Practical experience in a surgical unit when changing from scrub to rub

Abstract

Concurring with the move to a new facility at the end of 2008, alcohol-based hand rub (AHR) dispensers were allocated in all anterooms of operating theatres in a tertiary care hospital in Madrid, Spain. Routine educational sessions on surgical hand disinfection (SHD) were performed by infection control personnel, emphasizing the preferred method of AHR. Our aim was to evaluate the knowledge about SHD, as well as the performance of SHD and perceptions concerning the use of AHR or antiseptic soap hand scrub (ASHS) by surgeons and operating room nurses (ORNs). An anonymous survey on SHD was circulated to the surgeons, resident surgeons and nurses who perform SHD in our hospital. In all, 70 surveys were completed, corresponding to 27 ORNs (38.6%), 20 resident surgeons (29%), and 23 staff surgeons (33%), 41 (59%) of them being females. Forty percent of them perform mostly disinfectant soap hand scrub (DSHS) and 19% mostly hand rubs; 41% perform both methods. AHR rub is believed to be more efficacious than DSHS in reducing hand contamination (mean 6.5 vs 5.6; P > 0.001). Almost half of the personnel (49%) perform AHR >50% of the time (AHR users). AHR use is associated with ORNs (odds ratio: 3.4; 95% confidence interval [CI] 1.2-9.3; P = 0.018) but not with resident surgeons (odds ratio: 4.1; 95% CI 1.3-13.2; P = 0.017). When comparing both methods of SHD, personnel favour AHR for its colour (P > 0.01) and speed of drying (P > 0.01). Compared with surgeons, ORNs scored DSHS as more skin-irritating (4.1 vs 5.2; P = 0.013), more associated with skin dryness (3.2 vs 4.7; P > 0.001), and inferior overall score (4.7 vs 5.6; P > 0.005). Most of the personnel agree that AHR (85%) improves compliance with SHD. Nevertheless ASHS is the method preferred for surgeons (63%) whereas AHR is the method preferred by nurses (70%; P< 0.001). According to auto-evaluation of hand skin after use, AHR has better outcomes in terms of lack of dryness (5.3 vs 4.6; P > 0.05). In addition, nurses scored ASHS lower than did surgeons in terms of skin redness (4.7 vs 6.0; P > 0.001), lack of skin integrity (4.8 vs 5.9; P = 0.004), skin dryness (3.6 vs 5.4; P > 0.001), and overall score (4.0 vs 5.2; P > 0.002). Change of perceptions and behaviours about SHD can be accomplished, and the AHR method is better adhered to by nursing personnel.