How was surgical hand disinfection handled when you took up your position as a physician assistant?
In a purely classical manner. Before surgical procedures, we scrubbed our hands and forearms with water, soap and a brush. Afterwards, we poured ninety-six percent alcohol over the skin, which was then dried with sterile cloths. An effective method, which, in retrospect, was not ideal.
Many surgeons had rough and cracked skin due to the washing with its strong degreasing effect. Many physicians suffered from hand eczema and chronic inflammations. Single-use gloves did not yet exist.
When did you realise that things had to be changed? Was there a crucial experience?
Yes, I had one. In 1964. Three of our patients died a miserable death due to infection after heart surgeries, which had actually been successful. I still remember their names. My boss at that time and I, we were in despair, because we could not save them. Investigations showed that the detected pathogens reached the wound from the outside. Our aim was to keep the environment almost sterile. We contacted the disinfection specialists from Dr. Bode & Co. and met with chemist Rolf Steinhagen. He showed us what the methodology of surface disinfection entails. We got canisters from fruit growers that we buckled on to spray the operating theatre’s walls and floors with formalin-based Bacillol – with gas masks. This way, we could reduce the infection rate a little.
When did you get onto the subject of hand disinfection?
During one of the Wednesday 7 o’clock ward rounds only the most important physicians went in the small rooms. The others and I stayed outside. There was a washbowl with diluted disinfection solution that all physicians had to use after contact with the patient to clean their hands. This solution appeared suspicious to me. After the ward round, I took a sample and sent it to the bacteriologist. One day later, I had the proof that the stuff had no effect. The solution was alive with germs. Suddenly, I had a skin-friendly rub in mind that does not require a usual hand wash with water and soap.
How did you realise your idea?
My boss supported me, and shortly afterwards, I met Rolf Steinhagen from Bode & Co.; we reviewed literature and tried out a lot. After brainstorming with several examinations, we identified the formula that has remained unchanged to this day. A formula that is gentle on the skin and is active during surgeries lasting three to four hours. Sterillium®, the first hygienic and also surgical hand disinfectant to be rubbed in, was born.
What was the greatest challenge during the development?
We had to ensure that the product reaches the deeper corneal layers, for microorganisms residing on the stratum corneum not getting through to the skin’s surface and does not harm the skin. That worked out with our formula and with an exposure time of 30 seconds for hygienic and three to five minutes for surgical hand disinfection. Following bacteriological testing, the preparation was authorised for practical use in 1965.
Do you have a strong urge to explore?
Well, I love to get to the bottom of things. To prove that it is not necessary to pre-wash hands I made some tests with students – the result was convincing. For twenty years, for every patient I had kept records of infections to monitor the frequency and draw conclusions.
Can you give an example?
We set up a preparation room between the changing room and operating theatre. The door only opened after the dispenser with hand disinfectant had been activated.
How did Sterillium® change clinical routine and nosocomial infection?In the mid-1960s, the infection rate was more than ten percent and thus relatively high. Today, it is much lower ranging between two to three percent. This of course also is the result of the establishment of several preventive measures, for example surface disinfection, isolation of the cardiovascular OR- and IC-unit with a lock system. Changing clothes, repetitive education in hygienic behaviour and the new way of hand disinfection. Since 1965, there have been dispensers in the patient wards and also on the corridor wall between the doors of the patient rooms and in washrooms that, of course, have to be used.