State-of-the-art hand hygiene in community medicine.

Hand hygiene becomes more important in community medicine not only since antibiotic resistant bacteria such as MRSA spread within the community. Hands may be colonized with transient microorganism in up to 75%. Among those transient pathogens S. aureus, C. difficile or the hepatitis C virus may be found. During patient care the number of microorganisms on the hands steadily increases. In addition hands may be contaminated with different kinds of germs even if only "clean" activities are carried out. Gloves may be worn but do not provide complete protection from contamination due to leaks. Therefore hands should always be treated after gloves are taken off. State-of-the-art treatment of hands is the hygienic hand disinfection with alcohol-based hand rubs. They are more effective, quicker to carry out, better tolerated by the skin, with a positive effect on compliance, and cost effective in comparison to antiseptic soaps based on chlorhexidine or triclosan and in comparison to normal non-medicated soaps. Healthy skin easily tolerates alcohol-based products from the beginning on. Only health care workers with an underlying irritative contact dermatitis which is often caused by bar or liquid antiseptic soaps may have difficulties to use alcohol-based products initially. In such a case treatment of the underlying skin condition is the way to go and not staying with a preparation which has caused the dermatitis. All this knowledge is now reflected in current guidelines on hand hygiene. Beside liquids alcohol-based gels can be used if they have an antimicrobial activity equal to alcohol-based liquid preparations. Hand hygiene remains the single most important tool to avoid cross transmission of microorganisms between patients. This state-of-the-art hand hygiene should also be emphasized more in community medicine. This review may help to go the first step into this direction.