Water-wise hand preparation - the true impact of our practice: A controlled before-and-after study.

Abstract

South Africa (SA) and other countries worldwide are experiencing extreme drought conditions. Since the start of the drought in SA, many ways of saving water have been proposed and innovative water-saving mechanisms have become part of the lives of communities. We investigated water use during surgical scrubbing procedures and possible interventions to reduce water consumption. To compare water use during surgical hand preparation before and after the implementation of specific water-saving interventions. This was a non-randomised controlled study, following a before-and-after design, of orthopaedic theatre personnel scrubbing for surgical cases at Tygerberg Hospital, Cape Town. A control (CON) group (n=32) was established to observe standard practice for baseline measurements including total amount of water used, wash time and water flow rate during surgical hand preparation. After this, three interventions were randomly assigned to a single theatre each, where the same variables were measured. Intervention AS entailed using an alcohol scrub (n=18), intervention SN (n=12) had a dedicated assistant to open and close taps during scrubbing, and intervention SW (n=12) made use of adjusted tap levers to allow the surgeon to open and close taps more easily. Analysis of variance was used to detect global differences between groups, and Tukey's post hoc test was performed to detect differences between groups. Significant differences in water use (p<0.001), wash time (p<0.001) and water flow rate (p<0.001) were observed between the four groups. On average, the AS group used the least water per scrub (mean (standard deviation) 0.82 (1.43) L), which was significantly less than the CON (5.56 (1.79) L; p<0.001) and SN (2.29 (0.37) L; p=0.002) groups. The amount of time spent per scrub was significantly less in the AS group than all the other groups (p<0.05 for all comparisons), with no significant differences observed between the CON, SN and SW groups independently. The SW group had the lowest mean water flow rate (0.73 (0.22) L/min), which was significantly lower than the CON group (2.19 (0.84) L/min; p<0.001). The flow rate of the SN group (1.36 (0.66) L/min) was also significantly lower than that of the CON group (p=0.005). Water use during surgical hand preparation can easily be reduced by implementing easy and effective interventions. The practicality of interventions may differ between institutions, and their acceptance by surgical staff is important to ensure compliance. However, ensuring that alternative scrubbing options are available to surgical staff would equate to substantial savings over time.