[Matthias.Maiwald@KKH.COM.SG Subject: Re: Waterless Surgical Scrubs In-Reply-To:]

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 1387

Cath Murphy
To
Sent by: AICA AICALIST@AICALIST.ORG.AU
Infexion cc
Connexion
Waterless 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 Coast

http://www.icp.au.com

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