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Antiseptic Effect of Conventional Povidone–Iodine Scrub, Chlorhexidine Scrub, and Waterless Hand Rub in a Surgical Room: A Randomized Controlled Trial

Published online by Cambridge University Press:  20 December 2016

Jui-Chen Tsai ,
Yen-Kuang Lin ,
Yen-Jung Huang ,
El-Wui Loh ,
Hsiao-Yun Wen ,
Chia-Hui Wang ,
Yin-Tai Tsai ,
Wen-Shyang Hsieh  and
Ka-Wai Tam
Jui-Chen Tsai
Affiliation:
Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
Yen-Kuang Lin
Affiliation:
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan Biostatistics Center, Taipei Medical University, Taipei, Taiwan
Yen-Jung Huang
Affiliation:
Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
El-Wui Loh
Affiliation:
Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
Hsiao-Yun Wen
Affiliation:
Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
Chia-Hui Wang
Affiliation:
Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
Yin-Tai Tsai
Affiliation:
Department of Laboratory Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
Wen-Shyang Hsieh
Affiliation:
Department of Laboratory Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan Department of Education, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan School of Medical Laboratory Science and Biotechnology, Taipei Medical University, Taipei, Taiwan
Ka-Wai Tam*
Affiliation:
Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan Department of Surgery, School of Medicine, College of Medicine, Taipei Medical, University, Taiwan Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
*
Address correspondence to Ka-Wai Tam, MD, PhD, Center for Evidence-Based Health Care, Taipei Medical University—Shuang Ho Hospital, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan ([email protected]).
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Abstract

OBJECTIVE

Effective perioperative hand antisepsis is crucial for the safety of patients and medical staff in surgical rooms. The antimicrobial effectiveness of different antiseptic methods, including conventional hand scrubs and waterless hand rubs, has not been well evaluated.

DESIGN, SETTING, AND PARTICIPANTS

A randomized controlled trial was conducted to investigate the effectiveness of the 3 antiseptic methods among surgical staff of Taipei Medical University—Shuang Ho Hospital. For each method used, a group of 80 participants was enrolled.

INTERVENTION

Surgical hand cleansing with conventional 10% povidone–iodine scrub, conventional 4% chlorhexidine scrub, or waterless hand rub (1% chlorhexidine gluconate and 61% ethyl alcohol).

RESULTS

Colony-forming unit (CFU) counts were collected using the hand imprinting method before and after disinfection and after surgery. After surgical hand disinfection, the mean CFU counts of the conventional chlorhexidine (0.5±0.2, P<0.01) and waterless hand rub groups (1.4±0.7, P<0.05) were significantly lower than that of the conventional povidone group (4.3±1.3). No significant difference was observed in the mean CFU count among the groups after surgery. Similar results were obtained when preexisting differences before disinfection were considered in the analysis of covariance. Furthermore, multivariate regression indicated that the antiseptic method (P=.0036), but not other variables, predicted the mean CFU count.

CONCLUSIONS

Conventional chlorhexidine scrub and waterless hand rub were superior to a conventional povidone–iodine product in bacterial inhibition. We recommend using conventional chlorhexidine scrub as a standard method for perioperative hand antisepsis. Waterless hand rub may be used if the higher cost is affordable.

Infect Control Hosp Epidemiol 2017;38:417–422

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 4 , April 2017 , pp. 417 - 422
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

TRIAL REGISTRATION. clinicaltrials.gov Identifier: NCT02294604

References

REFERENCES

1. Rotter, ML. Hand washing and hand disinfection. In: Mayhall CG, editor. Hospital epidemiology and infection control. 2nd ed. Philadelphia PA: Lippincott Williams &Wilkins; 1999:1339e55.Google Scholar
2. World Health Organization. WHO guidelines on hand hygiene in health care. First global patient safety challenged clean care is safer care. Geneva: WHO Press; 2009.Google Scholar
3. Rotter, ML. Hand washing, hand disinfection, and skin disinfection. In: Wenzel RP, editor. Prevention and control of nosocomial infections. 3rd ed. Baltimore MD: Williams & Wilkins; 1997:691–709.Google Scholar
4. Marchand, R, Theorate, S, Dion, D, Pellerin, M. Clinical implementation of a scrubless chlorhexidine/ethanol pre-operative surgical hand rub. Can Oper Room Nurs J 2008;26:21–31.Google Scholar
5. Parienti, JJ, Thibon, P, Heller, R, et al. Hand-rubbing with an aqueous alcoholic solution vs traditional surgical hand-scrubbing and 30-day surgical site infection rates: a randomized equivalence study. JAMA 2002;288:722–727.Google Scholar
6. Hobson, DW, Woller, W, Anderson, L, Guthery, E. Development and evaluation of a new alcohol-based surgical hand scrub formulation with persistent antimicrobial characteristics and brushless application. Am J Infect Control 1998;26:507–512.Google Scholar
7. Hajipour, L, Longstaff, L, Cleeve, V, Brewster, N, Bint, D, Henman, P. Hand washing rituals in trauma theatre: clean or dirty? Ann R Coll Surg Engl 2006;88:13–15.CrossRefGoogle ScholarPubMed
8. Herruzo-Cabrera, R, Vizcaino-Alcaide, MJ, Fdez-Aciñero, MJ. Usefulness of an alcohol solution of N-duopropenide for the surgical antisepsis of the hands compared with handwashing with iodine-povidone and chlorhexidine: clinical essay. J Surg Res 2000;94:6–12.Google Scholar
9. Pietsch, H. Hand antiseptics: rubs versus scrubs, alcoholic solutions versus alcoholic gels. J Hosp Infect 2001;48:S33–S36.Google Scholar
10. Chen, CF, Han, CL, Kan, CP, Chen, SG, Hung, PW. Effect of surgical site infections with waterless and traditional hand scrubbing protocols on bacterial growth. Am J Infect Control 2012;40:e15–e17.Google Scholar
11. Gupta, C, Czubatyj, AM, Briski, LE, Malani, AK. Comparison of two alcohol-based surgical scrub solutions with an iodine-based scrub brush for presurgical antiseptic effectiveness in a community hospital. J Hosp Infect 2007;65:65–71.CrossRefGoogle Scholar
12. Pereira, LJ, Lee, GM, Wade, KJ. An evaluation of five protocols for surgical handwashing in relation to skin condition and microbial counts. J Hosp Infect 1997;36:49–65.Google Scholar
13. Hsieh, HF, Chiu, HH, Lee, FP. Surgical hand scrubs in relation to microbial counts: systematic literature review. J Adv Nurs 2006;55:68–78.Google Scholar
14. Bauer, AW, Kirby, WM, Sherris, JC, Turck, M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol 1966;45:493–496.Google Scholar
15. Barry, AL, Garcia, F, Thrupp, LD. An improved single-disk method for testing the antibiotic susceptibility of rapidly growing pathogens. Am J Clin Pathol 1970;53:149–158.Google Scholar
16. Clinical and Laboratory Standards Institute. Approved standard: M2-A9. Performance standards for antimicrobial disk susceptibility tests. 9th ed. Wayne PA: Clinical and Laboratory Standards Institute; 2006.Google Scholar
17. Faul, F, Erdfelder, E, Buchner, A, Lang, AG. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Meth 2009;41:1149–1160.Google Scholar
18. Lai, KW, Foo, TL, Low, W, Naidu, G. Surgical hand antisepsis—a pilot study comparing povidone iodine hand scrub and alcohol-based chlorhexidine gluconate hand rub. Ann Acad Med Singapore 2012;41:12–16.Google Scholar
19. Shen, NJ, Pan, SC, Sheng, WH, et al. Comparative antimicrobial efficacy of alcohol-based hand rub and conventional surgical scrub in a medical center. J Microbiol Immunol Infect 2015;48:322–328.Google Scholar
20. Darouiche, RO, Wall, MJ Jr, Itani, KM, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010;362:18–26.Google Scholar
21. Tuuli, MG, Liu, J, Stout, MJ, et al. A randomized trial comparing skin antiseptic agents at cesarean delivery. N Engl J Med 2016;374:647–655.Google Scholar
22. World Health Organization. WHO guidelines on hand hygiene in health care. First global patient safety challenged clean care is safer care. Chapter 15: Factors to consider when selecting hand hygiene products. Geneva: WHO Press; 2009.Google Scholar
23. Widmer, AF. Surgical hand hygiene: scrub or rub? J Hosp Infect 2013;83:S35–S39.Google Scholar
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