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Am Fam Physician. 2002;66(12):2297-2298

Studies have shown that even with standard hand-scrubbing procedures, surgical-site infections with bacteria from operating room personnel occur all too often. These infections result in higher costs and morbidity. Parienti and colleagues compared two preoperative-antisepsis protocols to determine their effects on surgical-site infection rates.

The study lasted for 16 months and included surgical services in six hospitals in France (three teaching, three nonteaching). Surgical teams were randomized to two antisepsis protocols. The traditional hand-scrub consisted of a five-minute scrub with 4 percent povidone iodine or 4 percent chlorhexidine gluconate. The hand-rub protocol consisted of a one-minute wash with nonantiseptic soap followed by a five-minute rub with at least 5 mL of a 75 percent aqueous alcohol solution. Surgical-site infections were diagnosed by a surgeon, an infectious-disease specialist, or a hygiene specialist. Surgeries that were considered contaminated or dirty and those that took place in patients who had an operation within the previous 15 days were excluded. Participants were asked about the dermatologic effects of the protocols with regard to dryness, desquamation, and irritation.

There were 4,387 surgeries included in the analysis. The surgical-site infection rate 30 days after surgery was 2.46 percent, with 99 in-hospital infections and nine infections after discharge. In the hand-scrubbing group, the infection rate was 2.48 percent, and in the hand-rubbing group, it was 2.44 percent. There were no significant differences between the groups in terms of the infections.

Participants in the aqueous-alcohol group rubbed their hands significantly longer before the first procedure of the day compared with those in the hand-scrubbing group. There was better overall compliance with the recommended duration of cleaning in the hand-rubbing group (although compliance was poor in both groups). Skin dryness and hand irritation were less prevalent in the hand-rubbing group than in the hand-scrubbing group.

The authors conclude that traditional hand antisepsis with povidone iodine or chlorhexidine gluconate is essentially equivalent to antisepsis with a 75 percent aqueous alcohol solution, in terms of reducing surgical-site infections. The aqueous alcohol solution is more cost-effective. Because all persons on the surgical team might not accept or tolerate the aqueous alcohol solution, the authors do not recommend completely replacing traditional surgical hand scrubbing with aqueous alcohol hand rubbing. The two protocols can be considered alternatives to each other.

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