Surgical hand scrub

[Jane Barnett]

Hi

We’ve 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

Infection Prevention and Control is Everyone’s Business

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[Matthias Maiwald (KKH)]

Hi Jane,

Alcohol products are perfectly adequate for surgical hand and arm antisepsis. There is a chapter in the 2009 WHO Hand Hygiene Guideline, starting on page 54, and a similar article (by some of the same authors) in J Hosp Infect:

http://www.ncbi.nlm.nih.gov/pubmed/19716627

In fact, alcohol products for surgical hand antisepsis (a) provide far greater microbial reduction than aqueous detergent products such as chlorhexidine and betadine scrubs, and (b) are generally better tolerated on skin than detergent products, but (c) so far there is no study that the better microbial reduction on hands translates into lesser surgical site infections.

I would personally recommend against (!) using alcohol gels for that purpose, because the gel residue is often sticky and will be uncomfortable under the gloves.

My recommendation would be to look for a product that meets the European standard EN 12791 for surgical hand antisepsis, because this is a very stringent standard and products that meet it generally have very good performance.

Typical alcohol products that are designed for surgical hand antisepsis often consist of blends of different alcohol types (e.g. a certain percentage of isopropanol plus n-propanol, etc.), because iso- and n-propanol have greater relative antimicrobial efficacy than ethanol. Some commercial products have some added mecetronium etilsulfate (which is from the quaternary ammonium compounds (QAC) class of disinfectants). But there is generally no need to add chlorhexidine, betadine or PCMX to the alcohol.

There are several decades of practical clinical as well as testing and approval experience of alcohols for surgical hand antisepsis in Europe.

Companies that have products that are suitable for surgical hand antisepsis and meet EN 12791 might include B. Braun, Ecolab, Schuelke and Bode (perhaps others). I have heard that the Australian TGA has started registering alcohol products for surgical hand antisepsis, but I am not sure about the NZ status.

It is important to make sure that hands are clean and dry before using alcohols for surgical hand antisepsis. This can be achieved for the first scrub of the day by a thorough soap hand and arm wash (does not need to be antiseptic soap) and removal of dirt under the fingernails. After the soap wash, it is important to dry hands and arms completely, e.g. with a sterilised towel. Then, the alcohol is rubbed in very liberally (note: the amount is different from a hand rub as in the 5 Moments), typically such that the hands amd arms are being kept wet and being rubbed for the entire period. Typical periods are about 3-5 minutes. For subsequent scrubs on the same day (if hands have not been contaminated by other, e.g. ward work), an alcohol rub alone without prior soap step is sufficient.

There has been discussion whether the WHO-formulated hand rubs (which are excellent for usual hand hygiene and meet EN 1500) meet the surgical standard EN 12791 and proposals have been made for improved WHO formulations (however, this is more relevant for low-resource settings which would benefit most from cheap standard formulations):

http://www.ncbi.nlm.nih.gov/pubmed/21450366

http://www.ncbi.nlm.nih.gov/pubmed/21741115

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
We’ve 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

Infection Prevention and Control is Everyone’s Business
________________________________

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Thank You.

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[Helen Scott]

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
, Jane
Barnett 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
Infection Prevention and Control is Everyone’s Business

Attention:
The information contained in this message and or attachments is
intended only for the person or entity to which it is addressed and may
contain confidential and/or privileged material. Any review,
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in reliance upon, this information by persons or entities other than the
intended recipient is prohibited. If you received this in error, please
contact the sender and delete the material from any system and destroy
any copies.

Thank You.

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[Matthias Maiwald (KKH)]

Dear Helen,
Yes, Skinman Soft N (Ecolab, formerly Henkel, distributed in Australia by Orion) is one of the formulations that are suitable for surgical hand antisepsis and it fulfils EN 12791.
Sorry, which article in MMWR do you mean? I could not find it in the 2002 list of articles:
http://www.cdc.gov/mmwr/index2002.htm
Note, there is also another article from a US perspective in the AORN Journal in 2004:
http://www.sciencedirect.com/science/article/pii/S0001209206606194
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 Helen Scott
Sent: Tuesday, 12 June, 2012 12:36 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
________________________________

Attention:
The information contained in this message and or attachments is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact the sender and delete the material from any system and destroy any copies.

Thank You.

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The information contained in this e-mail and the attachments (if any) may be privileged and confidential and is intended solely for the named addressee. If you are not the intended recipient, please do not print, retain copy, disseminate, distribute, or use this e-mail or any part thereof. Please notify the sender immediately by replying to this e-mail and delete all copies of this e-mail and the attachments.

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[Tracy Sloane]

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
________________________________

Attention:
The information contained in this message and or attachments is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact the sender and delete the material from any system and destroy any copies.

Thank You.

________________________________
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[Robert Robinson]

Good morning

I would like to know from those facilities who currently uses 70% Isopropyl alcohol v/v in 0.5% to 1% Chlorhexidine, and are moving towards or have now changed to using 2% Chlorhexidine in alcohol specifically for insertion of an Peripheral IVC.

I am aware of the current recommendations surrounding this but would like others comments on this matter.

regards

Robert Robinson

Clinical Nurse Consultant | Infection Control
Blacktown/Mt. Druitt Hospitals
Tel 02 9881 8994 | Mob 0408 923 789 | robert.robinson@swahs.health.nsw.gov.au

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06/15/12 – 10:03:00

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[Matthias Maiwald (KKH)]

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
________________________________

Attention:
The information contained in this message and or attachments is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact the sender and delete the material from any system and destroy any copies.

Thank You.

________________________________
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[Michael Wishart]

Hi all

Along the lines of Matthias’ post, has anyone yet seen any standardised protocols for Australian HCW’s from any Australian college or association? I think that ACORN was working on something, and possibly RACS, but I have not yet seen anything. Has any other Australian professional entity produced some usage protocols for surgical antisepsis with waterless agents yet?

I am not asking about protocols developed by manufacturers or suppliers.

Thanks
Michael

Michael Wishart

Public Health Nurse,Communicable Disease Control
Logan West Moreton PHU
Ph 34131200 Fax 34131221

To contact Nursing team:
LWM_PHN@health.qld.gov.au

>>> “Matthias Maiwald (KKH)” 15/06/2012 11:05 am >>>

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 , Jane Barnett 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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