Determination of antiseptic efficacy of rubs on the forearm and consequences for surgical hand disinfection N.-O. Hübner a, b, * , N.B. Kellner a , L.I. Partecke b, c , T. Koburger d , C.-D. Heidecke b, c , T. Kohlmann e , A. Kramer a, b a Institute of Hygiene and Environmental Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany b The Paul-Leopold-Friedrich-Working Group c Department of Surgery, Clinic of General, Visceral, Vascular and Thoracic Surgery, Ernst-Moritz-Arndt University, Greifswald, Germany d Hygiene-Nord GMBH, Greifswald, Germany e Institute of Community Medicine Ernst-Moritz-Arndt University, Greifswald, Germany article info Article history: Received 9 January 2010 Accepted 17 January 2010 by S.J. Dancer Available online 27 March 2011 Keywords: ASTM 1115 EN 12791 Preoperative hand disinfection Skin antiseptic summary While hands are acknowledged to be the most important source of pathogens from the skin of the surgical team, the transmission of pathogens from the forearms may also be relevant. Preoperative hand disinfection is recommended, but evidence-based standards for the fore- arms are lacking. As neither the European standard EN 12791 nor the American guidelines ASTM 1115 are applicable tothe forearms, a new test method based on the European standard EN 12791 and the German Society for Hygiene and Microbiology (DGHM) method for testing for the efficacy of skin antiseptics was developed to address the forearms. The antiseptic efficacy of a commercially available alcohol-based hand rub [76.7% (w/w) ethanol] was assessed on the upper arm after 15 s, 2.5 min, and 30 min, and on the lower arm after 2.5 min, 30 min, and 3 h. On the upper arm, application of the product followed the DGHM standard procedure. On the forearm, the product was applied by the participants themselves with the right hand over the left forearm and vice versa as performed during preoperative hand disinfection. Sampling and culture were performed according to the DGHM method for skin antisepsis on the upper arm. Twenty-two volunteers were investigated. The efficacy of the antiseptic treatment on the forearm was not significantly lower than on the upper arm for any of the areas tested (P > 0.05). Reduction factors for all tested areas and times were quite similar, with confidence intervals ranging between 1.43 and 2.31 log 10 . We suggest that an application time of 10 s may be sufficient for the treatment of the forearm as part of preop- erative hand disinfection, provided that an appropriate product is used. Ó 2011 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved. Introduction Preoperative hand disinfection by the surgical team is an essential part of the strategy to prevent surgical site infection. To ensure adequate antimicrobial activity, agents for preoperative hand disinfection are required to meet performance standards. In 2005, the European standard EN 12791 for the antimicrobial efficacy of surgical hand disinfection was issued and is based on a method published by the German Society for Hygiene and Microbiology (DGHM). 1,2 The study used a randomised, reference- controlled, cross-over hand design to determine the reduction of the release of bacteria from the volunteers’ fingertips achieved following the application of a test preparation compared with a reference preparation, immediately after disinfection and after 3 h. While the hands have been acknowledged to be the most important source of pathogens from the skin of the surgical team, possible transmission from skin of the forearm has been raised. The forearm is a possible source of pathogens because of its close proximity to the surgical field and the potential break in the aseptic * Corresponding author. Address: Institute of Hygiene and Environmental Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany. Tel.: þ49 3834 515546; fax: þ49 3834 515541. E-mail address: nhuebner@uni-greifswald.de (N.-O. Hübner). Available online at www.sciencedirect.com Journal of Hospital Infection journal homepage: www.elsevierhealth.com/journals/jhin 0195-6701/$ e see front matter Ó 2011 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jhin.2010.01.033 Journal of Hospital Infection 78 (2011) 11e15