17 Hygienic hand disinfection instead of washing: substantial savings potential Hygienic hand disinfection with ABHR eliminates germs transferred to the surface of the skin, for example by touching contaminated objects. If, for the same purpose, hands are only washed in everyday ward life, yearly water consumption increases by ~52 million liters, energy consumption by 1.3 million kWh, and working time by 130,000 hours. Surgical hand disinfection also contributes to savings Before any surgery, the transient skin flora should be eliminated and the resident skin flora reduced for the duration of the operation. Nowadays, it is recommended to only scrub hands and forearms before the first surgery or when visibly soiled and to use ABHR throughout the day [2]. Using only scrubbing increases the consumption of water, energy, and time by 220,000 liters, 5,600 kWh, and 525 hours. Beyond that, Sustainable hand hygiene Hand hygiene is one of the most important measures to prevent healthcare-associated infections [1]. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) clearly advocate the use of alcohol-based rubs (ABHR) for the implementation of hand hygiene [2, 3]. However, using preparations containing chlorhexidine, especially on a daily basis, is not recommended due to the risk of skin irritation, allergies, and the development of resistance [2], even though these preparations are still used in practice in many places [4]. ABHR are not only more skin-friendly but can also help conserve resources. The example of an average hospital illustrates the potential for savings. References 1. Kampf G et al. (2009) Hand hygiene for the prevention of nosocomial infections. Dtsch Arzteblatt Int 106: 649-655. https://doi.org/10.3238/arztebl.2009.0649 2. WHO (2009). WHO Guidelines on Hand Hygiene in Health Care (accessed June 6, 2023) 3. Centers for Disease Control and Prevention (2002) Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 51: RR-16. https://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf (accessed June 6, 2023) 4. Badia JM et al. (2020) The persistent breach between evidence and practice in the prevention of surgical site infection. Qualitative study. Int J Surg 82: 231-239. https:// doi.org/10.1016/j.ijsu.2020.08.027 5. https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Gesundheit/Krankenhaeuser/Publikationen/Downloads-Krankenhaeuser/grunddaten-krankenhaeuser-2120611207004.pdf?__blob=publicationFile (accessed June 7, 2023) 6. Golpe MC et al. (2022) Chlorhexidine residues in sludge from municipal wastewater treatment plants: analytical determination and toxicity evaluation. Anal Bioanal Chem 414: 6571-6580. https://doi.org/10.1007/s00216-022-04214-0 7. Östman M et al. (2017) Screening of biocides, metals and antibiotics in Swedish sewage sludge and wastewater. Water Res 115: 318-328. https://doi.org/10.1016/j.watres.2017.03.011 8. Duane B et al. (2022) Hand hygiene with hand sanitizer versus handwashing: what are the planetary health consequences? Environ Sci Pollut Res Int 29: 48736-48747. https://doi.org/10.1007/s11356-022-18918-4 chlorhexidine, which is contained in many antimicrobial soaps, accumulates in the environment [6, 7]. Advantages of ABHR Using ABHR instead of antimicrobial soap is more effective, less time-consuming, usually better tolerated by the skin, and saves both water and energy [2, 3, 8]. Example hospital 260 beds 500 employees (med. 90, care 190, other non-med. 220) 10 surgeries with each 3.25 professionals per day • Water consumption of 52 million litres/ year corresponds to 21 Olympic pools • Energy consumption of 1.3 million kWh/ year corresponds to a distance of > 7 million km or > 4.3 million miles with an electric car Handwashing/scrubbing Surgical preparation scrubbing 6 min Handwashing 2 min Water temperature 37°C No water and no energy for heating required Hand disinfection using ABHR Surgical HD 1.5 min Hygienic HD 0.5 min Hand disinfectants are more skin-friendly than washing hands The better skin compatibility of ABHR compared to (especially chlorhexidine-containing) handwash preparations has been clinically proven. This applies all the more, the more often hand hygiene is carried out. Washing hands with antimicrobial detergents should therefore primarily be used to remove dirt and pathogens or spores that are insensitive to alcohol [2]. Why disinfecting is more resource-efficient than washing and scrubbing PRACTICE
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