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Dear Colleagues,
A few remarks. I have seen it stated occasionally that the first surgical hand preparation of the day should be done water and (antiseptic) detergent-based, and alcohol-based preparation only for subsequent procedures (but not for the first). This is INCORRECT. You may refer to the WHO 2009 hand hygiene guideline, pages 54-60, where surgical hand preparation is described. Detergent and water-based wash is necessary (followed by towel drying before applying the alcohol) when the hands are visibly dirty, but the first hand preparation of the day can still be done with alcohol.
Alcohol-based preparation has a few advantages over detergent and water-based:
(1) It achieves much greater microbial reduction factors on arms/hands than detergent-based scrubbing, thus providing an advantage in terms of residual germs on hands/arms.
(2) It requires much shorter application times than detergent-based scrubbing, saving time for the surgeons and the surgical teams.
(3) If adequate preparations with good emollients are used, it leads to substantially less damage/irritation on hands/skin.
(4) It is ecologically more friendly, because it saves a lot of running water.
A large French clinical trial of alcohol-based versus antiseptic detergent-based surgical hand preparation has shown equivalence in terms of surgical site infection (SSI) rates:
Parienti JJ, Thibon P, Heller R, Le Roux Y, von Theobald P, Bensadoun H, 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: 722-7. doi:10.1001/jama.288.6.722
http://www.ncbi.nlm.nih.gov/pubmed/12169076
On one past occasion, I have taken the liberty to publish a small letter to the editor that emphasizes the need for proper technique:
Maiwald M. Technique is important for alcohol-based surgical hand antisepsis. Healthcare Infection 17(3) 106-107.
http://www.publish.csiro.au/paper/HI12028.htm
In my personal opinion, human learning is better when following an example or when something is personally shown/taught than when something has to be learnt from reading manuals or policy and procedure documents (there are so many around already). So, I think it would be a good choice for an organization to have a senior person (e.g. scrub nurse or surgeon) who is familiar with the technique and is able to show this, by personal example, to every newcomer to the facility (or to established staff when the technique is newly introduced) as part of operating theatre introduction/orientation.
And to confirm what Michael has stated, in some settings alcohol-based surgical hand preparation has been done for a long time. When I did my surgical internship in 1986 (this shows my age), it was already the established standard of care.
Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387
Hi Fran
Not sure if you are referring to use of alcohol hand gels/rubs in procedural areas for social handwashing, or use of waterless alcohol as a scrub agent.
We have been doing both here for a number of years. There are some surgical disciplines where the use of waterless alcohol based scrub agents has been embraced with a gusto. And some surgical disciplines where waterless alcohol based scrub agents are still frowned upon.
I would say 70% of all of our surgical scrubbing is now down with waterless alcohol based products. It has generally been well received. My only reservations are bout the professional societies not having good guidance on their use. ACORN has recently released some better guidance, but none of the surgical colleges have any specific guidance about how to use waterless agents, when you need to wash with soap and water, or anything. This to me makes to hard to enforce good practice across all disciplines. But then again, I have recently discovered that RACS doesn’t even have a procedure on how to do a water based surgical scrub!
Europeans have been using waterless based alcohol scrubbing for some time, and there has been no reported changes in SSI rates there.
So, I would give surgeons and theatre nurses the option of using these products, setting some simple ground rules for their use (like soap and water wash before the first waterless scrub of each list).
Good luck.
Cheers
Michael
Michael Wishart
Infection Control Coordinator
A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
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P Please consider the environment before printing this email
Dear all,
How many of you out there are currently using an alcohol-based surgical hand rub in the Perioperative Suites? Some Visiting Medical Officers states that they’ve never heard of it and others can’t go without it.
Kind Regards
Franciska Ferreira
Infection Prevention & Control/Wound Management Consultant
Burnside War Memorial Hospital
120 Kensington Road, Toorak Gardens, SA 5056
t: 08 8202 7222 f: 08 8407 8573 e: fferreira@burnsidehospital.asn.au
[user] [bHand Hygiene day 16]
“Share the fun not the germs, clean your hands”
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