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Published on: June 7, 2017
An in-use microbiological comparison of two surgical hand disinfection techniques in cardiothoracic surgery: hand
C Carro1, L Camilleri, O Traore
1CHU Clermont-Ferrand, Cardiovascular Surgery Department, Gabriel Montpied University Hospital, Clermont Ferrand, France. ccarro@chu-clermontferrand.fr
Abstract:
Surgical site infection after heart surgery increases morbidity and mortality. The method of presurgical hand disinfection could influence the infection risk. From February to April 2003, we compared the microbiological efficacy of hand-rubbing (R) and hand-scrubbing (S) procedures. The surgical team alternately used hand-scrubbing or hand-rubbing techniques every two weeks. Fingertip impressions were taken before and immediately after hand disinfection, every 2h and at the end of the operation. Acceptability of hand rubbing was assessed by a questionnaire. Mean durations of surgical procedures were 259+/-68 and 244+/-69min for groups S and R respectively (P=0.43). Bacterial counts immediately after hand disinfection were comparable with the two techniques, but significantly lower in group R at the end of surgery. No differences were observed between the percentages of negative samples taken after 2h, 4h and at the end of surgery between the two groups. Bacterial skin flora reduction immediately after hand disinfection, after 2h and 4h of operating time and at the end of surgery was better in group R, but the difference was not statistically significant. Before surgery, the hand-rubbing method with alcohol solution preceded by hand washing with mild neutral soap is as effective as hand scrubbing to reduce bacterial counts on hands. It decreased the bacterial counts both immediately after hand disinfection and at the end of long cardiothoracic surgical procedures. The acceptability of hand rubbing was excellent and it can be considered to be a valid alternative to the conventional hand-scrubbing protocol.
Insights
Hand-rubbing with alcohol solution is as effective as traditional hand-scrubbing for reducing bacterial counts before cardiothoracic surgery. This method offers excellent acceptability and is a viable alternative for surgical teams.
Area of Science:
- Infectious Disease
- Surgical Hygiene
- Microbiology
Background:
- Surgical site infections (SSIs) following heart surgery significantly increase patient morbidity and mortality.
- Presurgical hand disinfection protocols are critical in mitigating SSI risk.
Purpose of the Study:
- To compare the microbiological efficacy of hand-rubbing versus hand-scrubbing for presurgical disinfection in cardiac surgery.
- To assess the bacterial reduction and acceptability of hand-rubbing as an alternative to hand-scrubbing.
Main Methods:
- A comparative study alternating hand-rubbing (R) and hand-scrubbing (S) techniques every two weeks.
- Fingertip bacterial impressions were collected pre-disinfection, immediately post-disinfection, every 2 hours, and at the end of surgery.
- Acceptability of hand-rubbing was evaluated via questionnaire.
Main Results:
- Bacterial counts post-disinfection were similar, but significantly lower at the end of surgery in the hand-rubbing group.
- Hand-rubbing demonstrated better bacterial skin flora reduction throughout the surgical procedure, though not always statistically significant.
- No significant differences in negative sample percentages were observed at 2h, 4h, or end of surgery between groups.
Conclusions:
- Hand-rubbing with alcohol solution, preceded by mild soap hand washing, is as effective as hand-scrubbing for reducing bacterial counts.
- This method effectively decreases bacterial counts immediately after disinfection and at the conclusion of long cardiothoracic procedures.
- Hand-rubbing is an excellent, acceptable, and valid alternative to conventional hand-scrubbing protocols in cardiac surgery.
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