"I wash my hands of it!?" – Trends in hand hygiene over the past decades

Hand hygiene is the most important measure to protect against the spread of nosocomial infections. With the development of in vitro und in vivo test methods for evaluation of the effect of hand hygiene, there has been a sharp increase over the past 50 years in the body of knowledge relating to effective methods for removal from the hands or killing and inactivation of pathogens. In 1958 the German Society of Hygiene and Microbiology (DGHM) published a first “Guidelines for Testing Chemical Disinfectants” and included only those hand disinfection products on its “List of Tested Chemical Disinfectants Found To Be Effective” that had been tested as per the methods cited in the guidelines. The American Society of Testing and Materials (today: ASTM International) was next, with the first test protocols for hand disinfection products, which in 1974 were adopted by the US Food and Drug Agency as “Guidelines” in a “Tentative Final Monograph” (TFM) and in 1994, having revised it to incorporate new insights, it was published once again. Where the user is concerned, guidelines for hand disinfection containing information on indication and implementation are of course more important than methods dealing with efficacy testing of products. Such guidelines are compiled within the hospitals by the infection control teams set up during the 1970s. Written guidelines were also published by several healthcare institutions, scientific societies and associations. The guidelines formulated by the World Health Organisation (WHO), in an expert committee under the direction of Didier Pittet, proved to be the most successful of the attempts undertaken at global level to enhance hand hygiene. The most remarkable changes appear to be the efforts aimed at improving compliance among medical personnel and the increasing international acceptance of hand disinfection by using alcohols in the form of rubs; whether this will be with lotions or gels remains to be seen.