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Dear AICA, ACSQHC and ACORN Colleagues
I have been asked about the suitability of using “waterless surgical scrubs” as an alternative to the first ‘soap and water’ wash of the day in the operating theatre or surgical procedural unit. Does anybody know if this is common? Acceptable? Widespread and based on credible evidence or policy?
Any commentary welcomed. Thanks.
Cath
Assoc. Prof Cathryn Murphy RN PhD CIC
CNC Infection Control
Gold Coast Health Service District
Robina Hospital
Gold CoastMessages posted to this list are solely the opinion of the authors, and do not represent the opinion of AICA.
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I just re-read Cath’s original question, and find I need to emphasize
that my understanding is that waterless scrubbing should only be used on
CLEAN hands. Thus, the first scrub of the day should be with ‘soap and
water’ (whether the first scrub requires an antimicrobial seems to be
debatable if waterless scrubbing is used prior to the first case). The
obvious rationale for this is to remove any debris from the hands prior
to the use of the waterless scrub.I have seen some EU guidelines for use of waterless scrubbing in OT but
can’t seem to find them currently. Can anyone direct Cath to some
guidelines for waterless scrubbing?Thanks
MichaelMichael Wishart | GPH – Infection Control Coordinator
GPH – Quality & Safety Unit (Infection Control) | Greenslopes Private
Hospital
Newdegate St, Greenslopes QLD 4120
t: 07 3394 7919 | pager 047 | f: 07 3394 7985
e: WishartM@ramsayhealth.com.au | w: http://www.ramsayhealth.com.auRamsay Health Care is an environmentally responsible corporation, please
consider the environment before printing this email.—–Original Message—–
Behalf Of Cath MurphyDear AICA, ACSQHC and ACORN Colleagues
I have been asked about the suitability of using “waterless surgical
scrubs” as an alternative to the first ‘soap and water’ wash of the day
in the operating theatre or surgical procedural unit. Does anybody know
if this is common? Acceptable? Widespread and based on credible evidence
or policy?Any commentary welcomed. Thanks.
Cath
Assoc. Prof Cathryn Murphy RN PhD CIC
CNC Infection Control
Gold Coast Health Service District
Robina Hospital
Gold CoastMessages posted to this list are solely the opinion of the authors, and
do not represent the opinion of AICA.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 message send an email to aicalist@aicalist.org.auTo send a message to the list administrator send an email to
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Hi All,
Surgical hand rub (SHR) is the subject of the Masters thesis that I am currently undertaking. No they do not have TGA approval for use in Australia. 3M have had a product before TGA for a few years now (so I’m told) but have yet to gain license. SHR is appropriate for the first scrub of the day. The expectation is that hands are washed prior to entry into the OR. Of course if hands are visibly soiled then one needs to wash them.
Cath, check out the WHO guidelines there is a section on SHR, also the US AORN guidelines.
Cheers,
Tracy.Tracy Sloane
Infection Control Manager
Angliss Hospital & Yarra Ranges
Ph: 9764 6289 Mob: 0407 502 096
email Tracy.Sloane@easternhealth.org.au
Please consider the environment before printing this e-mail notice—–Original Message—–
From: AICA Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Wishart, Michael
Sent: Tuesday, 10 August 2010 7:41 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: [AICA_Infexion_Connexion] Waterless Surgical ScrubsI just re-read Cath’s original question, and find I need to emphasize
that my understanding is that waterless scrubbing should only be used on
CLEAN hands. Thus, the first scrub of the day should be with ‘soap and
water’ (whether the first scrub requires an antimicrobial seems to be
debatable if waterless scrubbing is used prior to the first case). The
obvious rationale for this is to remove any debris from the hands prior
to the use of the waterless scrub.I have seen some EU guidelines for use of waterless scrubbing in OT but
can’t seem to find them currently. Can anyone direct Cath to some
guidelines for waterless scrubbing?Thanks
MichaelMichael Wishart | GPH – Infection Control Coordinator
GPH – Quality & Safety Unit (Infection Control) | Greenslopes Private
Hospital
Newdegate St, Greenslopes QLD 4120
t: 07 3394 7919 | pager 047 | f: 07 3394 7985
e: WishartM@ramsayhealth.com.au | w: http://www.ramsayhealth.com.auRamsay Health Care is an environmentally responsible corporation, please
consider the environment before printing this email.—–Original Message—–
From: AICA Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On
Behalf Of Cath Murphy
Sent: Monday, 9 August 2010 8:02 PM
To: AICALIST@AICALIST.ORG.AU
Subject: [AICA_Infexion_Connexion] Waterless Surgical ScrubsDear AICA, ACSQHC and ACORN Colleagues
I have been asked about the suitability of using “waterless surgical
scrubs” as an alternative to the first ‘soap and water’ wash of the day
in the operating theatre or surgical procedural unit. Does anybody know
if this is common? Acceptable? Widespread and based on credible evidence
or policy?Any commentary welcomed. Thanks.
Cath
Assoc. Prof Cathryn Murphy RN PhD CIC
CNC Infection Control
Gold Coast Health Service District
Robina Hospital
Gold CoastMessages posted to this list are solely the opinion of the authors, and
do not represent the opinion of AICA.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 message send an email to aicalist@aicalist.org.auTo send a message to the list administrator send an email to
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(without the quotes) to listserv@aicalist.org.auNOTICE: CONFIDENTIAL COMMUNICATION
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received this e-mail message in error please immediately
advise the sender by return e-mail, or telephone 1800 243 903.
You must destroy the original transmission and its contents.
Any views expressed within this communication are those of
the individual sender, except where the sender specifically
states them to be the views of Ramsay Health Care.
This communication should not be copied or disseminated
without permission.
————————————————————————Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of AICA.
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 message send an email to aicalist@aicalist.org.au
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Dear Cath, dear Group,
“Waterless surgical scrubs” or alcohol-based surgical hand/arm antisepsis
(as it is better called) has been the standard of care in Europe
(especially Germany, Austria, Switzerland) for about 30 years or longer.
(In fact, one now retired author describes in a book chapter [Groeschel &
Pruett, Surgical Antisepsis, in Block 1991] that it has already been in use
in the 1950s). How it is done (at least in the 80s when did my surgical
internship) is to do a soap-based handwash (plus arms) and to scrub with a
brush only under fingernails (not on other skin) for the first scrub of the
day, followed by drying of hands/arms with a sterile towel (not paper) and
followed by rubbing the alcohol-based hand disinfectant onto hands and arms
and keeping them ‘wet’ with alcohol for 5 minutes. Then letting the alcohol
dry (as for a normal alcohol hand rub) before gowning and gloving. One of
the speakers at the recent Infection Control Course in Port Douglas,
Andreas Widmer from Switzerland, has been presenting on this topic at ICAAC
meetings, and it appears that the tendency goes towards shorter scrubbing
times now (than in the 80s), and about 3 min is consideres satisfactory.There are two main advantages: (a) it is more gentle to skin, consistent
with alcohol-based hand antiseptics having emollients, and (b) it achieves
far greater microbial reduction. While water-based surgical scrubbing
achieves a microbial reduction typically by about 1-2 log (factor 10-100),
alcohol-based surgical hand antisepsis achieves about 3-4 log reduction
(factor 1000-10000, that is a factor 10-100 better than water-based
scrubbing. When agents for persistence are added, then there is no or only
minimal regrowth of microorganisms under the surgical gloves for the
duration of the operation. In fact, the lack of significant regrowth is
assessed as part of the European standard EN 12791 for surgical hand
antiseptics. Note that no aqueous surgical scrub stands a chance of passing
this stringent testing standard.One should mention that there are no clinical trials with surgical
infection rates as the outcome that show a difference in infection rates
between water-based and alcohol-based scrubs, however, the much lower
residual microorganisms provide a strong microbiological and
pathophysiological rationale that at least there is a greater safety margin
in case of accidental glove leaks or rupture (which is what surgical
acrubbing is designed for).And yes, there is a section on surgical scrubbing, including alcohol
formulations, in the new 2009 WHO hand hygiene guideline.I would personally strongly advocate NOT to use gels for that purpose,
because most gels have distinctly less antimicrobial activity than liquids,
because surface coverage is more difficult to achieve with the more viscous
gels, and because gels often leave a sticky residue, which will be
uncomfortable under the surgical gloves. There are a number of European
companies that have alcohol-based surgical hand antiseptics in their
product range; they are specially formulated for that purpose and pass the
stringent EN 12791. Not to make undue advertisements, but among the
European companies with such products in their range and an established
distribution network in Australia is B. Braun. (Of course, there are
several other possibilities with equally good products).And yes, TGA should look at approving some of these, in my opinion.
I do have some literature about this, which I am certainly offering to
share.Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 1389
Fax +65 6394 1387Cath Murphy
To
Sent by: AICA AICALIST@AICALIST.ORG.AU
Infexion cc
Connexion
Waterless Surgical Scrubs09/08/2010 06:01
PMPlease respond to
AICA Infexion
ConnexionDear AICA, ACSQHC and ACORN Colleagues
I have been asked about the suitability of using “waterless surgical
scrubs” as an alternative to the first ‘soap and water’ wash of the day in
the operating theatre or surgical procedural unit. Does anybody know if
this is common? Acceptable? Widespread and based on credible evidence or
policy?Any commentary welcomed. Thanks.
Cath
Assoc. Prof Cathryn Murphy RN PhD CIC
CNC Infection Control
Gold Coast Health Service District
Robina Hospital
Gold CoastMessages posted to this list are solely the opinion of the authors, and do
not represent the opinion of AICA.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
message send an email to aicalist@aicalist.org.auTo send a message to the list administrator send an email to
aicalist-request@aicalist.org.au.You can unsubscribe from this list be sending ‘signoff aicalist’ (without
the quotes) to listserv@aicalist.org.au—————————————————————————–
The information contained in this e-mail or in any attachment is
confidential and may be privileged. If you are not the intended recipient,
you are not authorised to read, print, retain, copy, disseminate,
distribute, or use this e-mail or any part thereof. If you receive this
e-mail in error, please notify the sender immediately by e-mail and delete
all copies of this e-mail. All opinions, conclusions and other information
expressed in this e-mail that are not of an official nature shall not be
deemed as given or endorsed by KK Women’s & Children’s Hospital.Insofar as this e-mail contains any medical opinion or advice, the medical
opinion or advice is premised solely on the extent of medical information
available to the writer of this e-mail and, where applicable, qualified by
the lack of direct physical assessment and personal evaluation of the
patient. Any medical opinion or advice expressed in this email does not
necessarily represent the views of KK Women’s & Children’s Hospital.Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of AICA.
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 message send an email to aicalist@aicalist.org.au
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Nice summary Matthias. We are not aware of any evidence that would
suggest the first wash of the day in OR be done with anything but soap
and water. Certainly subsequent to that, but not the first.Surgical hand preparation: State of the art.
Widmer AF, Rotter M, Voss A, Nthumba P, Allegranzi B, Boyce J, Pittet D.
J Hosp Infect. 2010 Feb;74(2):112-22. Epub 2009 Aug 28. Review.Regards
Phil Russo, M.Clin.Epid
Hand Hygiene Australia
National Project Manager
P: +61 3 9496 3587 | M: +61 411 659 486 |F: +61 3 9496 6677 |E:
philip.russo@austin.org.au
http://www.hha.org.au/
Hand Hygiene Australia, c/- Austin Health Infectious Diseases Dept. PO
5555 Heidelberg, VIC, Australia 3084—–Original Message—–
Behalf Of Matthias.Maiwald@KKH.COM.SGDear Cath, dear Group,
“Waterless surgical scrubs” or alcohol-based surgical hand/arm
antisepsis (as it is better called) has been the standard of care in
Europe (especially Germany, Austria, Switzerland) for about 30 years or
longer.
(In fact, one now retired author describes in a book chapter [Groeschel
& Pruett, Surgical Antisepsis, in Block 1991] that it has already been
in use in the 1950s). How it is done (at least in the 80s when did my
surgical
internship) is to do a soap-based handwash (plus arms) and to scrub with
a brush only under fingernails (not on other skin) for the first scrub
of the day, followed by drying of hands/arms with a sterile towel (not
paper) and followed by rubbing the alcohol-based hand disinfectant onto
hands and arms and keeping them ‘wet’ with alcohol for 5 minutes. Then
letting the alcohol dry (as for a normal alcohol hand rub) before
gowning and gloving. One of the speakers at the recent Infection Control
Course in Port Douglas, Andreas Widmer from Switzerland, has been
presenting on this topic at ICAAC meetings, and it appears that the
tendency goes towards shorter scrubbing times now (than in the 80s), and
about 3 min is consideres satisfactory.There are two main advantages: (a) it is more gentle to skin, consistent
with alcohol-based hand antiseptics having emollients, and (b) it
achieves far greater microbial reduction. While water-based surgical
scrubbing achieves a microbial reduction typically by about 1-2 log
(factor 10-100), alcohol-based surgical hand antisepsis achieves about
3-4 log reduction (factor 1000-10000, that is a factor 10-100 better
than water-based scrubbing. When agents for persistence are added, then
there is no or only minimal regrowth of microorganisms under the
surgical gloves for the duration of the operation. In fact, the lack of
significant regrowth is assessed as part of the European standard EN
12791 for surgical hand antiseptics. Note that no aqueous surgical scrub
stands a chance of passing this stringent testing standard.One should mention that there are no clinical trials with surgical
infection rates as the outcome that show a difference in infection rates
between water-based and alcohol-based scrubs, however, the much lower
residual microorganisms provide a strong microbiological and
pathophysiological rationale that at least there is a greater safety
margin in case of accidental glove leaks or rupture (which is what
surgical acrubbing is designed for).And yes, there is a section on surgical scrubbing, including alcohol
formulations, in the new 2009 WHO hand hygiene guideline.I would personally strongly advocate NOT to use gels for that purpose,
because most gels have distinctly less antimicrobial activity than
liquids, because surface coverage is more difficult to achieve with the
more viscous gels, and because gels often leave a sticky residue, which
will be uncomfortable under the surgical gloves. There are a number of
European companies that have alcohol-based surgical hand antiseptics in
their product range; they are specially formulated for that purpose and
pass the stringent EN 12791. Not to make undue advertisements, but among
the European companies with such products in their range and an
established distribution network in Australia is B. Braun. (Of course,
there are several other possibilities with equally good products).And yes, TGA should look at approving some of these, in my opinion.
I do have some literature about this, which I am certainly offering to
share.Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Department of Pathology and Laboratory Medicine KK Women’s and
Children’s Hospital 100 Bukit Timah Road Singapore 229899 Tel. +65 6394
1389 Fax +65 6394 1387Cath Murphy
To
Sent by: AICA AICALIST@AICALIST.ORG.AUInfexion
cc
ConnexionWaterless Surgical Scrubs
09/08/2010 06:01
PM
Please respond to
AICA Infexion
Connexion
Dear AICA, ACSQHC and ACORN Colleagues
I have been asked about the suitability of using “waterless surgical
scrubs” as an alternative to the first ‘soap and water’ wash of the day
in the operating theatre or surgical procedural unit. Does anybody know
if this is common? Acceptable? Widespread and based on credible evidence
or policy?Any commentary welcomed. Thanks.
Cath
Assoc. Prof Cathryn Murphy RN PhD CIC
CNC Infection Control
Gold Coast Health Service District
Robina Hospital
Gold CoastMessages posted to this list are solely the opinion of the authors, and
do not represent the opinion of AICA.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 message send an email to aicalist@aicalist.org.auTo send a message to the list administrator send an email to
aicalist-request@aicalist.org.au.You can unsubscribe from this list be sending ‘signoff aicalist’
(without the quotes) to listserv@aicalist.org.au————————————————————————
—–
The information contained in this e-mail or in any attachment is
confidential and may be privileged. If you are not the intended
recipient, you are not authorised to read, print, retain, copy,
disseminate, distribute, or use this e-mail or any part thereof. If you
receive this e-mail in error, please notify the sender immediately by
e-mail and delete all copies of this e-mail. All opinions, conclusions
and other information expressed in this e-mail that are not of an
official nature shall not be deemed as given or endorsed by KK Women’s &
Children’s Hospital.Insofar as this e-mail contains any medical opinion or advice, the
medical opinion or advice is premised solely on the extent of medical
information available to the writer of this e-mail and, where
applicable, qualified by the lack of direct physical assessment and
personal evaluation of the patient. Any medical opinion or advice
expressed in this email does not necessarily represent the views of KK
Women’s & Children’s Hospital.Messages posted to this list are solely the opinion of the authors, and
do not represent the opinion of AICA.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 message send an email to aicalist@aicalist.org.auTo send a message to the list administrator send an email to
aicalist-request@aicalist.org.au.You can unsubscribe from this list be sending ‘signoff aicalist’
(without the quotes) to listserv@aicalist.org.au
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