In Vivo Comparison of Chlorine-Based Antiseptics versus Alcohol Antiseptic for Surgical Hand Antisepsis.

Zhannur Myltykbayeva,Sandugash Omarova,Rashid Nadirov,Galina Kovaleva,Azamat Mukhitdinov

doi:10.1155/2020/3123084

Abstract

Despite being commonly used as effective preparation for surgical hand antisepsis, alcohol solutions have major drawbacks, such as drying effect, emergence of hand eczema, and other diseases. This study aimed to demonstrate the effectiveness of sodium hypochlorite (NaOCl) and hydrogen peroxide (H2O2) as antiseptic in comparison to single sodium hypochlorite and 70% ethanol. In 5-day tests, the effects of 3 antiseptics were established according to standard test methods. The antiseptics were applied to the hands of 82 volunteers, and samples of bacteria were collected on days 1 and 5, immediately after drying and 6 hours later after antiseptic application. Student's t test and ANOVA were applied in a statistical study. The NaOCl with H2O2 composition demonstrated noninferiority to both sodium hypochlorite only and alcohol products and superiority to these antiseptics on day 5 (P < 0.05 at a significance level of 5% for each comparative trial in this day) at equivalence margin of 20%. The effectiveness of the NaOCl plus H2O2 composition as an antiseptic was explained by the formation of singlet oxygen in the system. Together, these data suggest that NaOCl and H2O2 may be an effective hand antisepsis that avoids the drawbacks seen with alcohol solutions.

Highlights

During surgery, multiresistant bacterial flora of the hands of a surgical team is a potential source of pathogens that can be considered as a cause of surgical site infection (SSI)
We compared the effectiveness of the indicated antiseptic with ethanol (70%) as well as with sodium hypochlorite solution. e study was designed as a noninferiority investigation. e ASTM E1115, Standard Test Method for Evaluation of Surgical Hand Scrub Formulation [16], and the in vivo method specified by the US Food and Drug Administration for evaluation of surgical hand scrubs were used for comparison of the specified composition and substances as antiseptics [17]
E composition was prepared from commercial sodium hypochlorite (CAS No 7681-52-9, Hebei Qige Biotechnology Co., Ltd.), monosodium phosphate (≥99.0%, SigmaAldrich), and double-distilled water. e 0.25 wt% of NaOCl solution was prepared and 4 g of NaH2PO4 was added to 1 L of the solution. e resulting solution was used for evaluation. e fresh solution was prepared every day to ensure the stability of the composition

Summary

Introduction

Multiresistant bacterial flora of the hands of a surgical team is a potential source of pathogens that can be considered as a cause of surgical site infection (SSI). E ASTM E1115, Standard Test Method for Evaluation of Surgical Hand Scrub Formulation [16], and the in vivo method specified by the US Food and Drug Administration for evaluation of surgical hand scrubs were used for comparison of the specified composition and substances as antiseptics [17]. In vivo methods including hands testing for levels of skin microbiota before and after antisepsis are comparatively easy to perform; it is subject to many uncontrollable factors [18, 19]. Such methods are widely used to test the capacity of a formulation to reduce the level of transient microflora on the hands without regards to the resident flora

Materials and Methods

Results and Discussion

II III

Conclusions