Hand hygiene.pdf

een banned worldwide because of its high rate of dermal absorption and subsequent toxic
effects 26,290 . At the end of a surgical intervention, iodophor-treated hands can have even
more microorganisms than before surgical scrubbing. Warm water makes antiseptics and
soap work more effectively, while very hot water removes more of the protective fatty acids
from the skin. Therefore, washing with very hot water should be avoided.
11.4.1 REQUIRED TIME FOR THE PROCEDURE
Hingst and colleagues compared hand bacterial counts after 3-minute and 5-minute
scrubs with seven different products 302 . Results showed that the 3-minute scrub could be as
effective as the 5-minute scrub, depending on the formula of the scrub agent.
Immediate and postoperative hand bacterial counts after 5-minute and 10-minute scrubs
with 4% chlorhexidine gluconate were compared by O’Farrell and colleagues before total
hip arthroplasty procedures 396 . The 10-minute scrub reduced the immediate colony count
more than the 5-minute scrub. The postoperative mean log CFU count was slightly higher
for the 5-minute scrub than for the 10-minute scrub but the difference between post-scrub
and post-operative means CFU counts were higher for the 10-minute scrub than for the
5 minute-scrub in longer procedures (>90 minutes). The study recommended a 5-minute
scrub before total hip arthroplasty.
A study by O’Shaughnessy and colleagues used 4% chlorhexidine gluconate in 2, 4 and
6-minute scrubs. A reduction in post-scrub bacterial counts was found in all three groups.
Scrubbing for longer than two minutes did not confer any advantage. This study recommended
a 4-minute scrub for the surgical team’s first procedure and a 2-minute scrub for
subsequent procedures 397 . Bacterial counts on hands after 2-minute and 3-minute scrubs
with 4% chlorhexidine gluconate were compared 398 . A statistically significant difference in
mean CFU counts was found between groups, with the higher mean log reduction in the
2-minute group. The investigators recommended a 2-minute procedure.
Poon and colleagues applied different scrub techniques with a 10% povidone-iodine
solution 399 . Investigators found that a 30-second handwash can be as effective as a 20-
minute contact with an antiseptic in reducing bacterial flora and that vigorous friction scrub
is not necessarily advantageous.
11.4.2 USE OF BRUSHES
Almost all studies discourage the use of brushes. Early in the 1980s, Mitchell and colleagues
suggested a brushless surgical hand scrub 400 . Scrubbing with a disposable sponge
or combination sponge-brush has been shown to reduce bacterial counts on the hands as
effectively as scrubbing with a brush 401-403 . Today, almost all studies discourage the use
of brushes. Recently, even a randomized controlled clinical trial failed to demonstrate an
additional antimicrobial effect by using a brush 404 . It is conceivable that a brush may be
beneficial on visibly dirty hands before entering the operating theatre. Members of the
surgical team who have contaminated their hands before entering the hospital may wish
to use a sponge or brush to render their hands visibly clean before entering the operating
theatre area.
11.4.3 DRYING OF HANDS
Sterile cloth towels are most frequently used in operating theatres to dry wet hands after
surgical hand antisepsis. Several methods of drying have been tested without significant differences
between techniques 182 .