Abstract
BackgroundSurgical hand preparation is an essential part of modern surgery. Both alcohol-based and antiseptic detergent-based hand preparation are recommended practices, with a trend towards use of alcohol based handrubs. However, discussion has arisen whether chlorhexidine is a required ingredient in highly efficacious alcohol-based formulations, in view of providing sustained antimicrobial efficacy.MethodsOne alcohol-only formulation (product A), containing ethanol and n-propanol, and one formulation containing a chlorhexidine-ethanol combination (product B) were directly compared with each other using a modified test protocol based on European standard EN 12791 (2016) with 25 volunteers. The alcohol-only formulation (product A) was applied for only 90 s, the chlorhexidine-alcohol formulation (product B) for 180 s. Microbial log reduction factors were determined and statistically compared immediately after application and at 6 h under surgical gloves.ResultsThe alcohol-only formulation (product A) achieved mean log reduction factors of 1.96 ± 1.06 immediately after application and 1.67 ± 0.71 after 6 h. The chlorhexidine-alcohol combination (product B) achieved mean log reduction factors of 1.42 ± 0.79 and 1.24 ± 0.90 immediately and after 6 h, respectively. The values for product A were significantly greater than those for product B at both measured time points (p ≤ 0.025 immediately after application and p ≤ 0.01 after 6 h).ConclusionsAn optimized alcohol-only formulation tested according to a modified EN 12791 protocol in 25 healthy volunteers outperformed a chlorhexidine-alcohol formulation both immediately after application and at 6 h under surgical gloves, despite a much shorter application time. Thus, optimized alcohol-only formulations do not require chlorhexidine to achieve potent immediate and sustained efficacy. In conclusion, chlorhexidine is not an essential component for alcohol-based surgical hand preparation.
Highlights
Surgical hand preparation is an essential part of modern surgery
The goal of surgical hand preparation is to generate a near-elimination of transient hand flora or hand contamination, and a substantial reduction of resident hand flora that would be sustained for the duration of the surgery [2]
The mean log reduction factors obtained with use of product A were significantly greater than those of product B at both time points, immediately after application (p ≤ 0.025) and after 6 h under surgical gloves (p ≤ 0.01)
Summary
Surgical hand preparation is an essential part of modern surgery. Termed surgical hand antisepsis or surgical scrubbing, has become an essential part of modern surgery. It was introduced as part of the postListerian system of aseptic surgery that was widely adopted in Europe and the USA at the turn of the twentieth century [1]. Hands are frequently contaminated with microorganisms, accidental sterile glove leaks are common and there are observations of case clusters of surgical infections when hand preparation protocols were inadequate or breached [2,3,4,5]
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