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There is a need for cheap and efficacious wound dressings in developing countries. Banana leaves have been described as an excellent, inexpensive, easily available dressing material in tropical countries. As a natural product, banana leaves are heavily contaminated with various pathogens that must be removed before they can be used as wound dressings, but effective sterilization methods that do not affect the beneficial wound-dressing properties of banana leaves have not been described.To study different sterilization methods and determine which can be used on banana leaves without affecting their beneficial wound-dressing properties.We first compared the use of different decontamination techniques to reduce the natural microflora of the leaves and then tested the wound-dressing properties of the leaves in a mouse model of skin transplantation and in postsurgical patients in Uganda, Africa.Steam sterilization proved to be the optimal sterilization technique. Banana leaves displayed wound-dressing properties that equaled those of petroleum jelly gauze dressings and were tested successfully in a clinical setting in postsurgical patients in Uganda, Africa.We found banana leaves to be an excellent alternative wound dressing, combining the desirable properties of modern wound-dressing material with low cost.

Summary Background: Accurate pre-operative or intra-operative labeling of the skin is often necessary to mark exactly the surgical excision lines. Pre-operative “unsterile” permanent skin labeling systems are needed for example for vein and sentinel lymph node surgery; here the dyes must resist two surgical skin disinfection procedures. In contrast, excision borders are labeled during surgery using a “sterile” skin marking system. Methods: Many commercial and non-commercial pre- and intra-operative skin-labeling systems are available, such as autologous patient blood, fluorescence triphenylmethane dyes and commercial skin markers. The available skin marking systems have specific advantages and disadvantages. We review the different labeling systems, offering guidelines to help choose a cost-effective system appropriate for a given surgical procedure. Results: The Edding® permanent markers 400 und 3000 are well suited for preoperative skin labeling and less expensive than commercial skin labeling systems. Autologous patient blood and eosin are well suited for intra-operative labeling and are most cost effective. Eosin Y is widely used and well suited for labeling of dark skin, bone, cartilage, and muscle tissue and spares the expense of expensive commercial skin markers. Conclusion: Knowledge of the many commercial and non-commercial pre- and intra-operative skin labeling systems and their advantages and disadvantages helps to reduce the use of relatively expensive commercial skin markers.

This report describes the isolation of a linezolid-resistant Enterococcus faecium and a carbapenem-resistant Acinetobacter baumannii from an infected open patella fracture after a car accident in southern Italy.

Summary In 2001 two outbreak episodes (January – March and June – July) caused by vancomycin-resistant E. faecium (VRE) of the VanA-type were observed at a neonatal intensive care unit (NICU) of a university hospital in south-west Germany. To identify the initial source and the route of transmission environmental samples were examined as well as stool samples from patients and the staff. VRE was not found in environmental samples. However, stool samples from 24 hospitalised children tested positive and bacterial clonality was assessed by Smal-based macro restriction analysis. Furthermore, esp gene and vancomycin resistance gene carriage were examined as well as bacteriocin production. PCR analysis showed that all 24 isolates carried vanA gene cluster, encoding resistance to vancomycin and teicoplanin. However, five of the vanA-positive isolates were resistant to vancomycin but not to teicoplanin. Only these five isolates produced bacteriocin, but in none of the isolates esp gene was detected. PFGE revealed that both outbreaks were caused by two different clones. The patient initiating the first episode, was identified whereas the origin of the second episode remained unknown. From one of the 40 staff stool samples VRE was isolated. This strain was related to the clone of the summer outbreak. In conclusion there were two independent episodes of self limiting VRE outbreaks and transmission on the ward is highly probable.

Outbreaks of gram-negative bacteria such as Pseudomonas aeruginosa in neonatal intensive care units (NICU) can be life-threatening to pre-term infants, which are highly susceptible to serious infections with bacteria. Forty-two ventilated neonates in the NICU of the University Children's Hospital of Tuebingen were found to be colonized (n = 40) or infected (n = 2) with P. aeruginosa within a sampling period of one year. To investigate the colonization patterns and identify potential outbreak sources, epidemiological investigations, environmental surveillance and typing by serotyping and pulsed-field gel electrophoresis of the recovered isolates were performed. The investigation demonstrated a genetically related cluster of P. aeruginosa isolates during the surveillance period in 39 neonates and a second cluster at the end of the period in two neonates. A third strain representing a genetically distinct group was found in only one patient. Environmental investigations demonstrated the presence of P. aeruginosa in the ventilation equipment of 22 patients: binasal prongs (n = 22), water reservoir (n = 9), and heater (n = 1). In one case, P. aeruginosa was found in breast milk. Other environmental investigations revealed no P. aeruginosa. Although no evidence for a unique source was found, a series of intervention steps were initiated by the NICU personnel, medical microbiologists and infection control experts. The intervention steps included reinforced training of health care staff and a change from chemical to thermal disinfection of binasal prongs. Implementation of these measurements successfully stopped the recurrent occurrence of P. aeruginosa colonization.

Objective: To determine whether reprocessed single-use devices (SUD) would (1) meet regulatory standards for sterility, and (2) meet the same material standards as new devices or if they pose an infection risk to other patients. Design: The study included in the first stage single-use laparoscopic dissection devices and in the second stage a variety of clinically used and reprocessed SUDs. The suitability of these devices for cleaning, disinfection, and sterilization was examined.Methods: Testing of cleanability was conducted on devices contaminated with radioactively labeled blood. Instruments were cleaned using hospital recommended practices. Gamma counts/second were determined before and after cleaning to localize contaminants, which were additionally visualized using light and scanning electron microscopy (SEM). X-ray photoelectron spectroscopy (XPS) was used to quantify contamination elements on the materials tested. Residual bioburden testing on instruments contaminated with microorganisms suspended in blood prior to reprocessing was carried out to establish the efficacy of disinfection and sterilization.Results: During the first stage of the study all devices remained contaminated after cleaning, but were effectively disinfected. Sterilization could not eliminate the challenge microorganisms completely. The findings during the second stage — examination of clinically used devices — were as follows: 11% of the sterile packages were damaged; 33% of the devices were incomplete and parts were missing; 54% did not meet the criteria for functionality; light microscopy, SEM, and XPS showed contamination on the outside and inside of all devices. Of the tested SUDs, 40% remained unsterile following resterilization.Conclusions: None of the reprocessed SUDs were effectively cleaned or sterilized. This may provide an opportunity for survival and growth of non-resistant or nosocomial organisms and viruses. The use of such inadequately reprocessed SUDs increases the risk for the patient, and can lead to nosocomial infection and to legal consequences for the health care facility.

Objective:To determine whether reprocessed single-use devices would meet regulatory standards for sterility and meet the same materials standards as a new device.Design:The study included single-use and reusable biopsy forceps and papillotomes and a reusable stone retrieval basket. The suitability of these devices for cleaning and disinfection or sterilization was examined.Methods:Testing of cleanability was conducted on devices contaminated with technetium 99-radiolabeled human blood. Instruments were cleaned using hospital recommended practices for manual cleaning. Gamma counts per second were determined before and after cleaning to localize contaminants, which were additionally visualized using light and scanning electron microscopy. X-ray phc-toelectron spectroscopy was used to quantify contamination elements on the materials tested. Residual bioburden testing on instruments contaminated with microorganisms suspended in coagulable sheep blood was carried out to establish the efficacy of disinfection and sterilization.Results:All devices remained contaminated after cleaning, but single-use devices and the stone basket tended to be more heavily contaminated than reusable forceps and papillotomes. Cleaning procedures facilitated distribution of contaminants further into the lumens of the disposable forceps. Decreased concentrations of silicon and increased concentrations of carbon and nitrogen suggested that layers of silicon lubricant had been removed and contaminants were organic material. Reusable devices were effectively disinfected, but single-use devices were not Sterilization could not eliminate the challenge microorganisms completely.Conclusions:None of the reprocessed single-use instruments were effectively cleaned, disinfected, or sterilized. This condition may provide an opportunity for the viability of non-resistant or nosocomial organisms and viruses. Additionally, reprocessing procedures may result in material destruction of fragile devices. Cost-saving initiatives that have inspired reprocessing of single-use devices, despite the absence of data establishing the efficacy of decontamination and the durability of materials throughout reprocessing, should be pushed into the background.

The introduction of dynamic intensity modulation into radiotherapy using conventional photon beams or scanning particle beams requires additional and efficient methods of dose verification. Dose measurements in dynamically generated dose distributions with a single ionization chamber require a complete application of the treatment field for each single measurement. Therefore measurements are performed by simultaneous use of multiple ionization chambers. The measurement is performed by a computer controlled system and is comprised of the following steps: (a) automated positioning of the ionization chambers, (b) measurement at these points, (c) a comparison with the calculated dose from the treatment planning system, and (d) documentation of the measurement. The ionization chambers are read out by a multichannel electrometer and are densely packed into a mounting of polymethylmetacrylate, which is attached to the arm of a three-dimensional motor-driven water phantom. The measured and planned dose values are displayed numerically as well as graphically. The mean deviation between measured and planned doses as well as their standard deviation are calculated and displayed. Through printouts complete documentation of the measurement is obtained and a quick decision can be made whether the dose distribution is acceptable for the patient. The system is now routinely used for dose verification at the heavy ion therapy project at the Gesellschaft für Schwerionenforschung in Darmstadt. Up to now 242 measurements have been performed for heavy ion treatment of 30 patients. The system allows efficient verification and documentation of carbon ion fields and is in principle also applicable to intensity-modulated photon beams.

The method to measure absorbed dose to water in a field of carbon ions as applied for the heavy ion therapy project at the Heavy Ion Research Laboratory in Darmstadt (GSI), Germany, is described in detail. Thimble ionization chambers with a water absorbed calibration factor are applied. The dose obtained with this method was compared with that obtained at the heavy ion therapy facility HIMAC at the National Institute of Radiological Sciences in Chiba, Japan, using the Japanese code of practice. The agreement found was better than 1%. The combined uncertainty of the determination of absorbed dose to water was estimated to amount to 5%.

On the basis of a large outbreak of vancomycin-resistant Enterococcus faecium in a German university hospital, we estimated costs ( approximately 1 million Euros) that could have been avoided by early detection of the imminent outbreak. For this purpose, we demonstrate an easy-to-use statistical method.

Background In this study we investigate the accuracy of industrial six axes robots employed for patient positioning at the Heidelberg Ion Beam Therapy Center. Methods In total 1018 patient setups were monitored with a laser tracker and subsequently analyzed. The measurements were performed in the two rooms with a fixed horizontal beam line. Both, the 3d translational errors and the rotational errors around the three table axes were determined. Results For the first room the 3d error was smaller than 0.72 mm in 95 percent of all setups. The standard deviation of the rotational errors was at most 0.026° for all axes. For the second room Siemens implemented an improved approach strategy to the final couch positions. The 95 percent quantile of the 3d error could in this room be reduced to 0.53 mm; the standard deviation of the rotational errors was also at most 0.026°. Conclusions Robots are very flexible tools for patient positioning in six degrees of freedom. This study proved that the robots are able to achieve clinically acceptable accuracy in real patient setups, too.

The following on new requirements of endoscopy contains commentaries on the risk of infection in endoscopy, the need to eliminate contamination, and the use of a disposable system in transnasal endoscopy.

Hand washing and hand disinfection put considerable stress on the skin thus requiring specific hand care. It is important however that the care products do not impair the effect of hand disinfectants. We therefore investigated the interaction of two hand care products (oil-in-water and water-in-oil emulsions) on the microbicidal efficacy of different alcoholic hand-rubs, using the contamination model described in EN 1500. The mean log10-reduction factors for three hand-rubs varied between 4.03 and 4.22 compared with 3.76 and 4.43 for six possible combinations of hand-rubs and hand care products applied immediately prior to disinfection. Differences between reduction factors achieved with hand-rubs alone and in combination with hand care were not significant. Repeated application of care products with subsequent hand disinfection also did not result in significantly lower reduction factors than achieved with hand disinfection alone. Our data suggest that administration of selected products for hand care does not necessarily impair hand disinfection and is therefore recommended for occupational health as well as for infection control reasons.

We determined interleukin-6 (IL-6) concentrations in collected shed drainage blood intended for retransfusion in a prospective study in 81 patients after total knee replacement. We found large increases in IL-6 levels, averaging 6.5 (SD 3.9) ng/mL, in shed blood collected in the first 6 postoperative hours. 3 patients had febrile reactions after collected blood was retransfused. The IL-6 levels in the drainage blood of these patients were very high (9.6-13.4 ng/mL). In the blood collected after 6 hours, IL-6 concentrations increased to 47 (SD 33) ng/mL (p < 0.001). These results suggest a relation between increased interleukin-6 concentrations in shed drainage blood and the occurrence of febrile reactions after retransfusion of such blood.

The increasing number of complicated soft-tissue or invasive infections caused by methicillin-resistant Staphylococcus aureus (MRSA) is a frequent reason for elaborate treatment regimens. Unidentified MRSA carriers may be the origin of endemic spread to other patients and medical staff. Recently, community-associated cMRSA with particular virulence factors were isolated from persons without the typical history of hospital contacts. Molecular tools for the timely detection of the mecA resistance gene for the identification of MRSA in medical test specimens have become a standard approach in MRSA-related diagnostic procedures. The actual therapy of MRSA infections requires consideration of both the appropriate spectrum of activity and the adequate pharmacological properties of a chosen antimicrobial. Preventive strategies rely on the consistent application of standard hygiene precautions, which have to be supplemented with increased barriers for the isolation of identified MRSA patients.

This report describes the isolation of Aeromonas veronii biovar sobria as the causative enteropathogen of diarrhoea in an oncological patient after failure of detection of other infectious agents. The case points out the severe and long course of the infection, the diagnostic dilemma, and the prompt recovery after antibiotic treatment.

Recently, it has been suspected that long durations of hospitalization might be a possible risk factor to get colonized by multiple VRE strains. Here we present the case of a patient who underwent stem cell transplantation and subsequently stayed at the hospital for about 4 months until death. At least four different Enterococcus faecium strains were identified from routinely taken microbiological specimens as demonstrated by pulsed-field gel-electrophoresis. Additionally, these strains showed variable susceptibility to quinupristine/dalfopristine, vancomycin, and/or linezolid depending on different antibiotic administrations. These findings indicate that patients might be colonized with multiple Enterococcus faecium strains and that the enterococcal flora quickly adapts due to antibiotic exposure.

Summary Background Ralstonia mannitolilytica is a non-fermentative, Gram-negative bacterium isolated infrequently from clinical samples. However, within a period of 11weeks five inpatients of the tertiary care hospital of the University of Tubingen developed clinical signs of infection and R. mannitolilytica was cultivated from blood samples of all patients suggesting an outbreak. Methods Blood cultures and one catheter tip were analysed by standard microbiological procedures. Genetic relatedness of the isolates was investigated by pulsed-field gel electrophoresis. To ascertain the possible source of the outbreak, environmental sampling and challenge-recovery experiments to test filters used for multi-dose solution bottles were performed. Results In the present study a monoclonal outbreak with R. mannitolilytica causing catheter-related infection of five haematological patients is reported. Underlying severe diseases with consecutive immunosuppression, permanent indwelling intravenous devices, multiple intravenous applications, and chemotherapy were possible risk factors promoting the infection. Challenge-recovery experiments revealed that R. mannitolilytica to a high extent even passed through Mini-spike Plus ® filters of pore size 0.2μm. Conclusion Although the source of the outbreak could not be identified, it is possible that solutions given intravenously were contaminated. Since R. mannitolilytica had never been isolated in our laboratory before and environmental testings performed were negative, it cannot be excluded that commercial products like drugs, saline solutions or infusion systems (filters) were contaminated.

Vancomycin-resistant enterococci (VRE) have been isolated in increasing numbers. Hospital-adapted VRE exhibit relatively high pathogenicity by expressing factors like enterococcal surface protein (Esp), which facilitates epidemic spread. By contrast, 'community-acquired' VRE show low pathogenicity and non-epidemic features. In 2004 and 2005 an extended outbreak of VRE occurred at a university hospital in Southwestern Germany and an infection control programme was implemented to confine the outbreak. Pulsed-field gel electrophoresis (PFGE), esp PCR, multiple-locus variable number of tandem repeat analysis (MLVA), purK1 typing and multiple-locus sequence typing (MLST) were performed on representative VRE isolates. Twenty-six non-epidemic and two epidemic VRE types (MLST203, MLST280) were identified by PFGE. Seven of the non-outbreak VRE types were esp gene negative, whereas 19 non-outbreak and both epidemic VRE types were esp positive. Eight MLVA types were identified. MLVA type 1 included five PFGE types and MLVA type 159 included 16 PFGE types. Currently there is no efficient method available to identify non-epidemic VRE and avoid unnecessary isolation of patients. More than 50% non-epidemic clones were esp positive; nevertheless, esp PCR appears to be the most promising approach to identify non-epidemic VRE.

Pumice is a potential source of infection for the dental technician and of cross-contamination between different dentures and patients. In this study, the number of microorganisms in two different combinations of pumice and disinfectant was compared with a conventional mixture of pumice and water. The results revealed that under practical conditions the mix of Steribim (pumice containing benzoic acid added by the manufacturer) with water reduced the number of bacteria by 99% compared with a mix of a conventional pumice and water. The addition of an antiseptic product that contained octenidine as active agent to conventional pumice reduced the number of microorganisms by 99.999%.

The ion beam therapy facility HICAT presently under construction at the Heidelberg University Clinic will be the first clinical irradiation facility for heavy ions in Europe. Its capacity should enable the treatment of 1000 patients per year. The use of different ion species ranging from protons to oxygen under identical conditions should clarify the question of which particle species is best suited in terms of indication. A synchrotron will accelerate the particles to energies corresponding to water-equivalent ranges from 2 cm to 30 cm. An intensity-controlled raster scanning technique will be used to optimize the use of the favorable depth dose distribution of ions. The planned heavy-ion gantry will be the first world-wide. The facility should be complete in 2006.

Outbreaks of Acinetobacter baumannii demonstrating multiple antibiotic resistance, including meropenem resistance, have been described as severe therapeutic problems. Here we describe a monoclonal outbreak of infection and colonization with multidrug-resistant A. baumannii over a two-month period. Resistance to meropenem was mediated by expression of a metallo-beta-lactamase enzyme. Four of 14 patients showed clinical signs of infection and two died. Contamination of the environment, water, or instruments were excluded as causes of the outbreak. All patients, except one, underwent surgery in a specific operation theatre where surgery of contamination class IV (infected, dirty) was performed. Although individual surgeon error was eliminated, analyses of the patients' histories suggested that bacterial transmission had occurred during surgery. Five patients showed signs of A. baumannii infection and two of these patients suffered from large abdominal wounds infected with a high density of A. baumannii requiring repeated revisions. Presumably, these revisions favoured the transmission of A. baumannii, which is remarkably resistant to various environmental stresses including soaps, disinfectants and dry conditions. No case of meropenem-resistant A. baumannii had been observed in the hospital before the outbreak. Interestingly, the resistant bacteria appear to have been imported by a patient returning from West Africa. This indicates that, similar to MRSA, multiresistant A. baumannii may be introduced by patients from foreign hospitals. The outbreak was stopped in the following months by reinforcing standard procedures and by taking all necessary precautions such as patient isolation, and finally only one new case was detected.

Since December 1997, patients are treated with carbon ions at GSI (Gesellschaft für Schwerionenforschung). Dose delivery is performed with the intensity-controlled raster-scanning technique, which allows a highly conformal treatment of the tumor. To meet the special requirements of dosimetry with heavy ion beams, new dosimetric measurement techniques were developed and introduced into clinical application by the DKFZ (Deutsches Krebsforschungszentrum). The techniques comprise calibration of the irradiation monitor, checks of lateral and depth dose profiles, as well as verification of the beam delivery for complex three-dimensional dose distributions. The developed dosimetric methods are now integral part of clinical application and enable safe treatment with carbon ion therapy.

The influence of acid-citrate-dextrose (ACD) anticoagulant on the blood quality was assessed in this prospective, randomized, controlled study. The clinical consequences with regard to retransfusion of drainage blood following total knee arthroplasty were evaluated. After total knee arthroplasty, retransfusion was performed utilizing a "SureTrans" retransfusion system in 81 patients. In 42 of them, blood was collected adding an ACD anticoagulant (group A), while in the remaining 39 patients blood was collected without any additives (group B). Blood losses were retransfused over a 6-h period after attaching the retransfusion system to the patient of either group. Blood samples of the 6-h blood collection were taken and analysed for several blood quality parameters. Significant differences were found in the platelet count (61,200+/-16,700 microl(-1) in group A versus 70,100+/-21,600 microl(-1) in group B, p=0.042), the lactate concentration (4.09+/-0.86 mmol/l vs 4.82+/-0.83 mmol/l, p0.001), the pH (6.96+/-0.10 vs 7.18+/-0.06, p0.001), as well as the protein content (5.44+/-0.57 g/dl vs 5.85+/-0.43 g/dl, p0.001). These observed significant differences were, however, of no clinical relevance to the patients' treatment. Hemoglobin concentration, hematocrit, mean corpuscular volume (MCV), erythrocyte count, leukocyte count, concentration of free hemoglobin in the blood plasma (fHb), potassium concentration, lactate dehydrogenase (LDH), serotonin concentration, triglyceride concentration, free fatty acid concentration, and interleukin-6 concentration did not differ significantly. This study indicates that the blood quality in retransfusion systems is not substantially influenced by adding ACD anticoagulant.

Background: Local anesthesia often suffices for surgery on the outside of the body. In recent years, it has been found that such local anesthesia can be adequately carried out using large amounts of highly diluted anesthetic solutions. Methods: Using one or more common infusomats, we injected mixed anesthetic solutions slowly, painlessly, paravenously, and automatically via subcutaneous infusion anesthesia (SIA) into the subcutaneous layer in a large group of patients scheduled for surgery. The local anesthetics used were prilocaine and ropivacaine (Xylonest and Naropin); these were diluted with original Ringer's solution with epinephrine (1:1,000,000) in 500-ml bottles. The concentration of the mixture varied between 0.3% and 0.08% depending on the requirements of surgery. The needles used ranged from 30-gauge to 20-gauge needles, with a length of 1.5–10 cm. The speed of injection varied between 30 ml/h and 1500 ml/h, depending on the location, the requirements of the surgery and the needle size. Volumes usually ranged from 2 ml to 600 ml depending on the concentrations used. The maximum dose was approximately 4 mg/kg prilocaine and 2 mg/kg ropivacaine. Patients: We used this technique in preparing for 5020 major and minor skin operations in 3270 patients ranging in age from 0.5 years to 95 years (mean age 54 years). Microbiological tests of the infusion system were carried out. Patients were asked about their pain during anesthesia, operation, and postoperatively. Results: There were no complications from local anesthesia. The technique proved safe and comfortable even for children and very sensitive patients. The median duration of postoperative anesthesia was 5 h (maximum 23 h). Choosing the concentration, the needle, the needle position, the flow rate, and the volume requires some experience.

In the present stage between the technological realization and the clinical phase, quality management gains a predominant role at the heavy ion therapy facility at GSI. Specific quality inspection procedures had to be developed for the subsequent parts of the beam delivery system, the treatment planning, the raster scanning device, the patient positioning, the dose verification and the safety interlock system. In the meantime the acceptance test of the whole facility has been carried out and an overview about our first experience with quality assurance procedures at the heavy ion irradiation facility is given, with a special emphasis on the medical physics part.

A new treatment planning program was developed for the heavy-ion therapy facility at GSI. In addition, a concise quality standard for treatment planning has been set up. It covers acceptance and constancy checks of all critical aspects in treatment planning. Dose verification measurements done during the commissioning phase show an overall good agreement with the treatment planning calculations.

Background Recent research suggests that alcohol-based skin antiseptics exhibit their efficacy on the resident skin flora of the forehead in less than 10 minutes. That is why we have looked at the efficacy of two ethanol-based skin antiseptics applied for 10, 2.5 and 2 minutes on skin with a high density of sebaceous glands. Each experiment was performed in a reference-controlled cross-over design with at least 20 participants. Application of isopropanol (70%, v/v) for 10 minutes to the forehead served as the reference treatment. The clear (skin antiseptic A) and coloured preparations (skin antiseptic B) contain 85% ethanol (w/w). Pre-values and post-values (immediately after the application and after 30 min) were obtained by swabbing a marked area of 5 cm2 for about 10 s. Swabs were vortexed in tryptic soy broth containing valid neutralizing agents. After serial dilution aliquots were spread on tryptic soy agar. Colonies were counted after incubation of plates at 36°C for 48 h. The mean log10 reduction of bacteria was calculated. The Wilcoxon matched-pairs signed-ranks test was used for a comparison of treatments. Results Skin antiseptic A applied for 10 min was significantly more effective than the reference treatment. When applied for 2.5 min (three experiments) it was significantly more effective than the reference treatment immediately after application (2.7 versus 2.2 log10 reduction; p < 0.001) and equally effective after 30 min (2.8 versus 2.6 log10 reduction; p = 0.053). Skin antiseptic B applied for 2.5 min (three experiments) was significantly more effective than the reference treatment both immediately after application (2.3 versus 1.9 log10 reduction; p < 0.001) and after 30 min (2.5 versus 2.1 log10 reduction; p = 0.002). Conclusion The clear and coloured skin antiseptics applied for 2.5 min on the skin of the forehead fulfilled the efficacy requirements for skin antisepsis. The shorter application time on skin with a high density of sebaceous glands will allow to act more efficiently in clinical practice.