• Vol. 41 No. 1, 12–16
  • 15 January 2012

Surgical Hand Antisepsis–A Pilot Study comparing Povidone Iodine Hand Scrub and Alcohol-based Chlorhexidine Gluconate Hand Rub



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 (t0 ). 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 (t1 ).

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 (t0 ): 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 (t1 ): The median CFU counts for second imprint (t1 ) 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.

Surgical site infection (SSI) is a globally recognised problem that results in significant morbidity (delayed healing, wound breakdown, sepsis) and negative economic impact (prolonged hospital stays, revision surgery). Hand antisepsis remains a cornerstone of the overall aseptic technique in surgery, to eliminate transient micro-organisms and reduce resident skin flora. Despite significant advances in glove manufacturing techniques and development in surgical instruments design, glove perforation rates have been reported to be as high as 17%, reiterating the importance of good hand antisepsis.

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