Wahrnehmung von Handhygienemaßnahmen durch Pflegepersonal: alkoholische Händedesinfektion versus hygienische Händewaschung - eine Multicenterfragebogenstudie mit anschließender Epikutantestung

Nurses have a high risk of developing hand eczema due to hand disinfection procedures. Objectives To investigate the perception of nurses on the adverse effects of hand washing (HW) and alcoholic disinfection (ADI), to obtain data on the prevalence of hand dermatitis and sensitization to alcohols and alcohol-based hand rubs (ABHR). A self-established-questionnaire survey, carried out as a pilot study (PS), followed by a modified multicentre study (MC) in 5 hospitals. Patch tests to ethanol (80%), 1-propanol (60%) and 2-propanol (70%) and ABHR were performed in a subsample. The majority (PS:60.1%/MC:69.5%) of nurses considered ADI as more damaging than HW. Mostly, ADI and HW were suspected to have irritant effects (ADI:79.2%/52.1%, HW:65.5%/36.2%) compared to an allergenic potential (ADI:10.4%/5.8%, HW:7.77%/3.9%). The prevalence of hand dermatitis in the MC was 13.40% by self-diagnosis and 22.39% by symptom-based questions. In 50 tested individuals no sensitization and only two irritant reactions to alcohols and three single-positive reactions to ABHR were observed, none of the latter related to alcohols. Though ADI is known to cause less skin irritation than HW, nurses perceive ADI as more damaging resulting in: 1.) a low compliance with ADI and 2.) a higher prevalence of hand dermatitis because the more deleterious HW is preferred. This may result in an increase in occupational disease and nosocomial infections. Educational programs should promote ADI as a procedure with good efficiency and skin tolerability to reduce the prevalence of hand eczema in nurses and enhance compliance with hand hygiene standards.