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Surgical hand antisepsis-a pilot study comparing povidone iodine hand scrub and alcohol-based chlorhexidine gluconate
Kah Weng Lai1, Tun Lin Foo, Wilson Low
1Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore. laikahweng@gmail.com
Introduction:
The surgeon uses different methods of surgical hand antisepsis with the aim of reducing surgical site infections. To date, there are no local studies comparing the efficacy of iodine hand scrub against newer alcohol-based hand rubs with active ingredients. Our pilot study compares a traditional aqueous hand scrub using 7.5% Povidone iodine (PVP-I) against a hand rub using Avagard: 61% ethyl alcohol, 1% chlorhexidine gluconate. The outcome measure is the number of Colony Forming Units (CFU) cultured from 10-digit fingertip imprints on agar plates.
Materials And Methods:
Ten volunteers underwent 2 hand preparation protocols, with a 30-minute interval in between-Protocol A (3-minute of aqueous scrub using PVP-I) and Protocol B (3-minute of hand rub, until dry, using Avagard). In each protocol, fingertip imprints were obtained immediately after hand preparation (t(0)). The volunteers proceeded to don sterile gloves and performed specific tasks (suturing). At one hour, the gloves were removed and a second set of imprints was obtained (t(1)).
Results:
Four sets of fingertip imprints were obtained. All 10 participants complied with the supervised hand preparation procedures for each protocol. CFUs of initial fingertip imprints (t(0)): The median CFU counts for initial imprint was significantly higher in the PVP-I treatment (median = 6, Inter Quartile Range (IQR) = 33) compared to the Avagard treatment (median = 0, IQR = 0, P <0.001). CFUs of fingertip imprint at 1 hour (t(1)): The median CFU counts for second imprint (t(1)) was significantly higher in the PVP-I treatment (median = 0.5, IQR = 11) compared to the Avagard treatment (median = 0, IQR = 0, P = 0.009). Our results suggest that the Avagard was more efficacious than aqueous PVP-I scrub at reducing baseline colony counts and sustaining this antisepsis effect.
Conclusion:
Alcohol hand rub with an active compound, demonstrated superior efficacy in CFU reduction. Based on our results, and those pooled from other authors, we suggest that alcohol-based hand rubs could be included in the operating theatre as an alternative to traditional surgical scrub for surgical hand antisepsis.
Insights
Alcohol hand rubs significantly reduced colony-forming units (CFUs) more effectively than povidone-iodine (PVP-I) scrubs. This suggests alcohol-based hand rubs are a superior alternative for surgical hand antisepsis.
Area of Science:
- Infection Control
- Microbiology
- Surgical Safety
Background:
- Surgical site infections are a concern, necessitating effective surgical hand antisepsis.
- Povidone-iodine (PVP-I) scrubs are traditional, but newer alcohol-based hand rubs offer potential advantages.
- Limited local data exists comparing PVP-I efficacy against alcohol-based hand rubs.
Purpose of the Study:
- To compare the efficacy of a 7.5% povidone-iodine (PVP-I) aqueous scrub versus an alcohol-based hand rub (Avagard) for surgical hand antisepsis.
- To evaluate the reduction in Colony Forming Units (CFUs) on fingertips after each hand preparation method.
Main Methods:
- A pilot study involved 10 volunteers undergoing two protocols: 3-minute PVP-I scrub and 3-minute Avagard hand rub.
- Fingertip imprints for CFU analysis were collected immediately after hand preparation (t(0)) and one hour post-gloving (t(1)).
- Volunteers performed suturing tasks between imprint collections.
Main Results:
- Avagard hand rub resulted in significantly lower initial CFU counts (median=0) compared to PVP-I scrub (median=6) (P <0.001).
- At one hour, Avagard also showed significantly lower CFU counts (median=0) versus PVP-I (median=0.5) (P = 0.009).
- Alcohol-based hand rub demonstrated superior efficacy in reducing and sustaining lower bacterial counts.
Conclusions:
- Alcohol-based hand rubs with active ingredients are more effective than traditional PVP-I scrubs in reducing CFUs.
- The study suggests incorporating alcohol-based hand rubs as a viable alternative for surgical hand antisepsis in operating theatres.
- Further research can build upon these findings to optimize infection prevention strategies.
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