Surgical hand antisepsis to reduce surgical site infection

Tanner J, Dumville JC, Norman G, Fortnam M

"There is no firm evidence that one type of hand antisepsis is better than another in reducing SSIs. Chlorhexidine gluconate scrubs may reduce the number of [Colony-Forming Units] on hands compared with povidone iodine scrubs; however, the clinical relevance of this surrogate outcome is unclear. Alcohol rubs with additional antiseptic ingredients may reduce CFUs compared with aqueous scrubs. With regard to duration of hand antisepsis, a 3 minute initial scrub reduced CFUs on the hand compared with a 2 minute scrub, but this was very low quality evidence, and findings about a longer initial scrub and subsequent scrub durations are not consistent. It is unclear whether nail picks and brushes have a differential impact on the number of CFUs remaining on the hand. Generally, almost all evidence available to inform decisions about hand antisepsis approaches that were explored here were informed by low or very low quality evidence."

Surgical site infections, occurrence, and risk factors, before and after an alcohol-based handrub intervention in a general surgical department in a rural hospital in Ujjain, India

Lindsjö C, Sharma M, Mahadik VK, Sharma S, Stålsby Lundborg C, Pathak A

"The amount of [alcohol-based handrub] used might not be sufficient to interrupt the chain of contamination of microorganisms; therefore, continuation of the intervention and surveillance is recommended."

Infection after hand surgery

Eberlin KR, Ring D

"Measures intended to reduce the risk of infection after hand surgery include hand washing, skin preparation, sterile technique, and prophylactic antibiotics. The role of prophylactic antibiotics for small, clean, elective hand surgery procedures lasting less than 2 hours is debated. "

Role of infection control in combating antibiotic resistance

Whitelaw AC

"Care bundles have been shown to reduce the incidence of common healthcare-associated infections, including catheter-associated urinary tract infection, ventilator-associated pneumonia, central line-associated bloodstream infection and surgical site infection. These bundles are relatively inexpensive, and can play an important role in reducing antibiotic use and improving clinical outcomes."

Infection control in the operating room

Cosgrove MS

"The use of antibiotics, attention to patient normothermia, and sound hand hygiene have been shown to decrease the rate of postoperative SSI. "

Removal of nail polish and finger rings to prevent surgical infection

Arrowsmith VA, Taylor R

"No trials have investigated whether wearing nail polish or finger rings affects the rate of surgical wound infection. There is insufficient evidence to determine whether wearing nail polish affects the number of bacteria on the skin post-scrub."

Removal of nail polish and finger rings to prevent surgical infection

Arrowsmith VA, Maunder JA, Taylor R

A review of randomized controlled trials concluded that there is no evidence of the effect of removing nail polish or finger rings on surgical wound infection rates and there is insufficient evidence on the effect of wearing nail polish on the bacterial count on the skin post-scrub.

Prospective, randomized in vivo comparison of a dual-active waterless antiseptic versus two alcohol-only waterless antiseptics for surgical hand antisepsis

Olson LK, Morse DJ, Duley C, Savell BK

A prospective, randomized in vivo study comparing three waterless, brushless alcohol-based surgical hand antiseptics on reducing resident skin flora found that using an alcohol-based hand antiseptic containing chlorhexidine gluconate appears to be the most appropriate choice for maintaining microbial levels as low as possible for as long as possible.

The efficacy of three hand asepsis techniques using chlorhexidine gluconate (CHG 2%)

da Cunha ÉR, Matos FG, da Silva AM, de Araújo EA, Ferreira KA, Graziano KU

A comparative crossover study of 29 healthcare providers evaluating three methods of pre-operative asepsis using chlorhexidine gluconate concluded that there were no significant differences regarding the number of colony-forming units between hand-scrubbing with brush, hand-scrubbing with sponge, and hand-rubbing with antiseptic agent only, which theoretically disregards the need for brushes or sponges for hand asepsis.

Surgical hand antisepsis to reduce surgical site infection

Tanner J, Swarbrook S, Stuart J

A review of ten randomized, controlled trials comparing surgical hand antisepsis techniques found that: alcohol rubs are at least as, if not more, effective than aqueous scrubs; there is no evidence suggesting that any particular alcohol rub is more effective than another; and chlorhexidine gluconate-based aqueous scrubs are more effective than povidone-iodine-based aqueous scrubs in terms of the bacterial colony-forming unit count on the hands.

An in-use microbiological comparison of two surgical hand disinfection techniques in cardiothoracic surgery: hand rubbing versus hand scrubbing

Carro C, Camilleri L, Traore O, Badrikian L, Legault B, Azarnoush K, Dualé C, De Riberolles C

A study including 54 patients undergoing cardiac operations comparing the microbiological efficacy of hand-rubbing and hand-scrubbing procedures found that hand-rubbing with alcohol preceded by hand washing with mild neutral soap is as effective as hand-scrubbing and can be considered a valid alternative to conventional hand-scrubbing.

Reduction in Surgical Site Infections in Neurosurgical Patients Associated With a Bedside Hand Hygiene Program in Vietnam

Le TA, Dibley MJ, Vo VN, Archibald L, Jarvis WR, Sohn AH

A quasi-experimental, intervention study of 786 patients in two neurosurgical wards assessing the impact of an alcohol-chlorhexidine-based hand sanitizer on surgical site infection rates found that the introduction of a hand sanitizer can reduce surgical site infection rates, particularly superficial surgical site infections, and can reduce postoperative length of stay and the duration of antimicrobial use.

Handwashing Program for the Prevention of Nosocomial Infections in a Neonatal Intensive Care Unit

Won S-P, Chou H-C, Hsieh W-S, Chen C-Y, Huang S-M, Tsou K-I, Tsao P-N

An open study on the effects of a hand hygiene campaign on compliance and the rate of nosocomial infections in a neonatal intensive care unit concluded that improved compliance with handwashing was associated with a significant decrease in overall rates of nosocomial infection, particularly respiratory infections. However, there was no significant correlation between handwashing and surgical site infection.

Hand-Rubbing With an Aqueous Alcoholic Solution vs Traditional Surgical Hand-Scrubbing and 30-Day Surgical Site Infection Rates: A Randomized Equivalence Study

Parienti JJ, Thibon P, Heller R, Le Roux Y, von Theobald P, Bensadoun H, Bouvet A, Lemarchand F, Le Coutour X; for Members of the Antisepsie Chirurgicale des Mains Study Group

A randomized equivalence study comprising 4,387 patients undergoing clean and clean-contaminated surgery comparing the effectiveness of hand-cleansing protocols in preventing surgical site infections found that hand-rubbing with aqueous alcoholic solution, preceded by a one-minute nonantiseptic hand wash, was as effective as traditional hand-scrubbing with antiseptic soap in preventing surgical site infections and can thus be a safe alternative to traditional surgical hand-scrubbing.

Effect of Surgical Hand Scrub Time on Subsequent Bacterial Growth

Wheelock SM, Lookinland S

An experimental study including 25 perioperative staff members at a tertiary care children's hospital evaluating the effect of surgical hand scrub time on bacterial growth suggests that a two-minute surgical hand scrub is clinically as effective as a three-minute surgical hand scrub.

An Outbreak of Handscrubbing-Related Surgical Site Infections in Vascular Surgical Procedures

Grinbaum RS, de Mendonça JS, Cardo DM

A case-control study to investigate an outbreak of surgical site infections in a vascular surgery unit during a period when the operating room was not provided with povidone-iodine found a strong suggestion that scrubbing with plain soap was associated with surgical site infection but could not demonstrate the findings definitively.