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Hi
Is anyone using these alcohol-based hand rub products after the first surgical scrub?
Do you have specific criteria for specialities that do use it?
Is it better to install the touch free design or autoclavable dispenser?
Any significant outcomes for patients?
What is your staff satisfaction rate?
Has it improved the efficiency in the operating theatre?
Thank you
Joe-Anne Bendall
Joe-Anne Bendall
Clinical Nurse Consultant Infection Prevention and Control
(Including vaccination and screening)
Monday – Friday 0800 – 1630
Sydney Hospital and Sydney Eye Hospital
8 Macquarie St
SYDNEY NSW 2000
|* ph +61 2 9382 7199 |?page 22070 via switch 9382 7111| 7 Fax 93827510 |
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Joe-Anne,
We have been using a brand in our Dental DSU and Oral Surgery for nearly 2 years.
We have touch free dispenser.No adverse outcomes for patients
All staff love it, less damaging for their hands.
Wendy
Wendy Bacalja
Principal Nursing Officer
Infection Control Advisor – AgenciesDental Health Services Victoria
oral health for better health
The Royal Dental Hospital of Melbourne
720 Swanston Street | Carlton | VIC 3053
T: 03 9341 1151 | M: 0401979497 | F: 03 9341 1234Hi
Is anyone using these alcohol-based hand rub products after the first surgical scrub?
Do you have specific criteria for specialities that do use it?
Is it better to install the touch free design or autoclavable dispenser?
Any significant outcomes for patients?
What is your staff satisfaction rate?
Has it improved the efficiency in the operating theatre?
Thank you
Joe-Anne Bendall
Joe-Anne Bendall
Clinical Nurse Consultant Infection Prevention and Control
(Including vaccination and screening)
Monday – Friday 0800 – 1630
Sydney Hospital and Sydney Eye Hospital
8 Macquarie St
SYDNEY NSW 2000
|* ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |
Mobile 0418984255 | * Joe-Anne.Bendall@HEALTH.NSW.GOV.AUThis message is intended for the addressee named and may contain confidential information. If you are not the intended recipient, please delete it and notify the sender.
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Dear Jo-Anne,
I am not sure how widespread alcohol-based surgical hand preparation is now in Australia (I am now based in Singapore), but it is certainly now state of the art according to all major hand hygiene guidelines, and it has been the standard of care (and has supplanted detergent-based surgical hand preparation) since the 1980s in continental Europe.
The WHO 2009 Hand Hygiene Guideline (I assume you have that) has a section on it from page 54 to page 60, and that should have all the information you require.
A published version (in a journal) of essentially that same section has appeared here:
Widmer AF, Rotter M, Voss A, Nthumba P, Allegranzi B, Boyce J, Pittet D. Surgical hand preparation: state-of-the-art. J Hosp Infect. 2010 Feb;74(2):112-22. doi: 10.1016/j.jhin.2009.06.020. Epub 2009 Aug 28.
http://www.ncbi.nlm.nih.gov/pubmed/19716627Essentially, alcohol-based surgical hand preparation has three major advantages over antiseptic detergent-based:
(1) It achieves much greater microbial reduction factors on arms/hands than detergent-based scrubbing.
(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 is gentler on hands/skin.
There are some highly active preparations around. While the standard time to fulfill the stringent European standard EN 12791 is 3 min, some of the better preparations fulfill EN 12791 in as short as 60 seconds (which is a phenomenally short time), but even with those preparations it is usually recommended to go slightly beyond that time (e.g. 2 min) for added safety. For most products, 3 min is appropriate.
It can be used for any type of surgery.
I have heard the notion before that alcohol-based hand/arm preparation cannot be used for the first scrub of the day (which is what you seem to indicate). But this is incorrect. It definitely can be used for the first and for subsequent scrubs, see WHO.
I have also published a small letter to the editor, highlighting the need for proper technique and providing some additional info, here:
Maiwald M. Technique is important for alcohol-based surgical hand antisepsis. Healthcare Infection 17(3) 106-107.
http://www.publish.csiro.au/paper/HI12028.htmBest 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 1387Hi
Is anyone using these alcohol-based hand rub products after the first surgical scrub?
Do you have specific criteria for specialities that do use it?
Is it better to install the touch free design or autoclavable dispenser?
Any significant outcomes for patients?
What is your staff satisfaction rate?
Has it improved the efficiency in the operating theatre?
Thank you
Joe-Anne Bendall
Joe-Anne Bendall
Clinical Nurse Consultant Infection Prevention and Control
(Including vaccination and screening)
Monday – Friday 0800 – 1630
Sydney Hospital and Sydney Eye Hospital
8 Macquarie St
SYDNEY NSW 2000
|* ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |
Mobile 0418984255 | * Joe-Anne.Bendall@HEALTH.NSW.GOV.AUThis message is intended for the addressee named and may contain confidential information. If you are not the intended recipient, please delete it and notify the sender.
Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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Dear Jo-Anne,
Forgot to add three more aspects, partially in response to your questions:
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/12169076The conclusion was: “Hand-rubbing with aqueous alcoholic solution, preceded by a 1-minute nonantiseptic hand wash before each surgeon’s first procedure of the day and before any other procedure if the hands were soiled, was as effective as traditional hand-scrubbing with antiseptic soap in preventing surgical site infections. The hand-rubbing protocol was better tolerated by the surgical teams and improved compliance with hygiene guidelines.”
In terms of dispensers, I would discourage hand-driven dispensers as commonly used at the bedside for the 5 Moments (due to the possibility of hand recontamination). In Europe, elbow-driven dispensers are in common use, as depicted here (not specific product endorsement intended, result from googling):
https://www.asport.nl/eurodispenser-1-plus-met-elleboog-bediening.html
With elbow-driven dispensers, autoclaving is not necessary, provided surgeons follow good technique (i.e. each rubbing act starts at the hands and ends at the elbows). Touch-free dispensers would be an option, but are not necessary with elbow-driven dispensers (simpler mechanics), and the concern with touch-free dispensers would be appropriate volumes dispensed (much larger volumes are required for surgical hand antisepsis than for ward-based hand hygiene as in the 5 Moments); see my little letter to the editor that I sent earlier.
Lastly, alcohol-based surgical hand preparation saves a lot of water (estimated 20 L required per surgical scrub) and is cheaper in cost.
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 1387Dear Jo-Anne,
I am not sure how widespread alcohol-based surgical hand preparation is now in Australia (I am now based in Singapore), but it is certainly now state of the art according to all major hand hygiene guidelines, and it has been the standard of care (and has supplanted detergent-based surgical hand preparation) since the 1980s in continental Europe.
The WHO 2009 Hand Hygiene Guideline (I assume you have that) has a section on it from page 54 to page 60, and that should have all the information you require.
A published version (in a journal) of essentially that same section has appeared here:
Widmer AF, Rotter M, Voss A, Nthumba P, Allegranzi B, Boyce J, Pittet D. Surgical hand preparation: state-of-the-art. J Hosp Infect. 2010 Feb;74(2):112-22. doi: 10.1016/j.jhin.2009.06.020. Epub 2009 Aug 28.
http://www.ncbi.nlm.nih.gov/pubmed/19716627Essentially, alcohol-based surgical hand preparation has three major advantages over antiseptic detergent-based:
(1) It achieves much greater microbial reduction factors on arms/hands than detergent-based scrubbing.
(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 is gentler on hands/skin.
There are some highly active preparations around. While the standard time to fulfill the stringent European standard EN 12791 is 3 min, some of the better preparations fulfill EN 12791 in as short as 60 seconds (which is a phenomenally short time), but even with those preparations it is usually recommended to go slightly beyond that time (e.g. 2 min) for added safety. For most products, 3 min is appropriate.
It can be used for any type of surgery.
I have heard the notion before that alcohol-based hand/arm preparation cannot be used for the first scrub of the day (which is what you seem to indicate). But this is incorrect. It definitely can be used for the first and for subsequent scrubs, see WHO.
I have also published a small letter to the editor, highlighting the need for proper technique and providing some additional info, here:
Maiwald M. Technique is important for alcohol-based surgical hand antisepsis. Healthcare Infection 17(3) 106-107.
http://www.publish.csiro.au/paper/HI12028.htmBest 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 1387Hi
Is anyone using these alcohol-based hand rub products after the first surgical scrub?
Do you have specific criteria for specialities that do use it?
Is it better to install the touch free design or autoclavable dispenser?
Any significant outcomes for patients?
What is your staff satisfaction rate?
Has it improved the efficiency in the operating theatre?
Thank you
Joe-Anne Bendall
Joe-Anne Bendall
Clinical Nurse Consultant Infection Prevention and Control
(Including vaccination and screening)
Monday – Friday 0800 – 1630
Sydney Hospital and Sydney Eye Hospital
8 Macquarie St
SYDNEY NSW 2000
|* ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |
Mobile 0418984255 | * Joe-Anne.Bendall@HEALTH.NSW.GOV.AUThis message is intended for the addressee named and may contain confidential information. If you are not the intended recipient, please delete it and notify the sender.
Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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Hi Joe,
If you are to use a waterless surgical scrub please ensure you are using a product that has a minimum 3- hours residual kill which should be equivalent to a 4% CHG soap for scrubbing. This innovation has been used widely throughout the US and Europe past 4-5 years and in quite a few hospitals in Australia currently use it. Studies showed that’s it’s less drying on skin when compared to water and soap and quicker than the classic scrubbing methods hence making it an efficient product. I also advise you to ensure you pick one which contains moisturisers to ensure the skin is kept intact.As for dispensers, automatic touch free dispensers are highly recommended to avoid any cross contamination and enable to user to scrub easily.
I also advise you to check out the ACORN standard in regards to the use of waterless surgical scrubs.
I hope this helps.
Happy to chat further about this if you like.
Thanks
Kind Regards
Christine Claighen BSc (Biotech), BSc (Micro)
Regulatory & Scientific Manager- AustralasiaOn 27 May 2016, at 4:06 PM, Joe-Anne Bendall <Joe-Anne.Bendall@HEALTH.NSW.GOV.AU> wrote:
Hi
Is anyone using these alcohol-based hand rub products after the first surgical scrub?
Do you have specific criteria for specialities that do use it?
Is it better to install the touch free design or autoclavable dispenser?
Any significant outcomes for patients?
What is your staff satisfaction rate?
Has it improved the efficiency in the operating theatre?
Thank you
Joe-Anne Bendall
Joe-Anne Bendall
Clinical Nurse Consultant Infection Prevention and Control
(Including vaccination and screening)
Monday Friday 0800 – 1630
Sydney Hospital and Sydney Eye Hospital
8 Macquarie St
SYDNEY NSW 2000
| ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |
Mobile 0418984255 | Joe-Anne.Bendall@HEALTH.NSW.GOV.AUThis message is intended for the addressee named and may contain confidential information. If you are not the intended recipient, please delete it and notify the sender.
Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities. MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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Hi Joanne,
We have started using these products, ACORN recently updated the standards regarding the use of these types of products, which now only require a social hand wash with a non antimicrobial scrub product prior to use (for surgical asepsis), rather than a 5 minute scrub with an antimicrobial scrub (see ACORN update Feb 2016).
Tina Owens
Director of Nursing[cid:9E350D6D-535C-4698-891D-F55ACC3FBEB3@tci.local]
M 0419 026 091 T 07 5613 2000
t.owens@thecosmeticinstitute.com.au
98 Marine Parade, Southport, QLD 4215
[cid:28BB8E47-FA99-4957-98F0-001299011A63@tci.local] [cid:0695DACD-A5A1-4802-8717-C1B1DE0F7CFC@tci.local] [cid:AA704435-49C1-4C20-AC86-9DF777D87F69@tci.local] [cid:3131B61C-C776-4A69-85FF-8DD35192640A@tci.local] thecosmeticinstitute.com.au[cid:image001.gif@01D1B81B.5BE001D0]
HiIs anyone using these alcohol-based hand rub products after the first surgical scrub?
Do you have specific criteria for specialities that do use it?
Is it better to install the touch free design or autoclavable dispenser?
Any significant outcomes for patients?
What is your staff satisfaction rate?
Has it improved the efficiency in the operating theatre?
Thank you
Joe-Anne Bendall
Joe-Anne Bendall
Clinical Nurse Consultant Infection Prevention and Control
(Including vaccination and screening)
Monday – Friday 0800 – 1630
Sydney Hospital and Sydney Eye Hospital
8 Macquarie St
SYDNEY NSW 2000
|* ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |
Mobile 0418984255 | * Joe-Anne.Bendall@HEALTH.NSW.GOV.AUThis message is intended for the addressee named and may contain confidential information. If you are not the intended recipient, please delete it and notify the sender.
Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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Hi All,
Im familiar with some of these products but no all.
You may find some require a 3min scrub at beginning of the day.
Best to check and follow the manufacturers instructions.
Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
ABN 47533508426
Of Tina Owens
Hi Joanne,
We have started using these products, ACORN recently updated the standards
regarding the use of these types of products, which now only require a
social hand wash with a non antimicrobial scrub product prior to use (for
surgical asepsis), rather than a 5 minute scrub with an antimicrobial scrub
(see ACORN update Feb 2016).Tina Owens
Director of Nursingcid:9E350D6D-535C-4698-891D-F55ACC3FBEB3@tci.local
M 0419 026 091 T 07 5613 2000
t.owens@thecosmeticinstitute.com.au
98 Marine Parade, Southport, QLD 4215cid:28BB8E47-FA99-4957-98F0-001299011A63@tci.local
cid:0695DACD-A5A1-4802-8717-C1B1DE0F7CFC@tci.local
cid:AA704435-49C1-4C20-AC86-9DF777D87F69@tci.localcid:3131B61C-C776-4A69-85F
F-8DD35192640A@tci.local
thecosmeticinstitute.com.auOf Joe-Anne Bendall
Hi
Is anyone using these alcohol-based hand rub products after the first
surgical scrub?Do you have specific criteria for specialities that do use it?
Is it better to install the touch free design or autoclavable dispenser?
Any significant outcomes for patients?
What is your staff satisfaction rate?
Has it improved the efficiency in the operating theatre?
Thank you
Joe-Anne Bendall
Joe-Anne Bendall
Clinical Nurse Consultant Infection Prevention and Control
(Including vaccination and screening)
Monday Friday 0800 – 1630
Sydney Hospital and Sydney Eye Hospital8 Macquarie St
SYDNEY NSW 2000
|( ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |
Mobile 0418984255 | *
Joe-Anne.Bendall@HEALTH.NSW.GOV.AUThis message is intended for the addressee named and may contain
confidential information. If you are not the intended recipient, please
delete it and notify the sender.Views expressed in this message are those of the individual sender, and are
not necessarily the views of NSW Health or any of its entities.MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is
discouraged by ACIPC. If you wish to discuss specific reference to products
or services by brand or commercial names, please do this outside the list.Archive of all messages are available at http://aicalist.org.au/archives –
registration and login required.Replies to this message will be directed back to the list. To create a new
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