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Dear Prue, dear Colleagues,
Just wanted to add one aspect to the discussion on alcohol-based surgical hand antisepsis: this is the importance of technique.
I realise there are differences between countries/settings where this is newly introduced versus those where this has been standard practice in operating theatres for many decades.
An example where this has been newly introduced and apparently failed due to non-adherence to proper technique is here:
http://www.ncbi.nlm.nih.gov/pubmed/20103542
In settings where this has been practiced for a long time such procedures become highly ritualised and are being watched by a number of (sometimes fierce) operating theatre nurses and surgeons, to make sure that every new person adheres to this.
A fundamental difference between simple ward-based hand antisepsis (such as for the 5 Moments) and surgical hand antisepsis is that for the former, a single volume of hand rub of about 3 mL is applied. For surgical hand antisepsis, the WHO 2009 Guideline recommends repeated application of about 15 mL to hands and forearms, but also states that one study demonstrated that keeping the hands and forearms literally wet with alcohol for the entire duration of the procedure is more important than the actual volume applied.
The latter would require re-thinking for those who are only used to the 5-Moments-type hand rub with about 3 mL, and is one reason why I do not recommend gels (but instead liquids) for surgical hand antisepsis — gels would just build up too much sludge when applied as required for surgical hand antisepsis.
As already mentioned, another article is here:
http://www.ncbi.nlm.nih.gov/pubmed/19716627
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
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Prue Wright
Sent: Friday, 15 June, 2012 5:28 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Surgical hand scrub
Hi All,
We have introduced Skinman which is an alcoholic based surgical scrub. It is very popular with the surgeons and scrub staff. Many of us have problems with dermatitis from traditional water based scrubbing, these have been resolved with the Skinman.
Prue Wright
Infection Control Coordinator
Hurstville Private Hospital
37 Gloucester Rd, Hurstville, NSW 2220, Australia
T +61 2 9579 7780 F +61 2 9579 7466
E Infection.Control@hurstvilleprivate.com.au W healthecare.com.au
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Tracy Sloane
Sent: Wednesday, 13 June 2012 9:19 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Surgical hand scrub
Hi All,
If you check out the latest edition of Healthcare Infections you will find an article about a study I did prior to TGA approval of a surgical hand rub (SHR) looking at HCW current scrub practices and their knowledge and attitudes about SHR. You might find the reference list helpful.
Cheers,
Tracy
Tracy Sloane
Senior Infection Control Consultant
Dandenong Hospital, Southern Health
T (03) 95548173 F (03) 95541905
E tracy.sloane@southernhealth.org.au
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Helen Scott
Sent: Tuesday, 12 June 2012 2:36 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Surgical hand scrub
Hi Jane,
The CDC have got a good article on this. It’s their MMWR and in October 2002, Vol 51, page 17 it discusses exactly this. I’m sure there’s a more up to date report somewhere. You could also try Skinman Soft, made by Orion.
Cheers,
Helen.
Helen Scott
Infection Control Co-ordinator
Nepean Private Hospital
Penrith, NSW.
0247 327333
Helen.Scott@healthscope.com.au
Please consider the environment before printing this message
>>> On 11/06/2012 at 5:50 am, in message <5CF778CD399D414080027BBC8F4991D83567DA@mschcexp07.cdhb.local>, Jane Barnett <Jane.Barnett@CDHB.HEALTH.NZ> wrote:
Hi
Weve got some staff who can only use the PCMX scrub product as they are sensitive to both chlorhex and betadine but BD have advised that they are withdrawing this product. Can I ask what other centres are doing for staff with allergies would plain soap and water washed followed by plain alcohol (without antiseptic additive) be sufficient for surgical procedures? Thoughts/ideas welcome.
Thanks
Jane Barnett
Clinical Nurse Specialist
Infection Prevention & Control
Christchurch Women’s Hospital
Private Bag 4711, Christchurch
Tel: 03 364 4510 (int 85510)
Fax: 03 364 4607
Infection Prevention and Control is Everyone’s Business
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