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Axel Kramer

Publications and source records attributed to Axel Kramer.

At least 19 recordsLinked to original sources
PubMed2006

Reproducibility and workability of the European test standard EN 12791 regarding the effectiveness of surgical hand antiseptics: a randomized, multicenter trial.

OBJECTIVES: To evaluate the reproducibility and workability of the in vivo test model of the European test standard EN 12791 regarding the effectiveness of surgical hand antiseptics and, as a secondary objective, to evaluate the power of the model to discriminate between the effectiveness of various formulations of surgical hand antiseptics. DESIGN: Prospective, randomized, multicenter study with a Latin square design. SETTING: Five laboratories at 2 universities, 2 disinfectant manufacturers, and 1 private testing institution. PARTICIPANTS: Twenty healthy adults in each laboratory. INTERVENTION: Surgical hand antisepsis was performed by scrubbing with chlorhexidine gluconate 4% detergent (CHG) or by rubbing the hands with propan-2-OL (70% by volume; Iso 70) or ethanol 85% (E 85); rubbing the hands and forearms for 3 minutes with propan-1-OL (N 60) was used as the reference disinfection procedure. We deliberately chose to use these antiseptics at the given concentrations because they were intended to cover the range of typical antiseptics submitted for approval according to EN 12791. METHODS: In once-weekly tests, the immediate effects of the 4 antiseptics were established according to the method laid down in EN 12791 by assessing the release of skin flora from the fingertips as viable bacteria counts per milliliter of sampling fluids before treatment and viable bacteria counts immediately after treatment, separately for both hands, such that after 4 weeks each volunteer had used every formulation once. RESULTS: The mean log reduction factor (RF) for the release of bacterial skin flora (the log RF was calculated as the log count before treatment minus the log count after treatment) and corresponding standard deviations for the 4 hand antisepsis formulations were as follows: for CHG, 1.1+/-0.3 colony-forming units (cfu) per milliliter of sampled fluid; for Iso 70, 1.7+/-0.3 cfu/mL; for E 85, 2.1+/-0.3 cfu/mL; and for N 60, 2.4+/-0.4 cfu/mL. The differences between these values proved significant (P<.001) by analysis of variance and in Tukey's "honestly significantly different" (HSD) post hoc test. Although, with regard to their immediate antibacterial activity, the same ranking of these antiseptics was found at all laboratories, the levels of efficacy were significantly different across laboratories (P<.001); no statistical difference was found between left and right hands (P>.01). Relating the log RF values of the other 3 formulations to those of the reference formulation (N 60) abolished differences between laboratories (P=.16); in addition, the interclass correlation coefficient decreased from 9.1% to 4.5%. With 20 volunteers, a minimum difference of 0.47 log between the mean log RFs of the reference formulation and an inferior test formulation will be detected as significant at an alpha of .05 (1-sided) and a 1- beta value of .8. CONCLUSION: The test method described in EN 12791 yielded the same conclusion on the effectiveness of the tested formulations in every laboratory and proved, therefore, reproducible and workable.

2-Propanol↗
PubMed2006

How long do nosocomial pathogens persist on inanimate surfaces? A systematic review.

BACKGROUND: Inanimate surfaces have often been described as the source for outbreaks of nosocomial infections. The aim of this review is to summarize data on the persistence of different nosocomial pathogens on inanimate surfaces. METHODS: The literature was systematically reviewed in MedLine without language restrictions. In addition, cited articles in a report were assessed and standard textbooks on the topic were reviewed. All reports with experimental evidence on the duration of persistence of a nosocomial pathogen on any type of surface were included. RESULTS: Most gram-positive bacteria, such as Enterococcus spp. (including VRE), Staphylococcus aureus (including MRSA), or Streptococcus pyogenes, survive for months on dry surfaces. Many gram-negative species, such as Acinetobacter spp., Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, Serratia marcescens, or Shigella spp., can also survive for months. A few others, such as Bordetella pertussis, Haemophilus influenzae, Proteus vulgaris, or Vibrio cholerae, however, persist only for days. Mycobacteria, including Mycobacterium tuberculosis, and spore-forming bacteria, including Clostridium difficile, can also survive for months on surfaces. Candida albicans as the most important nosocomial fungal pathogen can survive up to 4 months on surfaces. Persistence of other yeasts, such as Torulopsis glabrata, was described to be similar (5 months) or shorter (Candida parapsilosis, 14 days). Most viruses from the respiratory tract, such as corona, coxsackie, influenza, SARS or rhino virus, can persist on surfaces for a few days. Viruses from the gastrointestinal tract, such as astrovirus, HAV, polio- or rota virus, persist for approximately 2 months. Blood-borne viruses, such as HBV or HIV, can persist for more than one week. Herpes viruses, such as CMV or HSV type 1 and 2, have been shown to persist from only a few hours up to 7 days. CONCLUSION: The most common nosocomial pathogens may well survive or persist on surfaces for months and can thereby be a continuous source of transmission if no regular preventive surface disinfection is performed.

Bacterial Infections↗
PubMed2006

Electro-optic fiber sensor for amplitude and phase detection of radio frequency electromagnetic fields.

We present a miniature fiber-optic electromagnetic field (EMF) sensor that is capable of simultaneously detecting the amplitude and phase of an EMF in the range of 0.1-6 GHz. We focus on magnetic field measurements, since the H-field is more significant in our target applications due its direct relation to the current. The sensor is based on an open optical platform to which various antennas can be attached and contains a radio-frequency amplifier for signal conditioning and a vertical-cavity surface-emitting laser as an electro-optic converter. The millimeter size and the full electrical isolation of the sensor allow EMF detection with minimal disturbance. We have characterized the sensor in the near field of a lambda/2 dipole, a rectangular waveguide, and a microstrip line, and we explain the experimental results with a simple theoretical model confirming the mapped near-field distribution of the investigated field source.

Journal Article↗
PubMed2006

Does a preceding hand wash and drying time after surgical hand disinfection influence the efficacy of a propanol-based hand rub?

BACKGROUND: Recently, a propanol-based hand rub has been described to exceed the efficacy requirements of the European standard EN 12791 in only 1.5 min significantly. But the effect of a 1 min preceding hand wash and the effect of one additional minute for evaporation of the alcohol after its application on the efficacy after a 1.5 min application time has never been studied. METHODS: We have investigated a propanol-based hand rub (Sterillium, based on 45% propan-2-ol, 30% propan-1-ol and 0.2% mecetronium etilsulfate) in three variations: with (A) and without (B) a 1 min hand wash before the disinfection of 1.5 min with immediate sampling after the disinfection; and (C) without a hand wash before the disinfection but with sampling 1 min after the disinfection. The efficacy of the three variations was compared to the reference treatment of EN 12791. All experiments were performed in a Latin-square design with 20 volunteers. Pre- and post-values (immediate and after 3 hr) were obtained according to EN 12791. RESULTS: The 3 min reference disinfection reduced resident hand bacteria on average by 1.8 log10 steps (immediate effect) and 1.4 log10-steps (sustained effect) respectively. Method A was equally effective as the reference (immediate efficacy: 1.5 log10-steps; sustained efficacy: 1.6 log10-steps). Method B seemed to be more effective (immediate efficacy: 2.3 log10-steps; sustained efficacy: 1.7 log10-steps). Method C revealed the best efficacy (immediate efficacy: 2.3 log10-steps; sustained efficacy: 2.0 log10-steps). A comparison of all three treatment variations and the reference treatment revealed a significant difference for the immediate efficacy (p = 0.026; Friedman test), but not for the sustained efficacy (p = 0.430). A post-hoc-test for the immediate efficacy indicated a significant difference between methods A and C (p < 0.05; Wilcoxon-Wilcox test). Hence, none of the treatment variations was significantly less effective than the reference treatment. CONCLUSION: An application of the propanol-based hand rub for 1.5 min after 1 min hand wash fulfills the efficacy requirements of EN 12791. The efficacy can be improved to some extent by omitting the preceding hand wash and by awaiting the evaporation of the alcohol which is clinical practice anyway. The preceding hand wash has the most negative effect on the immediate effect. Based on our data hands should not be routinely washed before the disinfection period unless there is a good reason for it such as visible soiling.

Anti-Infective Agents, Local↗
PubMed2006

Effect of a 1 min hand wash on the bactericidal efficacy of consecutive surgical hand disinfection with standard alcohols and on skin hydration.

BACKGROUND: In most surgical theatres, a 1 min or even longer hand wash is routine as part of the pre-operative hand disinfection. But its benefit has recently been seen critically. METHODS: We have therefore investigated the effect of a 1 min hand wash on skin hydration and on the efficacy of consecutive surgical hand rubbing with three standard alcohols (60% propan-1-ol, 60% propan-2-ol, 80% ethanol; all v/v) on the resident hand flora. Three types of treatment were performed: (i) a 1 min pre-wash before surgical hand disinfection, (ii) no pre-wash before surgical hand disinfection and (iii) no pre-wash but use of a brush for 1 min during disinfection procedure. The efficacy of the alcohols was determined according to prEN 12791 with the same 20 volunteers in paired groups. To assess the effect of the hand wash on skin hydration, 10 volunteers washed their hands with sapo kalinus for 1 min and dried hands with a paper towel. Skin hydration was measured with a corneometer before the hand wash and subsequently up to 10 min thereafter both on the palm and dorsum of hands. We also tested the reduction of bacterial spores by a 15 s hand wash according to EN 1499 after artificial contamination of hands of 14 volunteers with spores of B. stearothermophilus. RESULTS: Propan-1-ol (60%) was most effective with a mean log10 reduction of 2.11, followed by ethanol (80%) with a mean log10 reduction of 1.76 and propan-2-ol (60%) with a mean log10 reduction of 0.57 (all immediate effect without hand wash). The efficacy of the alcohols was neither significantly improved nor impaired by a preceding 1 min hand wash, but there is a trend towards better efficacy on dry hands. Using a brush for 1 min during disinfection resulted in a better efficacy with all alcohols. An anaylsis of variance revealed that the immediate effect of ethanol (p = 0.013) and propan-2-ol (p = 0.001) is significantly influenced by the variation of treatments which is mainly explained by the effect of brushing during disinfection. But no significant difference between treatment variations was found in the sustained effect with any of the alcohols. Skin hydration increased significantly by a 1 min hand wash for up to 10 min despite drying hands with a paper towel. A 15 s hand wash reduced the number of bacterial spores significantly from log10 3.84 to log10 1.99 (p = 0.001). CONCLUSIONS: There is no benefit of a hand wash as part of surgical hand disinfection except that a short hand wash of 15 s can effectively reduce spores. The best time for this short hand wash is at the beginning of work in hospital, but at the latest in the sluice of the operating theatre about 10 min before applying an alcohol-based hand rub to give the skin enough time to dry.

Adult↗
PubMed2006

Comparison of different biological methods for the assessment of ecotoxicological risks.

To test the effects of heavy metals in river water, we compared the sensitivity of seven different biological test methods, using bacteria (Vibrio fischeri), human FL cells, protozoans (Paramecium spp.), nematodes (Rhabditis oxycerca), aquatic plants (Lemna minor), and fishes (Leuciscus idus melanotus). As test substance we used a representative mixture of 3.0 microg/l As, 2.5 microg/l Pb, 0.8 microg/l Cd, 1.7 microg/l Cr, 3.9 microg/l Cu, 6.7 microg/l Ni, 0.4 microg/l Hg, and 23.0 microg/l Zn, imitating the detectable heavy metal contamination of the Odra estuary (NE Germany/NW Poland). This mixture was defined as normal concentration (NC). Most sensitive was the test with L. minor (exposure time 10 d). The plants already showed phytotoxic effects at the heavy metal concentration found in the Odra estuary. Test systems with human cells, protozoans, and nematodes (exposure time 1-7 d) reacted at concentrations 85-100 times above the NC. Fish toxicity (exposure time 2 d) occurred from 130-fold concentration upwards. In contrast, the standard test carried out with luminescent bacteria (exposure time 30 min) was affected only at > 1000-fold concentrations. This test is therefore not suitable as an early warning system to detect ecological risks. Even the NC of heavy metals measured in the Odra estuary inhibits cells and the growth of aquatic plants. Of the single heavy metals tested, copper produced the strongest effects. Therefore, the reduction of heavy metal emissions, especially of copper-which can amplify the toxicity of other heavy metals-should be a task of highest priority.

Aliivibrio fischeri↗
PubMed2006

Effect of topical 1.25% povidone-iodine eyedrops used for prophylaxis of ophthalmia neonatorum on renal iodine excretion and thyroid-stimulating hormone level.

The 1% silver nitrate, which has been used for preventing gonococcal conjunctivitis in the neonate, is not effective against Chlamydia trachomatis and may provoke eye irritation. It is not known whether the alternative topical agent, 1.25% povidone-iodine, can influence thyroid function. In this study, no influence of povidone-iodine on thyroid function was observed.

Administration, Topical↗
PubMed2005

Seropositivity for anti-Borrelia IgG antibody is independently associated with carotid atherosclerosis.

BACKGROUND: Various infectious agents are associated with atherosclerosis. This analysis was performed to investigate relation between seropositivity for anti-Borrelia IgG and carotid atherosclerosis. METHODS: The cross-sectional Study of Health in Pomerania was conducted in a general community living in a region with endemic Lyme disease. A random sample of 2483 individuals aged 45-79 years was available for the present analysis. Carotid atherosclerosis was sonographically assessed as intima-media thickness of the common carotid artery and as prevalent atherosclerotic plaques in the extracranial carotid arteries. IgG antibodies to Borrelia were determined by ELISA. RESULTS: IgG antibodies to Borrelia were found positive (> 10 IU/mL) in 108 subjects (4.3%). Persons with and without positive anti-Borrelia IgG antibodies differed with respect to carotid intima-media thickness values (0.863 +/- 0.017 mm versus 0.792 +/- 0.004 mm; p < 0.001) and prevalent carotid plaques (odds ratio 2.65, 95% confidence interval 1.53-4.61; p = 0.001), respectively. Seropositivity for anti-Borrelia IgG was also associated with both atherosclerotic endpoints when age, sex and further atherogenic risk factors and confounders were included in multivariable statistical models. CONCLUSIONS: In a region with endemic Lyme disease, seropositivity for anti-Borrelia IgG antibodies is independently associated with atherosclerosis. Our findings add support to the hypothesis that exposure to infectious pathogens increases the atherosclerosis risk.

Adult↗
PubMed2005

Effect of selected wound antiseptics on adult articular cartilage (bovine sesamoid bone) in the presence of Escherichia coli and Staphylococcus aureus.

After removing an inoculum of 10(8)-10(9) cfu of Escherichia coli (E. coli) or Staphylococcus aureus (S. aureus) effectively within 2 h from bovine sesamoid bones (bsb) using the iodophore Betaisodona [0.5 and 1.0% (v/v) PVP-I], the biguanide polihexanide (PHMB) [0.005 and 0.01% (v/v)], and the bispyridinamine Octenidine (Oct) [0.005 and 0.01% (v/v)] the metabolic effect on proteoglycans (PG) in bsb was investigated by subsequent culture of bsb for 7 d and biosynthetically labeling with (35)S-sulfate for a period of 24 h. The treatment with the iodophore stimulates the incorporation of (35)S-sulfate into PG, whereas that of Oct was toxic. The PHMB treatment was both tolerated and effective only when it was used at low concentrations (0.005%). The antiseptic treatment did not result in an increase of catabolism of PG. This in vitro study clearly demonstrates that irrigation of cartilage with an antiseptic should be limited to an effective concentration and treatment time compatible with antiseptic function. Iodophores have no negative feedback on cartilage metabolism, moreover, they stimulate chondrocytes in vitro. Cationic antiseptics are not suited as irrigating solutions.

Animals↗
PubMed2004

Eradication of methicillin-resistant Staphylococcus aureus with an antiseptic soap and nasal mupirocin among colonized patients--an open uncontrolled clinical trial.

BACKGROUND: Aim of the study was to determine the clinical efficacy of a new antiseptic liquid soap (Stellisept scrub), based on the combination of undecylenamidopropyltrimonium methosulphate (4%) and phenoxyethanol (2%), for eradication of MRSA among colonized patients who do not receive antibiotic therapy. METHODS: Over two years 50 MRSA patients in 6 hospitals were observed. Treatment was defined as the daily application of Stellisept scrub for the antiseptic body and hair wash (at least 60 s) in combination with nasal mupirocin. A treatment cycle was a minimum of 5 days treatment. Screening was carried out at least 48 h after the treatment cycle was finished, with 24 h between each of the requested three or more samplings, which included the nasopharynx, groin, axilla, perineum and other MRSA-positive skin areas. RESULTS: Fifteen cases were retrospectively excluded (lack of outcome documentation, concomitant antibiotic therapy, open wounds). All 35 patients had colonization with MRSA before antiseptic treatment on the skin, in the groin (80%), the axilla (25.7%), the perineum (20%) or other skin areas (14.3%). Colonization at more than one skin sites was found in 34.3%. Nasal colonization was found in 21 of 28 patients (75%), 7 patients were without nasal screening prior to the antiseptic treatment. After one treatment cycle MRSA was eradicated in 25 patients (71.4%), after a second cycle the total eradication rate was 91.4%, after a third cycle the rate increased to 94.2%. No patient discontinued the antiseptic treatment due to dermal intolerance of the product. CONCLUSIONS: Progressive eradication of MRSA carriage was observed with the antiseptic soap and mupirocin. The eradication rate was not biased by concomitant antibiotic treatment, screening during treatment or lack of evidence for colonization in contrast to other studies with other preparations.

Journal Article↗
PubMed2004

Antimicrobial safety of a preservative-free nasal multiple-dose drug administration system.

Recent technical developments in metered-dose pumps allow preservative-free nasal drug application with multiple-dose systems, avoiding the cytotoxic and allergic problems of preservatives. The use of the 3K System as a representative of those systems is demonstrated as microbiologically safe and without risk for the user and for the product during shelf life, under challenge up to 24 weeks, as well as under worst-case conditions with heavy bacterial contamination on the outlet surface. Therefore, the authors assess preservative-free pump systems as the new gold standard for mucosal drug application.

Administration, Intranasal↗
PubMed2004

[Tinea capitis].

Explore the source record for details and available documents.

Antifungal Agents↗
PubMed2004

Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs.

The etiology of nosocomial infections, the frequency of contaminated hands with the different nosocomial pathogens, and the role of health care workers' hands during outbreaks suggest that a hand hygiene preparation should at least have activity against bacteria, yeasts, and coated viruses. The importance of efficacy in choosing the right hand hygiene product is reflected in the new Centers for Disease Control and Prevention guideline on hand hygiene (J. M. Boyce and D. Pittet, Morb. Mortal. Wkly. Rep. 51:1-45, 2002). The best antimicrobial efficacy can be achieved with ethanol (60 to 85%), isopropanol (60 to 80%), and n-propanol (60 to 80%). The activity is broad and immediate. Ethanol at high concentrations (e.g., 95%) is the most effective treatment against naked viruses, whereas n-propanol seems to be more effective against the resident bacterial flora. The combination of alcohols may have a synergistic effect. The antimicrobial efficacy of chlorhexidine (2 to 4%) and triclosan (1 to 2%) is both lower and slower. Additionally, both agents have a risk of bacterial resistance, which is higher for chlorhexidine than triclosan. Their activity is often supported by the mechanical removal of pathogens during hand washing. Taking the antimicrobial efficacy and the mechanical removal together, they are still less effective than the alcohols. Plain soap and water has the lowest efficacy of all. In the new Centers for Disease Control and Prevention guideline, promotion of alcohol-based hand rubs containing various emollients instead of irritating soaps and detergents is one strategy to reduce skin damage, dryness, and irritation. Irritant contact dermatitis is highest with preparations containing 4% chlorhexidine gluconate, less frequent with nonantimicrobial soaps and preparations containing lower concentrations of chlorhexidine gluconate, and lowest with well-formulated alcohol-based hand rubs containing emollients and other skin conditioners. Too few published data from comparative trials are available to reliably rank triclosan. Personnel should be reminded that it is neither necessary nor recommended to routinely wash hands after each application of an alcohol-based hand rub. Long-lasting improvement of compliance with hand hygiene protocols can be successful if an effective and accessible alcohol-based hand rub with a proven dermal tolerance and an excellent user acceptability is supplied, accompanied by education of health care workers and promotion of the use of the product.

Anti-Infective Agents, Local↗
PubMed2003

In vitro action of combinations of selected antimicrobial agents and adult bovine articular cartilage (sesamoid bone).

Anatomically intact articular cartilage in form of sesamoid bones from metacarpophalangeal joints of 2-year-old cows was tested for its influence on the microbicidal effect of the iodophore Betaisodona, the bispyridinamine Octenisept, and the biguanide Lavasept. Comparisons were carried out in Ham's F12 medium with and without 0.2% bovine serum albumin as organic matter loading. The expected abolition of the microbicidal effect of these antiseptics against the test organisms Escherichia coli or Staphylococcus aureus in the presence of sesamoid bone was not evident. Furthermore, sesamoid bone alone demonstrated antibacterial activity against Staphylococcus aureus, which may involve adherence of bacteria to surface constituents of articular cartilage. Final concentrations of 2.5-5% Betaisodona, 5% Octenisept as well as 0.025% Lavasept are effective in killing of 10(8)-10(9) cfu/ml Escherichia coli or Staphylococcus aureus in the presence of sesamoid bone without the reduction of antimicrobial activity expected from binding to CS, which has previously been demonstrated for CS in solution.

Animals↗
PubMed2003

In vitro assay for the screening of the plaque-reducing activity of antimicrobial agents.

Bacteria grown in biofilms are less susceptible to antimicrobial agents than planktonic bacteria. One of the most common biofilms in humans is dental plaque. To investigate the antimicrobial activity against dental bacteria grown in biofilms, biofilms were generated with Streptococcus sanguis on hydroxyapatite disks to mimic the tooth surface. After 48 h of aerobic incubation at 37 degrees C in a continuous flow culture, a biofilm consisting of Streptococcus sanguis became visible on the surface of the disks. The disks were removed from the growth chamber and placed in different vessels containing either chlorhexidine digluconate (CAS 55-56-1, 0.1% or 1.0%), polyvinylpyrrolidone iodine (1.5% or 7.5%), or octenidine dihydrochloride (CAS 70775-75-6, 0.05% or 0.1%) for 5 or 30 min. In addition, the antiseptics were applied to the bacterial suspension in the growth chamber. A significant difference was observed in the antimicrobial activity against bacteria in the suspension liquid compared to the bacteria grown in biofilms. The best reduction factors were obtained with chlorhexidine (1.0%, 30 min) for either sessile (3.97 Ig) or planktonic bacteria (> or = 5.58 Ig). Clear relationships between the doses and times of action were found for the assessed agents. Therefore, the authors conclude that the present in vitro assay is a quick and cost-effective model to screen the activity of antimicrobial agents against bacteria grown in biofilms.

Anti-Bacterial Agents↗
PubMed2003

The prevalence of undiagnosed thyroid disorders in a previously iodine-deficient area.

OBJECTIVE: The aim of the present study was to analyze the current status of morphologic and functional thyroid abnormalities in a previously iodine-deficient area. METHODS: The population based Study of Health in Pomerania (SHIP) comprised 4310 participants, aged 20-79 years. Thyroid function (thyrotropin [TSH] free triiodothyronine [FT(3)], and free thyroxine [FT(4)]) and serum autoantibodies to thyroperoxidase (TPOAb) were evaluated from blood samples. Thyroid structure and size were measured by ultrasound. Data from 3941 participants with no known thyroid disorders were analyzed. RESULTS: The median iodine urine excretion was 12.4 microg/dL. The rate of decreased serum TSH levels (<0.3 mIU/L) was 11.3%; 2.2% of participants had suppressed serum TSH levels (<0.1 mIU/L). The prevalence of subclinical hyperthyroidism was 1.8%, the prevalence of overt hyperthyroidism 0.4%. Elevated TSH levels were found in 1.2% of individuals. Subclinical hypothyroidism was observed in 0.5%, overt hypothyroidism in 0.7% of the sample. Elevated TPOAb were detected in 7% of subjects, 4.1% of participants had TPOAb greater than 200 IU/mL. The prevalence of goiter was 35.9%. An inhomogeneous echo pattern was detected in 35.2% and nodules in 20.2% of participants. Diffuse autoimmune thyroiditis was diagnosed in 47 subjects (1.2%). CONCLUSION: There are a number of thyroid disorders in this previously iodine-deficient region. Further studies are required to investigate the change of thyroid disorders during iodine supplementation programs.

Adult↗
PubMed2002

Limited efficacy of alcohol-based hand gels.

Alcohol-based gels have been introduced recently in many hospitals worldwide for hand antisepsis. We investigated the antimicrobial efficacy of ten gels and four rinses according to European standards (EN 1500). No gel met the EN 1500 requirements within 30 s of application, whereas all hand rinses did. The tested hand gels should be considered a retrograde step for hand hygiene because the application time in clinical practice is often shorter than 30 s; they should not replace alcohol-based liquid hand disinfectants currently used in hospitals or be implemented as first choice agents.

1-Propanol↗