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Alcohol for Surgical Scrubbing?

Published online by Cambridge University Press:  05 January 2022

Elaine L. Larson ,
Arlene M. Butz ,
Donna L. Gullette  and
Barbara A. Laughon
Elaine L. Larson*
Affiliation:
Johns Hopkins University School of Nursing, Baltimore, Maryland
Arlene M. Butz
Affiliation:
Johns Hopkins University School of Nursing, Baltimore, Maryland
Donna L. Gullette
Affiliation:
Johns Hopkins University School of Nursing, Baltimore, Maryland
Barbara A. Laughon
Affiliation:
Johns Hopkins University School of Nursing, Baltimore, Maryland
*
Johns Hopkins University School of Nursing, 600 N. Wolfe Street, Baltimore, MD 21205
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Abstract

To test the effects of four surgical scrub products on colonizing hand flora, 60 healthy adult volunteers were assigned by block randomization (12 subjects per group) to use one of the following formulations: 70% ethyl alcohol with 0.5% chlorhexidine gluconate (ALC); a liquid detergent base containing 1% triclosan (TRI); a liquid detergent base containing 4% chlorhexidine gluconate (CHG); a liquid detergent base containing 7.5% povidone-iodine (PI); or a nonantimicrobial liquid soap (control). Using standard protocol, subjects performed a surgical scrub daily for five consecutive days. Hand cultures were obtained at baseline and on test days 1 and 5 immediately after the scrub and following four hours of gloving. After the first and last scrubs, ALC, CHG and PI resulted in significant reductions in colonizing flora when compared to the control. Additionally, by day 5 ALC was associated with an almost 3-log reduction as compared to an approximate 1.5-log reduction for CHG and PI and less than a l-log reduction of TRI and the control (p = .009). After four hours of gloving on both days 1 and 5, microbial counts on hands of subjects using ALC, TRI and CHG were significantly lower than counts for the control (p < .001), whereas there was no significant difference in counts between the PI and control groups (p = .41). Skin assessment by study subjects rated products from least to most harsh as follows: control, TRI, CHG, ALC and PI (p = .00001). It was concluded that ALC could be an efficacious and acceptable alternative for surgical scrubbing.

Information

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 11 , Issue 3 , March 1990 , pp. 139 - 143
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1990 

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References

1. Price, PB. The bacteriology of normal skin; a quantitative test applied to a study of the bacterial flora and the disinfectant action of mechanical cleaning. J Infect Dis. 1938;63:301–318.Google Scholar
2. Morton, HE. Alcohols. In: Block, SS, ed. Disinfection, Sterilization and Preservation. 3rd ed. Philadelphia, Pa: Lea and Febiger; 1983:225–239.Google Scholar
3. Ayliffe, GAJ. Surgical scrub and skin disinfection. Infect Control. 1984;5:23–27.Google Scholar
4. Larson, EL, Eke, PI, Laughon, BE. Efficacy of alcohol-based hand rinses under frequent-use conditions. Antimicrob Agents Chemother. 1986;30:542–544.Google Scholar
5. Reybouck, G. Handwashing and hand disinfection. J Hosp Infect. 1986;8:5–23.Google Scholar
6. Altemeier, WA. Surgical antiseptics. In: Block, SS, ed. Disinfection, Sterilization and Preservation. 3rd ed. Philadelphia, Pa: Lea and Febiger; 1983:493–504.Google Scholar
7. Lowbury, EJL, Lilly, HA, Ayliffe, GAJ. Preoperative disinfection of surgeons' hands: use of alcoholic solutions and effects of gloves on skin flora. Br Med J. 1974;4:369–372.Google Scholar
8. Peterson, AF, Rosenberg, A, Alatary, SO. Comparative evaluation of surgical scrub preparations. Surg. 1978;146:63–65.Google Scholar
9. Ayliffe, GAJ, Babb, JR, Quoraishi, AH. A test for “hygienic” hand disinfection. J Clin Pathol. 1978;31:923–928.Google Scholar
10. Zamora, JL. Chemical and microbiological characteristics and toxicity of povidone-iodone solutions. Am J Surg. 1986;141:400–406.Google Scholar
11. Larson, EL, Laughon, BE. Comparison of four antiseptic products containing chlorhexidine gluconate. Antimicrob Agents Chemother. 1987;31:1572–1574.Google Scholar
12. Bartozokas, CA, Cm-kill, JE, Makin, T, Pinder, DC. Assessment of the remanent antibacterial effect of a 2% triclosan-detergent preparation on skin. J Hyg Camb. 1983;91:521–528.Google Scholar
13. Rotter, ML. Povidone iodine and chlorhexidine gluconate containing detergents for disinfection of hands. J Hosp Infect. 1981;1:149–158.Google Scholar
14. Bruch, M. Newer germicides: what they offer. In: Maibach, H, Aly, R, eds. Skin Microbiology: Relevance to Clinical Infection. New York, NY: Springer-Verlag; 1981:103–112.Google Scholar
15. American Society for Testing and Materials. Standard Test Method for Evaluation of Surgical Hand Scrub Formulation. Philadelphia: ASTM Committee on Standards. 1986;E1115-86:201–204.Google Scholar
16. Effectiveness testing of a surgical hand scrub (glove juice test). Federal Register. 1974;39:33137–33139.Google Scholar
17. Larson, EL, Strom, MS, Evans, CA. Analysis of three variables in sampling solutidns used to assay bacteria of hands: type of solution, use of antiseptic neutralizers, and solution temperature. J Clin Microbiol. 1980;12:355–360.Google Scholar
18. Larson, EL, Leyden, JJ, NcGinley, KJ, Grove, GL, Talbot, GH. Physiologic and microbiologic changes in skin related to frequent handwashing. Infect Control. 1986;7:59–63.Google Scholar
19. Berk, RA. Generalizability of behavioral observations. A clarification of inter-observer agreement and interobserver reliability. Am J Ment Deficiency. 1979;5:460–472.Google Scholar
20. Kimbrough, RD. Review of toxicity of hexachlorophene, including its neurotoxicity. J Clin Pharmacol. 1973;13:439–451.Google Scholar
21. Favero, MS. Iodine-champagne in a tin cup. Infect Control. 1982;3:30–32.Google Scholar
22. Mitchell, KG, Ravluk, DJR. Skin reactions related to surgical scrub up: results of Scottish survey. Br J Surg. 1984;71:223–224.Google Scholar
23. Connolly, RJ, Shepherd, JJ. The effect of preoperative surgical scrubbing with povidone-iodine on urinary iodine levels. Aust NZ J surg. 1972;42:94–95.Google Scholar
24. Vorherr, H, Vorherr, UF, Mehta, P, Ulrich, JA, Messa, RH. Vaginal absorption of p&done-iodine. JAMA. 1980;244:2528–2529.Google Scholar
25. Ulrich, JA. Antimicrobial efficacy in the presence of organic matter. In: Maibach, K, Aly, R, eds. Skin Microbiology: Relevance to Clinical Infection. New York, NY: Springer-Verlag; 1981:149–157.Google Scholar
26. Lowbury, EJL, Lilly, HA. The effect of blood on the disinfection of surgeons' hands. Br J Surg. 1974;61:19–21.Google Scholar
27. Mackenzie, I. Preoperative skin preparation and surgical outcome. J Hosp Infect. 1988;11(suppl B):27–32.Google Scholar
28. Goldblum, SE, Ulrich, JA, Goldman, RS, Reed, WP, Avasthi, PS. Comparison of 4% chlorhexidine in a detergent base (Hibiclens) and povidone-iodine (Betadine) for the skin preparation of hemodialysis patients and personnel. Am J Kidney Dis. 1983;2:548–552.Google Scholar
29. Aly, R, Maibach, HI. Comparative evaluation of chlorhexidine gluconate (Hibiclens) and povidone-iodine (E-Z Scrub) sponge/brushes for presurgical hand scrubbing. Curr Therap Res. 1983;34:740–745.Google Scholar
30. Tunevall, TG. Procedure and experiences with preoperative skin preparation in Sweden. J Hosp Infect. 1988;11(suppl B):11–14.Google Scholar
31. Ayliffe, GAJ, Babb, JR, Davies, JC, Lilly, HA. Hand disinfection: a comparison of various agents in laboratory and ward studies. J Hosp Infect. 1988;11:226–243.Google Scholar
32. Rotter, ML. Hygienic hand disinfection. Infect Control. 1984;5:18–22.Google Scholar
33. Murie, JA, Macpherson, SG. Chlorhexidine in methanol for the preoperative cleansing of surgeons' hands: a clinical trial. Scot Med J. 1980;25:309–311.Google Scholar
34. Rotter, ML, Hierschl, AM, Koller, W. Effect of chlorhexidine-containing detergent, non-medicated soap or isopropanol and the influence of neutralizer on bacterial pathogeniuity. J Hosp Infect. 1988;1:220–225.Google Scholar
35. Lowbury, EJL, Lilly, HA. Use of 4% chlorhexidine-detergent solution and other methods of skin disinfection. Br Med J. 1973;1:510–515.Google Scholar
36. Lilly, HA, Lowbury, EJL, Wilkins, MD. Detergents compared with each other and with antiseptics as skin degerming agents. J Hyg Comb. 1979;82:29–33.Google Scholar
37. Meers, PD, Yeo, GA. Shedding of bacteria and skin squames after handwashing. J Hyg Comb. 1978;81:99–105.Google Scholar
38. Larson, EL, Mayur, K, Laughon, BA. Influence of two handwashing frequencies on reduction in colonizing flora with three health-care handwashing products. Am J Infect Control . In press.Google Scholar