technique on required application time and hand coverage in hygienic hand disinfection. BMC Infect Dis. 2008; 8: 149. doi: 10.1186/1471-2334-8-149Widmer AF, Conzelmann M, Tomic M, Frei R, Stranden AM. Introducing alcohol-based hand rub for hand hygiene: the critical need for training. Infect Control Hosp Epidemiol. 2007; 28 (1): 50-54. DOI:10.1086/510788Widmer AF, Conzelmann M, Tomic M, Frei R, Stranden AM. Introducing alcohol-based hand rub for hand hygiene: the critical need for training. Infect Control Hosp Epidemiol. 2007; 28 (1): 50-54. DOI:10.1086/510788Kampf G, Wigger-Alberti W, Schoder V, Wilhelm KP. Emollients in a propanol-based hand rub can signicantly decrease irritant contact dermatitis. Contact Dermatitis. 2005; 53 (6): 344-349. DOI:10.1111/j.0105-1873.2005.00727.xKampf G, Wigger-Alberti W, Schoder V, Wilhelm KP. Emollients in a propanol-based hand rub can signicantly decrease irritant contact dermatitis. Contact Dermatitis. 2005; 53 (6): 344-349. DOI:10.1111/j.0105-1873.2005.00727.xHartmann RS, Pietsch H, Sauermann G, Neubert R. Untersuchung zur Hautverträglichkeit von alkoholischen Händedesinfektionsmitteln. Dermatosen. 1994; 42: 241-245Hartmann RS, Pietsch H, Sauermann G, Neubert R. Untersuchung zur Hautverträglichkeit von alkoholischen Händedesinfektionsmitteln. Dermatosen. 1994; 42: 241-245Kramer A, Bernig T, Kampf G. Clinical double-blind trial on the dermal tolerance and user acceptability of six alcohol-based hand disinfectants for hygienic hand disinfection. J Hosp Infect. 2002; 51 (2): 114-120. DOI:10.1053/jhin.2002.1223Kramer A, Bernig T, Kampf G. Clinical double-blind trial on the dermal tolerance and user acceptability of six alcohol-based hand disinfectants for hygienic hand disinfection. J Hosp Infect. 2002; 51 (2): 114-120. DOI:10.1053/jhin.2002.1223Houben E, de Paepe K, Rogiers V. Skin condition associated with intensive use of alcoholic gels for hand disinfection: a combination of biophysical and sensorial data. Contact Dermatitis. 2006; 54 (5): 261-267. DOI:10.1111/j.0105-1873.2006.00817.xHouben E, de Paepe K, Rogiers V. Skin condition associated with intensive use of alcoholic gels for hand disinfection: a combination of biophysical and sensorial data. Contact Dermatitis. 2006; 54 (5): 261-267. DOI:10.1111/j.0105-1873.2006.00817.xKampf G, Muscatiello M. Dermal tolerance of Sterillium, a propanol-based hand rub. J Hosp Infect. 2003; 55 (4): 295-298. DOI:10.1016/j.jhin.2003.09.001Kampf G, Muscatiello M. Dermal tolerance of Sterillium, a propanol-based hand rub. J Hosp Infect. 2003; 55 (4): 295-298. DOI:10.1016/j.jhin.2003.09.001Kampf G, Muscatiello M, Häntschel D, Rudolf M. Dermal tolerance and effect on skin hydration of a new ethanol-based hand gel. J Hosp Infect. 2002; 52 (4): 297-301. DOI: 10.1053/jhin.2002.1311Kampf G, Muscatiello M, Häntschel D, Rudolf M. Dermal tolerance and effect on skin hydration of a new ethanol-based hand gel. J Hosp Infect. 2002; 52 (4): 297-301. DOI: 10.1053/jhin.2002.1311Girard R, Bousquet E, Carré E, Bert C, Coyault C, Coudrais S, et al. Tolerance and acceptability of 14 surgical and hygienic alcohol-based hand rubs. J Hosp Infect. 2006; 63 (3): 281-288. DOI: 10.1016/j.jhin.2006.01.017Girard R, Bousquet E, Carré E, Bert C, Coyault C, Coudrais S, et al. Tolerance and acceptability of 14 surgical and hygienic alcohol-based hand rubs. J Hosp Infect. 2006; 63 (3): 281-288. DOI: 10.1016/j.jhin.2006.01.017Chamorey E, Marcy PY, Dandine M, Veyres P, Negrin N, Vandenbos F, et al. A prospective multicenter study evaluating skin tolerance to standard hand hygiene techniques. Am J Infect Control. 2011; 39 (1): 6-13. doi:10.1016/j.ajic.2010.03.021Chamorey E, Marcy PY, Dandine M, Veyres P, Negrin N, Vandenbos F, et al. A prospective multicenter study evaluating skin tolerance to standard hand hygiene techniques. Am J Infect Control. 2011; 39 (1): 6-13. doi:10.1016/j.ajic.2010.03.021Kampf G, Wigger-Alberti W, Wilhelm KP. Do atopics tolerate alcohol-based hand rubs? A prospective, controlled, randomized double-blind clinical trial. Acta dermato-venereologica. 2006; 86 (2): 140-143. DOI:10.2340/00015555-0045Kampf G, Wigger-Alberti W, Wilhelm KP. Do atopics tolerate alcohol-based hand rubs? A prospective, controlled, randomized double-blind clinical trial. Acta dermato-venereologica. 2006; 86 (2): 140-143. DOI:10.2340/00015555-0045Pittet D, Allegranzi B, Sax H, Chraiti MN, Grifths W, Richet H. Double-blind, randomized, crossover trial of 3 hand rub formulations: fast-track evaluation of tolerability and acceptability. Infect Control Hosp Epidemiol. 2007;28(12):1344-51. doi: 10.1086/523272Pittet D, Allegranzi B, Sax H, Chraiti MN, Grifths W, Richet H. Double-blind, randomized, crossover trial of 3 hand rub formulations: fast-track evaluation of tolerability and acceptability. Infect Control Hosp Epidemiol. 2007;28(12):1344-51. doi: 10.1086/523272Kampf G, Muscatiello M, Segger D. Dermal tolerance and effect on skin hydration of an improved ethanol-based hand gel. Int J Infect Control. 2009; 5 (1). doi:10.3396/ijic.V5i1.003.09Kampf G, Muscatiello M, Segger D. Dermal tolerance and effect on skin hydration of an improved ethanol-based hand gel. Int J Infect Control. 2009; 5 (1). doi:10.3396/ijic.V5i1.003.09Traore O, Hugonnet S, Lubbe J, Grifths W, Pittet D. Liquid versus gel handrub formulation: a prospective intervention study. Critical care. 2007; 11 (3): R52. doi: 10.1186/cc5906Traore O, Hugonnet S, Lubbe J, Grifths W, Pittet D. Liquid versus gel handrub formulation: a prospective intervention study. Critical care. 2007; 11 (3): R52. doi: 10.1186/cc5906Kramer A, Galabov AS, Sattar SA, Döhner L, Pivert A, Payan C, et al. Virucidal activity of a new hand disinfectant with reduced ethanol content: comparison with other alcohol-based formulations. J Hosp Infect. 2006;62(1):98-106. DOI:10.1016/j.jhin.2005.06.020Kramer A, Galabov AS, Sattar SA, Döhner L, Pivert A, Payan C, et al. Virucidal activity of a new hand disinfectant with reduced ethanol content: comparison with other alcohol-based formulations. J Hosp Infect. 2006;62(1):98-106. DOI:10.1016/j.jhin.2005.06.020Harada YU, Lekcharoensuk P, Furuta T, Taniguchi T. Inactivation of Foot-and-Mouth Disease Virus by Commercially Available Disinfectants and Cleaners. Biocontrol science. 2015; 20 (3): 205-208. doi: 10.4265/bio.20.205Harada YU, Lekcharoensuk P, Furuta T, Taniguchi T. Inactivation of Foot-and-Mouth Disease Virus by Commercially Available Disinfectants and Cleaners. Biocontrol science. 2015; 20 (3): 205-208. doi: 10.4265/bio.20.205Conrad A, Grotejohann B, Schmoor C, Cosic D, Dettenkofer M. Safety and tolerability of virucidal hand rubs: a randomized, double-blind, cross-over trial with healthy volunteers. Antimicrob Resist Infect Control. 2015; 4: 37. doi: 10.1186/s13756-015-0079-yConrad A, Grotejohann B, Schmoor C, Cosic D, Dettenkofer M. Safety and tolerability of virucidal hand rubs: a randomized, double-blind, cross-over trial with healthy volunteers. Antimicrob Resist Infect Control. 2015; 4: 37. doi: 10.1186/s13756-015-0079-yKRINKO am Robert Koch Institut. Händehygiene in Einrichtungen des Gesundheitswesens: Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (RKI). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2016; 59 (9): 1189-220. DOI:10.1007/s00103-016-2416-6KRINKO am Robert Koch Institut. Händehygiene in Einrichtungen des Gesundheitswesens: Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (RKI). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2016; 59 (9): 1189-220. DOI:10.1007/s00103-016-2416-6Jarral OA, McCormack DJ, Ibrahim S, Shipolini AR. Should surgeons scrub with chlorhexidine or iodine prior to surgery? Interact Cardiovasc Thorac Surg. 2011; 12 (6): 1017-1021. doi: 10.1510/icvts.2010.259796Jarral OA, McCormack DJ, Ibrahim S, Shipolini AR. Should surgeons scrub with chlorhexidine or iodine prior to surgery? Interact Cardiovasc Thorac Surg. 2011; 12 (6): 1017-1021. doi: 10.1510/icvts.2010.259796Widmer AF, Rotter M, Voss A, Nthumba P, Allegranzi B, Boyce J, et al. Surgical hand preparation: state-of-the-art. J Hosp Infect. 2010; 74 (2): 112-122. doi: 10.1016/j.jhin.2009.06.020Widmer AF, Rotter M, Voss A, Nthumba P, Allegranzi B, Boyce J, et al. Surgical hand preparation: state-of-the-art. J Hosp Infect. 2010; 74 (2): 112-122. doi: 10.1016/j.jhin.2009.06.020Widmer AF. Surgical hand hygiene: scrub or rub? J Hosp Infect. 2013; 83 suppl 1: S35-S39. doi: 10.1016/S0195-6701(13)60008-0Widmer AF. Surgical hand hygiene: scrub or rub? J Hosp Infect. 2013; 83 suppl 1: S35-S39. doi: 10.1016/S0195-6701(13)60008-0WHO. WHO guidelines on hand hygiene in health care. First Global Patient Safety Challenge Clean Care is Safer Care. Geneva: WHO; 2009. 270 pWHO. WHO guidelines on hand hygiene in health care. First Global Patient Safety Challenge Clean Care is Safer Care. Geneva: WHO; 2009. 270 pEN 14885: 2015. Chemical disinfectants and antiseptics. Application of European standards for chemical disinfectants and antiseptics. Brussels: CEN - Comité Européen de Normalisation; 2015. 64 pEN 14885: 2015. Chemical disinfectants and antiseptics. Application of European standards for chemical disinfectants and antiseptics. Brussels: CEN - Comité Européen de Normalisation; 2015. 64 pGinsberg F. Scrub brushes and nail les essential to aseptic technic. Mod Hosp. 1960; 94: 130Ginsberg F. Scrub brushes and nail les essential to aseptic technic. Mod Hosp. 1960; 94: 130McBride ME, Duncan WC, Knox JM. An evaluation of surgical scrub brushes. Surg Gynecol Obstet. 1973; 137 (6): 934-936McBride ME, Duncan WC, Knox JM. An evaluation of surgical scrub brushes. Surg Gynecol Obstet. 1973; 137 (6): 934-936Mitchell KG, Rawluk DJ. Skin reactions related to surgical scrub-up: results of a Scottish survey. Br J Surg. 1984; 71 (3): 223-224. doi: 10.1002/ bjs.1800710322Mitchell KG, Rawluk DJ. Skin reactions related to surgical scrub-up: results of a Scottish survey. Br J Surg. 1984; 71 (3): 223-224. doi: 10.1002/ bjs.1800710322Galle PC, Homesley HD, Rhyne AL. Reassessment of the surgical scrub. Surg Gynecol Obstet. 1978; 147 (2): 215-218Galle PC, Homesley HD, Rhyne AL. Reassessment of the surgical scrub. Surg Gynecol Obstet. 1978; 147 (2): 215-218Petterwood J, Shridhar V. Water conservation in surgery: a comparison of two surgical scrub techniques demonstrating the amount of water saved using a 'taps on/taps off' technique. Aust J Rural Health. 2009; 17 (4): 214-217. doi: 10.1111/j.1440-1584.2009.01074.xPetterwood J, Shridhar V. Water conservation in surgery: a comparison of two surgical scrub techniques demonstrating the amount of water saved using a 'taps on/taps off' technique. Aust J Rural Health. 2009; 17 (4): 214-217. doi: 10.1111/j.1440-1584.2009.01074.xAhmed A. Surgical hand scrub: lots of water wasted. Ann Afr Med. 2007; 6 (1): 31-33. DOI: 10.4103/1596-3519.55733.80. Somner JE, Stone N, Koukkoulli A, Scott KM, Field AR, Zygmunt J. Surgical scrubbing: can we clean up our carbon footprints by washing our hands? J Hosp Infect. 2008; 70 (3): 212-215. doi: 10.1016/j.jhin.2008.06.004Ahmed A. Surgical hand scrub: lots of water wasted. Ann Afr Med. 2007; 6 (1): 31-33. DOI: 10.4103/1596-3519.55733.80. Somner JE, Stone N, Koukkoulli A, Scott KM, Field AR, Zygmunt J. Surgical scrubbing: can we clean up our carbon footprints by washing our hands? J Hosp Infect. 2008; 70 (3): 212-215. doi: 10.1016/j.jhin.2008.06.004Holness DL, Tarlo SM, Sussman G, Nethercott JR. Exposure characteristics and cutaneous problems in operating room staff Contact Dermatitis. 1995; 32 (6): 352-358. doi: 10.1111/j.1600-0536.1995.tb00624.x.Holness DL, Tarlo SM, Sussman G, Nethercott JR. Exposure characteristics and cutaneous problems in operating room staff Contact Dermatitis. 1995; 32 (6): 352-358. doi: 10.1111/j.1600-0536.1995.tb00624.x.Antonov D, Kleesz P, Elsner P, Schliemann S. Impact of glove occlusion on cumulative skin irritation with or without hand cleanser-comparison in an experimental repeated irritation model. Contact Dermatitis. 2013; 68 (5): 293-299. doi: 10.1111/cod.12028Antonov D, Kleesz P, Elsner P, Schliemann S. Impact of glove occlusion on cumulative skin irritation with or without hand cleanser-comparison in an experimental repeated irritation model. Contact Dermatitis. 2013; 68 (5): 293-299. doi: 10.1111/cod.12028Sato K, Kusaka Y, Suganuma N, Nagasawa S, Deguchi Y. Occupational allergy in medical doctors. J Occup Health. 2004; 46 (2): 165-170. DOI: 10.1539/joh.46.165Sato K, Kusaka Y, Suganuma N, Nagasawa S, Deguchi Y. Occupational allergy in medical doctors. J Occup Health. 2004; 46 (2): 165-170. DOI: 10.1539/joh.46.165Higgins CL, Palmer AM, Cahill JL, Nixon RL. Occupational skin disease among Australian healthcare workers: a retrospective analysis from an occupational dermatology clinic, 1993-2014. Contact Dermatitis. 2016; 75 (4): 213-222. doi: 10.1111/cod.12616Higgins CL, Palmer AM, Cahill JL, Nixon RL. Occupational skin disease among Australian healthcare workers: a retrospective analysis from an occupational dermatology clinic, 1993-2014. Contact Dermatitis. 2016; 75 (4): 213-222. doi: 10.1111/cod.12616Apisarnthanarak A, Mundy LM. High incidence of chlorhexidine-induced rash among Thai health care workers. Clin Infect Dis. 2011; 53 (8): 848-849. doi: 10.1093/cid/cir518Apisarnthanarak A, Mundy LM. High incidence of chlorhexidine-induced rash among Thai health care workers. Clin Infect Dis. 2011; 53 (8): 848-849. doi: 10.1093/cid/cir518Wittczak T, Dudek W, Walusiak-Skorupa J, Swierczynska-Machura D, Palczynski C. Chlorhexidine--still an underestimated allergic hazard for health care professionals. Occup Med (Lond). 2013; 63 (4): 301-305. doi:10.1093/occmed/kqt035Wittczak T, Dudek W, Walusiak-Skorupa J, Swierczynska-Machura D, Palczynski C. Chlorhexidine--still an underestimated allergic hazard for health care professionals. Occup Med (Lond). 2013; 63 (4): 301-305. doi:10.1093/occmed/kqt035Liippo J, Kousa P, Lammintausta K. The relevance of chlorhexidine contact allergy. Contact Dermatitis. 2011; 64 (4): 229-234. doi: 10.1111/j.1600-0536.2010.01851.xLiippo J, Kousa P, Lammintausta K. The relevance of chlorhexidine contact allergy. Contact Dermatitis. 2011; 64 (4): 229-234. doi: 10.1111/j.1600-0536.2010.01851.xBeaudouin E, Kanny G, Morisset M, Renaudin JM, Mertes M, Laxenaire MC, et al. Immediate hypersensitivity to chlorhexidine: literature review. Eur Ann Allergy Clin Immunol. 2004; 36 (4): 123-126Beaudouin E, Kanny G, Morisset M, Renaudin JM, Mertes M, Laxenaire MC, et al. Immediate hypersensitivity to chlorhexidine: literature review. Eur Ann Allergy Clin Immunol. 2004; 36 (4): 123-126Hong CC, Wang SM, Nather A, Tan JH, Tay SH, Poon KH. Chlorhexidine Anaphylaxis Masquerading as Septic Shock. Int Arch Allergy Immunol. 2015; 167 (1): 16-20. doi: 10.1159/000431358Hong CC, Wang SM, Nather A, Tan JH, Tay SH, Poon KH. Chlorhexidine Anaphylaxis Masquerading as Septic Shock. Int Arch Allergy Immunol. 2015; 167 (1): 16-20. doi: 10.1159/000431358Odedra KM, Farooque S. Chlorhexidine: an unrecognised cause of anaphylaxis. Postgrad Med J. 2014; 90 (1070): 709-714. doi: 10.1136/postgradmedj-2013-132291Odedra KM, Farooque S. Chlorhexidine: an unrecognised cause of anaphylaxis. Postgrad Med J. 2014; 90 (1070): 709-714. doi: 10.1136/postgradmedj-2013-132291Ohtoshi T, Yamauchi N, Tadokoro K, Miyachi S, Suzuki S, Miyamoto T, et al. IgE antibody-mediated shock reaction caused by topical application of chlorhexidine. Clin Allergy. 1986; 16 (2): 155-161Ohtoshi T, Yamauchi N, Tadokoro K, Miyachi S, Suzuki S, Miyamoto T, et al. IgE antibody-mediated shock reaction caused by topical application of chlorhexidine. Clin Allergy. 1986; 16 (2): 155-161Vu M, Rajgopal Bala H, Cahill J, Toholka R, Nixon R. Immediate hypersensitivity to chlorhexidine. Australas J Dermatol. 2018; 59 (1): 55-56. doi: 10.1111/ajd.12674. 2017Vu M, Rajgopal Bala H, Cahill J, Toholka R, Nixon R. Immediate hypersensitivity to chlorhexidine. Australas J Dermatol. 2018; 59 (1): 55-56. doi: 10.1111/ajd.12674. 2017WHO. Global guidelines for the prevention of surgical site infections. Geneva: WHO; 2016. 184 pWHO. Global guidelines for the prevention of surgical site infections. Geneva: WHO; 2016. 184 pMisteli H, Weber WP, Reck S, Rosenthal R, Zwahlen M, Füglistaler P, et al. Surgical glove perforation and the risk of surgical site infection. Arch Surg. 2009; 144 (6): 553-558. DOI: 10.1001/archsurg.2009.60Misteli H, Weber WP, Reck S, Rosenthal R, Zwahlen M, Füglistaler P, et al. Surgical glove perforation and the risk of surgical site infection. Arch Surg. 2009; 144 (6): 553-558. DOI: 10.1001/archsurg.2009.60Nonnemann HC, Kisseih G. Untersuchungen verschiedener Händewaschmethoden im chirurgischen Operationssaal. Chirurg. 1972; 43 (10): 484-487Nonnemann HC, Kisseih G. Untersuchungen verschiedener Händewaschmethoden im chirurgischen Operationssaal. Chirurg. 1972; 43 (10): 484-487Decker LA, Gross A, Miller FC, Read JA, Cutright DE, Devine J. A rapid method for the presurgical cleansing of hands. Obstet Gynecol. 1978; 51 (1): 115-117Decker LA, Gross A, Miller FC, Read JA, Cutright DE, Devine J. A rapid method for the presurgical cleansing of hands. Obstet Gynecol. 1978; 51 (1): 115-117Blech M-F, Hartemann P, Paquin J-L. Activity of non antiseptic soaps and ethanol for hand disinfection. Zentralbl Bakteriol Hyg B. 1985; 181 (6): 496-512Blech M-F, Hartemann P, Paquin J-L. Activity of non antiseptic soaps and ethanol for hand disinfection. Zentralbl Bakteriol Hyg B. 1985; 181 (6): 496-512Dineen P. An evaluation of the duration of the surgical scrub. Surg Gynecol Obstet. 1969: 129 (6): 1181-1184Dineen P. An evaluation of the duration of the surgical scrub. Surg Gynecol Obstet. 1969: 129 (6): 1181-1184Hübner N-O, Kampf G, Kamp P, Kohlmann T, Kramer A. Does a preceding hand wash and drying time after surgical hand disinfection inuence the efcacy of a propanol-based hand rub? BMC Microbiol. 2006; 6: 57. DOI: 10.1186/1471-2180-6-57Hübner N-O, Kampf G, Kamp P, Kohlmann T, Kramer A. Does a preceding hand wash and drying time after surgical hand disinfection inuence the efcacy of a propanol-based hand rub? BMC Microbiol. 2006; 6: 57. DOI: 10.1186/1471-2180-6-57Grove GL, Zerweck CR, Heilman JM, Pyrek JD. Methods for evaluating changes in skin condition due to the effects of antimicrobial hand cleaners: two studies comparing a new waterless chlorhexidine gluconate/ ethanol-emollient antiseptic preparation with a conventional water-applied product. Am J Infect Control. 2001; 29 (6): 361-369. DOI: 10.1067/mic.2001.118619Grove GL, Zerweck CR, Heilman JM, Pyrek JD. Methods for evaluating changes in skin condition due to the effects of antimicrobial hand cleaners: two studies comparing a new waterless chlorhexidine gluconate/ ethanol-emollient antiseptic preparation with a conventional water-applied product. Am J Infect Control. 2001; 29 (6): 361-369. DOI: 10.1067/mic.2001.118619Larson EL, Aiello AE, Heilman JM, Lyle CT, Cronquist A, Stahl JB, et al. Comparison of different regimes for surgical hand preparation. AORN J. 2001; 73 (2): 412-418. DOI:10.1016/S0001-2092(06)61981-9Larson EL, Aiello AE, Heilman JM, Lyle CT, Cronquist A, Stahl JB, et al. Comparison of different regimes for surgical hand preparation. AORN J. 2001; 73 (2): 412-418. DOI:10.1016/S0001-2092(06)61981-9Vergara-Fernandez O, Morales-Olivera JM, Ponce-de-Leon-Rosales S, Vega-Batista R, Mejia-Ovalle R, Huertas-Jimenez M, et al. [Surgical team satisfaction levels between two preoperative hand-washing methods]. Rev Invest Clin. 2010; 62 (6): 532-537Vergara-Fernandez O, Morales-Olivera JM, Ponce-de-Leon-Rosales S, Vega-Batista R, Mejia-Ovalle R, Huertas-Jimenez M, et al. [Surgical team satisfaction levels between two preoperative hand-washing methods]. Rev Invest Clin. 2010; 62 (6): 532-537Parienti JJ, Thibon P, Heller R, Le Roux Y, von Theobald P, Bensadoun H, et al. Hand-rubbing with an aqueous alcoholic solution vs traditional surgical hand-scrubbing and 30-day surgical site infection rates - a randomized equivalence study. JAMA. 2002; 288 (6): 722-727. doi:10.1001/jama.288.6.722Parienti JJ, Thibon P, Heller R, Le Roux Y, von Theobald P, Bensadoun H, et al. Hand-rubbing with an aqueous alcoholic solution vs traditional surgical hand-scrubbing and 30-day surgical site infection rates - a randomized equivalence study. JAMA. 2002; 288 (6): 722-727. doi:10.1001/jama.288.6.722Stutz N, Becker D, Jappe U, John SM, Ladwig A, Spornraft-Ragaller P, et al. Nurses' perceptions of the benets and adverse effects of hand disinfection: alcohol-based hand rubs vs. hygienic handwashing: a multicentre questionnaire study with additional patch testing by the German Contact Dermatitis Research Group. Br J Dermatol. 2009; 160 (3): 565-572. doi: 10.1111/j.1365-2133.2008.08951.xStutz N, Becker D, Jappe U, John SM, Ladwig A, Spornraft-Ragaller P, et al. Nurses' perceptions of the benets and adverse effects of hand disinfection: alcohol-based hand rubs vs. hygienic handwashing: a multicentre questionnaire study with additional patch testing by the German Contact Dermatitis Research Group. Br J Dermatol. 2009; 160 (3): 565-572. doi: 10.1111/j.1365-2133.2008.08951.xGarcia-Gavin J, Perez-Perez L, Zulaica A. Hand eczema due to hygiene and antisepsis products: not only an irritative etiology. Actas Dermosiliogr. 2012; 103 (9): 845-846. DOI: 10.1016/j.ad.2012.06.002Garcia-Gavin J, Perez-Perez L, Zulaica A. Hand eczema due to hygiene and antisepsis products: not only an irritative etiology. Actas Dermosiliogr. 2012; 103 (9): 845-846. DOI: 10.1016/j.ad.2012.06.002Ludwig E, Hausen BM. Sensitivity to isopropyl alcohol. Contact Dermatitis. 1977; 3 (5): 240-244. DOI: 10.1111/j.1600-0536.1977.tb03668.xLudwig E, Hausen BM. Sensitivity to isopropyl alcohol. Contact Dermatitis. 1977; 3 (5): 240-244. DOI: 10.1111/j.1600-0536.1977.tb03668.xKwon JA, Lee MS, Kim MY, Park YM, Kim HO, Kim CW. Allergic contact dermatitis from dodecyldiaminoethyl-glycine and isopropyl alcohol in a commercial disinfectant swab. Contact Dermatitis. 2003; 48 (6): 339-340. DOI: 10.1034/j.1600-0536.2003.00132.xKwon JA, Lee MS, Kim MY, Park YM, Kim HO, Kim CW. Allergic contact dermatitis from dodecyldiaminoethyl-glycine and isopropyl alcohol in a commercial disinfectant swab. Contact Dermatitis. 2003; 48 (6): 339-340. DOI: 10.1034/j.1600-0536.2003.00132.xVujevich J, Zirwas M. Delayed hypersensitivity to isopropyl alcohol. Contact Dermatitis. 2007; 56 (5): 287. doi: 10.1111/j.1600-0536.2006.00983.xVujevich J, Zirwas M. Delayed hypersensitivity to isopropyl alcohol. Contact Dermatitis. 2007; 56 (5): 287. doi: 10.1111/j.1600-0536.2006.00983.xRotter ML. Hand washing and hand disinfection. In: Mayhall CG, editor. Hospital epidemiology and infection control. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 1999. p. 1339-1355Rotter ML. Hand washing and hand disinfection. In: Mayhall CG, editor. Hospital epidemiology and infection control. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 1999. p. 1339-1355EN 12791:2005. Chemical disinfectants and antiseptics. Surgical hand disinfection. Test method and requirement (phase 2, step 2) [Electronic resource]. Brussels: CEN - Comité Européen de Normalisation; 2005. Available at: https://www.en-standard.eu/csn-en-12791-chemical-disinfectants-and-antiseptics-surgical-hand-disinfection-test-method-and-requirement-phase-2-step-2/(accessed 15.11.2018)EN 12791:2005. Chemical disinfectants and antiseptics. Surgical hand disinfection. Test method and requirement (phase 2, step 2) [Electronic resource]. Brussels: CEN - Comité Européen de Normalisation; 2005. Available at: https://www.en-standard.eu/csn-en-12791-chemical-disinfectants-and-antiseptics-surgical-hand-disinfection-test-method-and-requirement-phase-2-step-2/(accessed 15.11.2018)EN 12791:2015. Chemical disinfectants and antiseptics. Surgical hand disinfection. Test method and requirement (phase 2, step 2). Brussels: CEN - Comité Européen de Normalisation; 2015. [Electronic resource] Available at: https://www.en-standard.eu/csn-en-12791-chemical-disinfectants-and-antiseptics-surgical-hand-disinfection-test-method-and-requirement-phase-2-step-2/ (accessed 15.11.2018)EN 12791:2015. Chemical disinfectants and antiseptics. Surgical hand disinfection. Test method and requirement (phase 2, step 2). Brussels: CEN - Comité Européen de Normalisation; 2015. [Electronic resource] Available at: https://www.en-standard.eu/csn-en-12791-chemical-disinfectants-and-antiseptics-surgical-hand-disinfection-test-method-and-requirement-phase-2-step-2/ (accessed 15.11.2018)Kampf G, Kramer A, Suchomel M. Lack of sustained efcacy for alcohol-based surgical hand rubs containing “residual active ingredients” according to EN 12791. J Hosp Infect. 2017; 95 (2): 163-168. doi: 10.1016/j.jhin.2016.11.001Kampf G, Kramer A, Suchomel M. Lack of sustained efcacy for alcohol-based surgical hand rubs containing “residual active ingredients” according to EN 12791. J Hosp Infect. 2017; 95 (2): 163-168. doi: 10.1016/j.jhin.2016.11.001Kampf G. Lack of antimicrobial efcacy of mecetronium etilsulfate in propanol-based hand rubs for surgical hand disinfection. J Hosp Infect. 2017; 96 (2): 189-191. doi: 10.1016/j.jhin.2017.03.001Kampf G. Lack of antimicrobial efcacy of mecetronium etilsulfate in propanol-based hand rubs for surgical hand disinfection. J Hosp Infect. 2017; 96 (2): 189-191. doi: 10.1016/j.jhin.2017.03.001Kampf G. Acquired resistance to chlorhexidine - is it time to establish an “antiseptic stewardship” initiative? J Hosp Infect. 2016; 94(3): 213-227. doi: 10.1016/j.jhin.2016.08.018Kampf G. Acquired resistance to chlorhexidine - is it time to establish an “antiseptic stewardship” initiative? J Hosp Infect. 2016; 94(3): 213-227. doi: 10.1016/j.jhin.2016.08.018FDA. FDA Drug Safety Communication: FDA warns about rare but serious allergic reactions with the skin antiseptic chlorhexidine gluconate. 2017. Available at: https:// www.fda.gov/Drugs/DrugSafety/ucm530975.htm(accessed 20.12.2013)FDA. FDA Drug Safety Communication: FDA warns about rare but serious allergic reactions with the skin antiseptic chlorhexidine gluconate. 2017. Available at: https:// www.fda.gov/Drugs/DrugSafety/ucm530975.htm(accessed 20.12.2013)Slotosch CM, Kampf G, Löfer H. Effects of disinfectants and detergents on skin irritation. Contact Dermatitis. 2007; 57 (4): 235-241. doi: 10.1111/j.1600-0536.2007.01200.xSlotosch CM, Kampf G, Löfer H. Effects of disinfectants and detergents on skin irritation. Contact Dermatitis. 2007; 57 (4): 235-241. doi: 10.1111/j.1600-0536.2007.01200.xKampf G. Die epidemiologische Bedeutung der Hände. In: Kampf G, editor. Kompendium Händehygiene. Wiesbaden: mhp-Verlag; 2017. p. 1-33Kampf G. Die epidemiologische Bedeutung der Hände. In: Kampf G, editor. Kompendium Händehygiene. Wiesbaden: mhp-Verlag; 2017. p. 1-33Ansari SA, Sattar SA, Springthorpe VS, Wells GA, Tostowaryk W. In vivo protocol for testing efcacy of hand-washing agents against viruses and bacteria: experiments with rotavirus and Escherichia coli. Applied and Environmental Microbiology. 1989; 55 (12): 3113-3118Ansari SA, Sattar SA, Springthorpe VS, Wells GA, Tostowaryk W. In vivo protocol for testing efcacy of hand-washing agents against viruses and bacteria: experiments with rotavirus and Escherichia coli. Applied and Environmental Microbiology. 1989; 55 (12): 3113-3118Ojajärvi J. Effectiveness of hand washing and disinfection methods in removing transient bacteria after patient nursing. J Hyg (Lond). 1980; 85 (2): 193-203Ojajärvi J. Effectiveness of hand washing and disinfection methods in removing transient bacteria after patient nursing. J Hyg (Lond). 1980; 85 (2): 193-203Mahl MC. New method for determination of efcacy of health care personnel hand wash products. J Clin Microbiol. 1989; 27 (10): 2295-2299Mahl MC. New method for determination of efcacy of health care personnel hand wash products. J Clin Microbiol. 1989; 27 (10): 2295-2299Ayliffe GA, Babb JR, Quoraishi AH. A test for "hygienic" hand disinfection. J Clin Pathol. 1978; 31 (10): 923-928Ayliffe GA, Babb JR, Quoraishi AH. A test for "hygienic" hand disinfection. J Clin Pathol. 1978; 31 (10): 923-928Lowbury EJ, Lilly HA, Bull JP. Disinfection of hands: removal of transient organisms. Brit Med J. 1964; 2 (5403): 230-233Lowbury EJ, Lilly HA, Bull JP. Disinfection of hands: removal of transient organisms. Brit Med J. 1964; 2 (5403): 230-233Ayliffe GA, Babb JR, Davies JG, Lilly HA. Hand disinfection: a comparison of various agents in laboratory and ward studies. J Hospital Infect. 1988; 11 (3): 226-243. DOI: 10.1016/0195-6701(88)90101-6Ayliffe GA, Babb JR, Davies JG, Lilly HA. Hand disinfection: a comparison of various agents in laboratory and ward studies. J Hospital Infect. 1988; 11 (3): 226-243. DOI: 10.1016/0195-6701(88)90101-6Kampf G, Ostermeyer C. Intra-laboratory reproducibility of the hand hygiene reference procedures of EN 1499 (hygienic hand wash) and EN 1500 (hygienic hand disinfection). J Hosp Infect. 2002; 52 (3): 219-224. DOI: 10.1053/jhin.2002.1299Kampf G, Ostermeyer C. Intra-laboratory reproducibility of the hand hygiene reference procedures of EN 1499 (hygienic hand wash) and EN 1500 (hygienic hand disinfection). J Hosp Infect. 2002; 52 (3): 219-224. DOI: 10.1053/jhin.2002.1299Mittermayer H, Rotter M. Vergleich der Wirkung von Wasser, einigen Detergentien und Äthylalkohol auf die transiente Flora der Haut. Zentralbl Bakteriol Orig B. 1975; 160 (2): 163-172Mittermayer H, Rotter M. Vergleich der Wirkung von Wasser, einigen Detergentien und Äthylalkohol auf die transiente Flora der Haut. Zentralbl Bakteriol Orig B. 1975; 160 (2): 163-172Rotter ML, Koller W. A European test for the evaluation of the efcacy of procedures for the antiseptic handwash. Hyg Med. 1991; 16: 4-12Rotter ML, Koller W. A European test for the evaluation of the efcacy of procedures for the antiseptic handwash. Hyg Med. 1991; 16: 4-12Rotter ML, Koller W. Test models for hygienic handrub and hygienic handwash: the effects of two different contamination and sampling techniques. J Hosp Infect. 1992; 20 (3): 163-171. DOI: 10.1016/0195-6701(92)90084-YRotter ML, Koller W. Test models for hygienic handrub and hygienic handwash: the effects of two different contamination and sampling techniques. J Hosp Infect. 1992; 20 (3): 163-171. DOI: 10.1016/0195-6701(92)90084-YMessager S, Hammer KA, Carson CF, Riley TV. Effectiveness of hand-cleansing formulations containing tea tree oil assessed ex vivo on human skin and in vivo with volunteers using European standard EN 1499. J Hosp Infect. 2005; 59 (3): 220-228. doi: 10.1016/j.jhin.2004.06.032Messager S, Hammer KA, Carson CF, Riley TV. Effectiveness of hand-cleansing formulations containing tea tree oil assessed ex vivo on human skin and in vivo with volunteers using European standard EN 1499. J Hosp Infect. 2005; 59 (3): 220-228. doi: 10.1016/j.jhin.2004.06.032Cardoso CL, Pereira HH, Zequim JC, Guilhermetti M. Effectiveness of hand-cleansing agents for removing Acinetobacter baumannii strain from contaminated hands. Am J Infect Control. 1999; 27 (4): 327-331. doi: 10.1016/S0196-6553(99)70052-0Cardoso CL, Pereira HH, Zequim JC, Guilhermetti M. Effectiveness of hand-cleansing agents for removing Acinetobacter baumannii strain from contaminated hands. Am J Infect Control. 1999; 27 (4): 327-331. doi: 10.1016/S0196-6553(99)70052-0Sickbert-Bennett EE, Weber DJ, Gergen-Teague MF, Sobsey MD, Samsa GP, Rutala WA. Comparative efcacy of hand hygiene agents in the reduction of bacteria and viruses. Am J Infect Control. 2005; 33 (2): 67-77. doi: 10.1016/j.ajic.2004.08.005Sickbert-Bennett EE, Weber DJ, Gergen-Teague MF, Sobsey MD, Samsa GP, Rutala WA. Comparative efcacy of hand hygiene agents in the reduction of bacteria and viruses. Am J Infect Control. 2005; 33 (2): 67-77. doi: 10.1016/j.ajic.2004.08.005Nicoletti G, Boghossian V, Borland R. Hygienic hand disinfection: A comparative study with chlorhexidine detergents and soap. J Hosp Infect. 1990;15 (4): 323-337. doi: 10.1016/0195-6701(90)90089-7Nicoletti G, Boghossian V, Borland R. Hygienic hand disinfection: A comparative study with chlorhexidine detergents and soap. J Hosp Infect. 1990;15 (4): 323-337. doi: 10.1016/0195-6701(90)90089-7Kim SA, Moon H, Lee K, Rhee MS. Bactericidal effects of triclosan in soap both in vitro and in vivo. J Antimicrob Chemother. 2015; 70 (12): 3345-3352. doi: 10.1093/jac/dkv275Kim SA, Moon H, Lee K, Rhee MS. Bactericidal effects of triclosan in soap both in vitro and in vivo. J Antimicrob Chemother. 2015; 70 (12): 3345-3352. doi: 10.1093/jac/dkv275Casewell M, Phillips I. Hands as route of transmission for Klebsiella species. Br Med J. 1977; 2 (6098): 1315-1317Casewell M, Phillips I. Hands as route of transmission for Klebsiella species. Br Med J. 1977; 2 (6098): 1315-1317Lilly HA, Lowbury EJL. Transient skin ora - their removal by cleansing or disinfection in relation to their mode of deposition. J Clin Pathol. 1978; 31(10): 919-922Lilly HA, Lowbury EJL. Transient skin ora - their removal by cleansing or disinfection in relation to their mode of deposition. J Clin Pathol. 1978; 31(10): 919-922Huang Y, Oie S, Kamiya A. Comparative effectiveness of hand-cleansing agents for removing methicillin-resistant Staphylococcus aureus from experimentally contaminated ngertips. Am J Infect Control. 1994; 22 (4): 224-227. doi:10.1016/0196-6553(94)99000-XHuang Y, Oie S, Kamiya A. Comparative effectiveness of hand-cleansing agents for removing methicillin-resistant Staphylococcus aureus from experimentally contaminated ngertips. Am J Infect Control. 1994; 22 (4): 224-227. doi:10.1016/0196-6553(94)99000-XGuilhermetti M, Hernandes SE, Fukushigue Y, Garcia LB, Cardoso CL. Effectiveness of hand-cleansing agents for removing methicillin-resistant Staphylococcus aureus from contaminated hands. Infect Control Hosp Epidemiol. 2001; 22 (2): 105-108. DOI: 10.1086/501872Guilhermetti M, Hernandes SE, Fukushigue Y, Garcia LB, Cardoso CL. Effectiveness of hand-cleansing agents for removing methicillin-resistant Staphylococcus aureus from contaminated hands. Infect Control Hosp Epidemiol. 2001; 22 (2): 105-108. DOI: 10.1086/501872Bellamy K, Alcock R, Babb JR, Davies JG, Ayliffe GA. A test for the assessment of "hygienic" hand disinfection using rotavirus. J Hosp Infect. 1993; 24 (3): 201-210. DOI: 10.1016/0195-6701(93)90049-6Bellamy K, Alcock R, Babb JR, Davies JG, Ayliffe GA. A test for the assessment of "hygienic" hand disinfection using rotavirus. J Hosp Infect. 1993; 24 (3): 201-210. DOI: 10.1016/0195-6701(93)90049-6Davies JG, Babb JR, Bradley CR, Ayliffe GAJ. Preliminary study of test methods to assess the virucidal activity of skin disinfectants using poliovirus and bacteriophages. J Hosp Infect. 1993; 25 (2):125-131. DOI: 10.1016/0195-6701(93)90103-7Davies JG, Babb JR, Bradley CR, Ayliffe GAJ. Preliminary study of test methods to assess the virucidal activity of skin disinfectants using poliovirus and bacteriophages. J Hosp Infect. 1993; 25 (2):125-131. DOI: 10.1016/0195-6701(93)90103-7Steinmann J, Nehrkorn R, Meyer A. Two in vivo protocols for testing virucidal efcacy of handwashing and hand disinfection. Zentralbl Hyg Umweltmed. 1995; 196 (5): 425-436Steinmann J, Nehrkorn R, Meyer A. Two in vivo protocols for testing virucidal efcacy of handwashing and hand disinfection. Zentralbl Hyg Umweltmed. 1995; 196 (5): 425-436Schürmann W, Eggers HJ. An experimental study on the epidemiology of enteroviruses: water and soap washing of poliovirus 1-contaminated hands, its effectiveness and kinetics. Med Microbiol Immunol. 1985; 174 (5): 221-326Schürmann W, Eggers HJ. An experimental study on the epidemiology of enteroviruses: water and soap washing of poliovirus 1-contaminated hands, its effectiveness and kinetics. Med Microbiol Immunol. 1985; 174 (5): 221-326Lages SL, Ramakrishnan MA, Goyal SM. In-vivo efcacy of hand sanitisers against feline calicivirus: a surrogate for norovirus. J Hosp Infect. 2008; 68 (2): 159-163. doi: 10.1016/j.jhin.2007.11.018Lages SL, Ramakrishnan MA, Goyal SM. In-vivo efcacy of hand sanitisers against feline calicivirus: a surrogate for norovirus. J Hosp Infect. 2008; 68 (2): 159-163. doi: 10.1016/j.jhin.2007.11.018Gehrke C, Steinmann J, Goroncy-Bermes P. Inactivation of feline calicivirus, a surrogate of norovirus (formerly Norwalk-like viruses), by different types of alcohol in vitro and in vivo. J Hosp Infect. 2004; 56 (1): 49-55. doi:10.1016/j.jhin.2003.08.019Gehrke C, Steinmann J, Goroncy-Bermes P. Inactivation of feline calicivirus, a surrogate of norovirus (formerly Norwalk-like viruses), by different types of alcohol in vitro and in vivo. J Hosp Infect. 2004; 56 (1): 49-55. doi:10.1016/j.jhin.2003.08.019Paulmann D, Steinmann J, Becker B, Bischoff B, Steinmann E, Steinmann J. Virucidal activity of different alcohols against murine norovirus - a surrogate of human norovirus. J Hosp Infect. 2011; 79 (4): 378-379. doi: 10.1016/j.jhin.2011.04.029Paulmann D, Steinmann J, Becker B, Bischoff B, Steinmann E, Steinmann J. Virucidal activity of different alcohols against murine norovirus - a surrogate of human norovirus. J Hosp Infect. 2011; 79 (4): 378-379. doi: 10.1016/j.jhin.2011.04.029Steinmann J, Paulmann D, Becker B, Bischoff B, Steinmann E, Steinmann J. Comparison of virucidal activity of alcohol-based hand sanitizers versus antimicrobial hand soaps in vitro and in vivo. J Hosp Infect. 2012; 82 (4): 277-280. doi: 10.1016/j.jhin.2012.08.005Steinmann J, Paulmann D, Becker B, Bischoff B, Steinmann E, Steinmann J. Comparison of virucidal activity of alcohol-based hand sanitizers versus antimicrobial hand soaps in vitro and in vivo. J Hosp Infect. 2012; 82 (4): 277-280. doi: 10.1016/j.jhin.2012.08.005Somner JE, Stone N, Koukkoulli A, Scott KM, Field AR, Zygmunt J. Surgical scrubbing: can we clean up our carbon footprints by washing our hands? J Hosp Infect. 2008; 70 (3): 212-215. doi: 10.1016/j.jhin.2008.06.004Somner JE, Stone N, Koukkoulli A, Scott KM, Field AR, Zygmunt J. Surgical scrubbing: can we clean up our carbon footprints by washing our hands? J Hosp Infect. 2008; 70 (3): 212-215. doi: 10.1016/j.jhin.2008.06.004

The authors declare that there are no conflicts of interest present.