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Dear Jo-Anne,
Forgot to add three more aspects, partially in response to your questions:
A large French clinical trial of alcohol-based versus antiseptic detergent-based surgical hand preparation has shown equivalence in terms of surgical site infection (SSI) rates:
Parienti JJ, Thibon P, Heller R, Le Roux Y, von Theobald P, Bensadoun H, et al. Hand-rubbing with an aqueous alcoholic solution vs traditional surgical hand-scrubbing and 30-day surgical site
infection rates: a randomized equivalence study. JAMA 2002; 288: 722-7. doi:10.1001/jama.288.6.722
http://www.ncbi.nlm.nih.gov/pubmed/12169076
The conclusion was: “Hand-rubbing with aqueous alcoholic solution, preceded by a 1-minute nonantiseptic hand wash before each surgeon’s first procedure of the day and before any other procedure if the hands were soiled, was as effective as traditional hand-scrubbing with antiseptic soap in preventing surgical site infections. The hand-rubbing protocol was better tolerated by the surgical teams and improved compliance with hygiene guidelines.”
In terms of dispensers, I would discourage hand-driven dispensers as commonly used at the bedside for the 5 Moments (due to the possibility of hand recontamination). In Europe, elbow-driven dispensers are in common use, as depicted here (not specific product endorsement intended, result from googling):
https://www.asport.nl/eurodispenser-1-plus-met-elleboog-bediening.html
With elbow-driven dispensers, autoclaving is not necessary, provided surgeons follow good technique (i.e. each rubbing act starts at the hands and ends at the elbows). Touch-free dispensers would be an option, but are not necessary with elbow-driven dispensers (simpler mechanics), and the concern with touch-free dispensers would be appropriate volumes dispensed (much larger volumes are required for surgical hand antisepsis than for ward-based hand hygiene as in the 5 Moments); see my little letter to the editor that I sent earlier.
Lastly, alcohol-based surgical hand preparation saves a lot of water (estimated 20 L required per surgical scrub) and is cheaper in cost.
Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387
Dear Jo-Anne,
I am not sure how widespread alcohol-based surgical hand preparation is now in Australia (I am now based in Singapore), but it is certainly now state of the art according to all major hand hygiene guidelines, and it has been the standard of care (and has supplanted detergent-based surgical hand preparation) since the 1980s in continental Europe.
The WHO 2009 Hand Hygiene Guideline (I assume you have that) has a section on it from page 54 to page 60, and that should have all the information you require.
A published version (in a journal) of essentially that same section has appeared here:
Widmer AF, Rotter M, Voss A, Nthumba P, Allegranzi B, Boyce J, Pittet D. Surgical hand preparation: state-of-the-art. J Hosp Infect. 2010 Feb;74(2):112-22. doi: 10.1016/j.jhin.2009.06.020. Epub 2009 Aug 28.
http://www.ncbi.nlm.nih.gov/pubmed/19716627
Essentially, alcohol-based surgical hand preparation has three major advantages over antiseptic detergent-based:
(1) It achieves much greater microbial reduction factors on arms/hands than detergent-based scrubbing.
(2) It requires much shorter application times than detergent-based scrubbing, saving time for the surgeons and the surgical teams.
(3) If adequate preparations with good emollients are used, it is gentler on hands/skin.
There are some highly active preparations around. While the standard time to fulfill the stringent European standard EN 12791 is 3 min, some of the better preparations fulfill EN 12791 in as short as 60 seconds (which is a phenomenally short time), but even with those preparations it is usually recommended to go slightly beyond that time (e.g. 2 min) for added safety. For most products, 3 min is appropriate.
It can be used for any type of surgery.
I have heard the notion before that alcohol-based hand/arm preparation cannot be used for the first scrub of the day (which is what you seem to indicate). But this is incorrect. It definitely can be used for the first and for subsequent scrubs, see WHO.
I have also published a small letter to the editor, highlighting the need for proper technique and providing some additional info, here:
Maiwald M. Technique is important for alcohol-based surgical hand antisepsis. Healthcare Infection 17(3) 106-107.
http://www.publish.csiro.au/paper/HI12028.htm
Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387
Hi
Is anyone using these alcohol-based hand rub products after the first surgical scrub?
Do you have specific criteria for specialities that do use it?
Is it better to install the touch free design or autoclavable dispenser?
Any significant outcomes for patients?
What is your staff satisfaction rate?
Has it improved the efficiency in the operating theatre?
Thank you
Joe-Anne Bendall
Joe-Anne Bendall
Clinical Nurse Consultant Infection Prevention and Control
(Including vaccination and screening)
Monday – Friday 0800 – 1630
Sydney Hospital and Sydney Eye Hospital
8 Macquarie St
SYDNEY NSW 2000
|* ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |
Mobile 0418984255 | * Joe-Anne.Bendall@HEALTH.NSW.GOV.AU
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