Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-25T18:40:06.295Z Has data issue: false hasContentIssue false
  • English
  • Français

Surgical Scrub and Skin Disinfection

Published online by Cambridge University Press:  02 January 2015

Graham A.J. Ayliffe
Graham A.J. Ayliffe*
Affiliation:
Department of Medical Microbiology, Birmingham University; and Hospital Infection Research Laboratory, Dudley Road Hospital, Birmingham, United Kingdom
*
Hospital Infection Research Laboratory, Dudley Road Hospital, Birmingham B18 7QH, United Kingdom
Get access Rights & Permissions [Opens in a new window]

Abstract

The role of pre-operative disinfection of the surgeon's hands and the skin of the operative site in the prevention of wound infection remains uncertain. The normal resident skin flora, consisting mainly of coagulase-negative staphylococci and aerobic and anaerobic diphtheroids, is an uncommon cause of infection except in prosthetic operations. Staphylococcus aureus is rarely a resident on normal skin other than the perineum, and is mostly present on the hands as a transient acquired from the nose. Nevertheless, it seems rational to kill or remove all transients on the hands of the surgeon and reduce residents to low levels.

Surgical skin disinfection is usually assessed by measuring the reduction in organisms on the hands immediately after disinfection, after repeated applications of the disinfectant and after wearing gloves for two to three hours. The hands are commonly sampled in a bowl or plastic bag containing Ringer's or a similar solution and relevant neutralizers, or by the use of glove washings. A standardized technique is necessary to provide a statistical comparison between agents. Antiseptic detergents, chlorhexidine or povidone iodine show immediate reductions in bacterial counts of 70% to 80%, increasing to 99% after repeated application. Hexachloraphene and triclosan detergents show a lower immediate reduction but a good residual effect. Seventy percent ethyl or 60% propyl alcohol, with or without an antiseptic, show an immediate reduction of over 95%, and in excess of 99% on repeated application. Residual levels of organisms tend to be lower after repeated alcohol treatment than following the use of antiseptic detergents. A two to three-minute application of the antiseptic to the hands, without a scrubbing brush, is commonly recommended in the UK, but possibly in routine surgery an application time of 30 seconds is sufficient, killing or removing transients and superficial residents.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 5 , Issue 1 , January 1984 , pp. 23 - 27
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1984

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Price, PB: The bacteriology of normal skin: A new quantitative test applied to a study of the bacterial flora and the disinfectant action of mechanical cleaning. J Infect Dis 1938;63:301–318.CrossRefGoogle Scholar
2. Eiermann, HJ: Antimicrobial regulatory aspects, in Maibach, HI, Aly, R (eds): Skin Microbiology: Relevance to Clinical Infection. New York, Springer-Verlag, 1981, pp 135–148.Google Scholar
3. Lowbury, EJL: Skin preparation for operation. Journal of Hospital Medicine 1973;10:627–634.Google Scholar
4. Gaschen, M: Etude comparative de deux methodes destinées au prevalement dela flora microbienne des mains. Helv Chir Acta 1968;35:372–377.Google Scholar
5. Deutsche Gesellschaft Fur Hygiene und Mikrobiologie. Richtlinien Furdie Prüf ung und Bewertung chemischen Disinfecktions-verfahren. Erster Teilabschnitt. Stuttgart, Gustav Fischer Verlag, 1981.Google Scholar
6. Rotter, M, Koller, W, Wewalka, G: Povidone-iodine and chlorhexidine gluconate-containing detergents for disinfections of hands. Journal of Hospital Infection 1980;2:149–158.Google Scholar
7. Peterson, AF, Rosenberg, A, Alatary, SD: Comparative evaluation of surgical scrub preparations. Surg Gynecol Obstet 1978;146:63–65.Google Scholar
8. Bruch, M: Newer germicides: What they offer, in Maibach, HI, Aly, R (eds): Skin Microbiology: Relevance to Clinical Infection. New York, Springer-Verlag, 1981, pp 103–112.CrossRefGoogle Scholar
9. Smyllie, HG, Logie, JRC, Smith, G: From Phisohex to Hibiscrub. Br Med J 1973;4:586–589.Google Scholar
10. Selwyn, S, Ellis, H: Skin bacteria and skin disinfection reconsidered. Br Med J 1972;1:136–140.Google Scholar
11. Lowbury, EJL: Special problems in hospital antisepsis, in Russell, AD, Hugo, WB, Ayliffe, GAJ (eds): Disinfection, Preservation and Sterilisation. Oxford, Blackwell, 1982, pp 262–284.Google Scholar
12. Hall, R: Degerming the hands of surgeons and nurses. Presented at the Interntaional Congress and Symposium on Problems in the Control of Hospital Infection, London, 1980, Royal Society of Medicine series 23, pp 29–38.Google Scholar
13. Lilly, HA, Lowbury, EJL: Disinfection of skin: An assessment of new preparations. Br Med J 1971;3:674–676.CrossRefGoogle ScholarPubMed
14. Lowbury, EJL, Lilly, HA: The use of 4% chlorhexidine detergent solution (Hibiscrub) and other methods of skin disinfection. Br Med J 1973;1:510–515.CrossRefGoogle ScholarPubMed
15. Lowbury, EJL, Lilly, HA, Ayliffe, GAJ: Preoperative disinfection of surgeons' hands: Use of alcoholic solutions and effects of gloves on skin flora. Br Med J, 1974;4:369–374.Google Scholar
16. Lilly, HA, Lowbury, EJL, Wilkins, MD, et al: Delayed antimicrobial effects of skin disinfection by alcohol. J Hyg Camb 1979;82:497–500.Google Scholar
17. Michaud, RN, McGrath, ME, Goss, WA: Applications of a gloved hand model for multiparameter measurements of skin germicide activity. J Clin Microbiol 1976;3:406–413.Google Scholar
18. Reber, H, Muntener, M, Neck, K, et al: Zur Prufriiethodik der chirurgeschen Hande disinfecktion. Z Bait Hyg Abt Orig 1975;160:601–627.Google Scholar
19. Davies, J, Babb, JR, Ayliffe, GAJ, et al: Disinfection of the skin of the abdomen. Br J Surg 1978;65:855–858.Google Scholar
20. Lowbury, EJL, Lilly, HA: Gloved hand as applicator of antiseptic to operation site. Lancet 1975;2:153–156.Google Scholar
21. Davies, J, Babb, JR, Ayliffe, GAJ, et al: The effect on the skin flora of bathing with antiseptic solutions. Antimicrob Chemother 1977;3:473–481.CrossRefGoogle ScholarPubMed
22. Brandberg, A, Andersson, I: Whole-body disinfection by shower bath with chlorhexidine soap. Presented at the International Congress and Symposium on Problems in the Control of Hospital Infection, London, 1980, Royal Society of Medicine series 23, pp 65–70.Google Scholar
23. Cruse, PJE, Foord, R: A five-year prospective study of 23,649 surgical patients. Arch Surg 1973;107:206–209.Google Scholar
24. Bruun, JN: Postoperative wound infection. Acta Med Scand 1970;188 (suppl 514):1–89.Google Scholar
25. Brandberg, A, Holm, J, Hammarsten, J, Schersten, T: Postoperative wound infections in vascular surgery—Effect of preoperative whole body disinfection by shower-bath with chlorhexidine soap. Presented at the International Congress and Symposium on Problems in the Control of Hospital Infection, London, 1980, Royal Society of Medicine series 23, pp 71–75.Google Scholar
26. Ayliffe, GAJ, Noy, MF, Babb, JR, et al: A comparison of preoperative bathing with chlorhexidine detergent and non-medicated soap in the prevention of wound infection. Journal of Hospital Infection 1983;4:237–244.Google Scholar
27. Seeberg, S, Bregman, BR: Preoperative total washing with chlorhexidine gluconate performed by patients undergoing orthopaedic surgery. Presented at the International Congress and Symposium on Problems in the Control of Hospital Infection, London, 1980, Royal Society of Medicine series 23, pp 77–80.Google Scholar
28. Taylor, LJ, Martin, H: Preoperative skin preparation of orthopaedic patients. Annual Conference of Infection Control Nurses 1977, pp 29–32.Google Scholar
29. Davidson, AIG, Clarke, C, Smith, G: Postoperative wound infection: A computer analysis. Br J Surg 1971;58:333–337.Google Scholar
30. Berry, AR, Watt, B, Goldacre, MJ, et al: A comparison of use of povidone-iodine and chlorhexidine in the prophylaxis of post-operative wound infection. Journal of Hospital Infection 1982;3:55–63.Google Scholar
31. Meers, PD, Ayliffe, GAJ, Emmerson, AM, et al: Report on the National Survey of Infection in Hospitals 1980. Journal of Hospital Infection 1981; 2(suppl).Google Scholar
32. Lidwell, OM, Lowbury, EJL, Whyte, W, et al: The effects of ultra-clean air in operating rooms on deep sepsis after total hip or knee replacement. Br Med J 1982;285:10–14.Google Scholar
33. Ayliffe, GAJ, Babb, JR, Bridges, K, et al: Comparison of two methods for assessing the removal of total organisms and pathogens from the skin. J Hyg Camb 1975;75:259–274.Google Scholar
34. Taylor, LJ: An evaluation of hand-washing techniques. Nursing Times 1978;74:54–110.Google Scholar
35. Goonatilake, PCL, Ayliffe, GAJ, Etheridge, RA: Factors associated with the risk of postoperative wound infection and nasal carriage of Staph, aureus . Proceedings of the 14th Hawaii International Conference of System Sciences 1981;11:681–707.Google Scholar