The clinical impact of using an insufficient volume of hand rub for surgical hand disinfection has been reported recently in an outbreak of surgical-site infections [ 15].
This is attached via a plastic tube to an irrigation bag holding up to 2 l of water; alternatively a low-volume system consisting of a hand pump and a cone may be employed.
In this situation, a surgeon with large hands is encouraged to use the same volume of hand rub as a surgeon with small hands.
In contrast to patients with acute CRPS, in which hand edema and clinical aspects of a "warm" hand dominates, the volume of the affected hand was significantly reduced when compared to the contralateral side, and on average the hand affected by CRPS appeared "colder" [49].
Interestingly, in contrast to studies of diffusion MR data, previous studies using gross anatomical markers, such as the depth of the central sulcus and/or volume of the hand knob, consistently report a hemisphere-by-handedness interaction.
Johanna Wokalek's Ensslin is seen lolling in a hot bath, a volume of Trotsky in hand, looking like the centrefold in the May '68 issue of Anarcho-Syndicalist Babes.
For example, Hopkins and Cantalupo [45] reported an interaction between hand preference and the volume of the hand representation of primary motor cortex (the "knob" region), and Dadda et al. [46] reported an interaction between hand preference and the depth of the central sulcus at the level of the hand representation.
The volume of a crystal, on the other hand, converts discontinuously, increasing abruptly when the solid is reheated to a liquid at the melting point d.
A critical variable impacting the quality of hand disinfection is the volume of alcohol-based hand rub (ABHR) applied during a single HH event (i.e. application volume or AV).
Infection control practitioners should try to ensure patient safety by not reducing the volume of hand rub required for adequate for hand disinfection.
