Surgical handwashing: drying with one or two surgical towels - a randomized clinical trial

Hand drying following surgical scrubbing is a critical step in reducing bacterial transmission, yet the optimal method remains uncertain. This randomized clinical superiority trial evaluated whether using one versus two towels affects contamination risk among healthcare personnel.

Anesthesiologists, surgeons, residents and scrub technologists from three centers in Bogotá, Colombia, performing surgical handwashing at least weekly, were eligible. A parallel 1:1 randomized design was implemented, with operating theaters selected via stratified randomization and intervention allocation determined using a Big Stick design. The control group used a single surgical towel, while the intervention group used two towels, one per limb. Contamination was defined as the presence of fluorescent cream on previously washed upper extremities after drying. Procedures were conducted by unblinded research assistants, while data were analyzed blindly using Rstudio.

Thirty-six participants were assigned to each group, with no losses. Baseline characteristics were balanced. Overall contamination incidence was 21%. No statistically significant difference was found in the proportion of contamination according to Fisher's exact test (P=0.07). The estimated relative risk of contamination with two surgical towels was 2.75 (95% confidence interval: 0.46-16.12; P=0.26). No harms or unintended events were reported.

In the context of surgical scrubbing, no difference in cross-contamination risk was observed when drying upper limbs with one towel versus two towels. These findings suggest that using a single towel is as effective as using separate towels for each limb.