Comparative efficacy of alcohol-based surgical scrubs: the importance of formulation

Alcohol-based surgical scrubs (ABSSs) are used to prevent surgical site infections. Chlorhexidine gluconate (CHG) often is added to enhance persistent germicidal activity. The aim of this study was to determine the influence of ABSS product formulation on efficacy. We evaluated three commercially available ABSS formulations and one control alcohol formulation according to the surgical scrub methodology specified by the US Food and Drug Administration (FDA). Only one ABSS formulation met FDA efficacy requirements when tested at the manufacturer's recommended dosage. In contrast, two ABSS formulations, one of which contained CHG, failed to meet the FDA acceptance criteria for a 3-log10 reduction on day 5, meaning the formulations did not sufficiently reduce bacteria levels on hands on the fifth day of product application. The data suggest that recommendations to include CHG in ABSS formulations should be reconsidered, and product efficacy, skin tolerability, and user acceptability should be evaluated on a case-by-case basis.