5-minute Scrub Research Articles

Is a 10-minute surgical scrub necessary in urologic prosthetic surgery? A randomized study of the effect of a 5- vs 10-minute surgical scrub on bacterial colony counts in the genital skin.

To determine the antiseptic efficacy on bacterial colony counts of a 5- vs 10-minute surgical site scrub in urologic surgery. A prospective cohort study was conducted in 101 patients presenting for elective urological procedures. Patients were randomized to a 5- or 10-minute groin scrub with Betadine (povidone-iodine). Skin swabs were taken immediately after skin clipping and following routine painting with Betadine. A third swab was taken after the betadine skin scrub. Bacterial colony counts were reported as a number of colony-forming units (CFUs). The primary outcome measure was a quantitative comparison of CFUs in the two arms. Fifty-three patients were randomized to a 5-minute scrub and 48 to a 10-minute scrub. After Betadine painting, CFUs were present in 38% of patients in the 5-minute group (mean, 33.5 CFU) and in 27% of the 10-minute group (mean, 45.4 CFU). Following the surgical scrub, only 7.5% of the 5-minute group and 8.3% of the 10-minute group had a measurable CFU count of greater than or equal to 1, and colony counts were low in both groups (5- minute group: mean, 1.5 CFU; 10-minute group: mean, 2.0 CFU). There was no significant difference in CFUs following a 5- or 10-minute scrub (P = 0.28). The addition of a surgical skin scrub leads to a fourfold reduction in the skin CFU count compared with Betadine painting. However, there is no difference between the antibacterial effects of a 5- and 10-minute scrub. A 5-minute scrub may be sufficient in urologic prosthetic surgery.

Segurança do doente e os processos sociais na relação com enfermeiros em contexto de bloco operatório

Patient safety is a worldwide problem that affects countries in all levels of development, given the risk of damages, injuries or death due to unsafe health care provision in the surgical context. This study aimed to understand the perception of nurses about patient safety in the operating room context. Descriptive and exploratory study conducted in 50 moments of participant observation and 6 semistructured interviews with nurses from the central operating room in a Public Hospital of the Sotavento Islands, Praia, Cape Verde. For data interpretation, we applied content analysis techniques. The ethical principles were followed. The explanatory cultural identity of the social processes in that context revealed unfavorable relation to patient safety as regards the aspects of surgical hand scrubbing with 2-to 5-minute scrub with chlorhexidine, use of surgical safety checklist, verifying sterilization indicators, conflict management and communication among the interdisciplinary team, people as centrality of care. Both professionals in the operating room and institutions should consider standards, supervisions, audits, and protocols as strong points for patient safety in the operating room context.

Is Alcohol-Based Hand Disinfection Equivalent to Surgical Scrub Before Placing a Central Venous Catheter?

Waterless antiseptic surgical hand scrub (1% chlorhexidine gluconate and 61% ethyl alcohol, Avagard™; 3M Health Care, St. Paul, MN), alcohol-only cleanser (62% ethyl alcohol), and traditional surgical scrub (5-minute scrub with 4% chlorhexidine soap using a sterile scrub brush with water) are techniques used for hand cleansing and disinfection. We hypothesized that alcohol-only cleanser and waterless antiseptic scrub (Avagard) would be as effective as a traditional surgical scrub for hand cleansing before placement of central venous catheters. Fingers of subjects were plate-cultured for 24 hours after 5 methods of hand cleansing: method 1: traditional surgical scrub (n = 49 plates produced by 14 subjects); method 2: traditional surgical scrub (5-minute scrub with water, brush, and 4% chlorhexidine soap) followed by a 15-minute break, then alcohol-only cleanser (62% alcohol) (n = 49 plates produced by 14 subjects); method 3: alcohol-only cleanser alone (n = 49 plates produced by 14 subjects); method 4: alcohol-only cleanser (62% alcohol), followed by a 15-minute break, then traditional surgical scrub (5-minute scrub with brush, and 4% chlorhexidine soap with water) (n = 49 plates produced by 14 subjects); and method 5: waterless surgical scrub (Avagard) alone (n = 116 plates produced by 38 subjects). The 15-minute break was introduced to allow a short period of recontamination, and to test for residual effects from prior cleansing. Alcohol-only cleanser alone (method 3) was significantly less effective than the traditional surgical scrub (method 1) (P < 0.001; 82% plate growth). Waterless surgical scrub (Avagard) (method 5) had a 0% observed difference (95% confidence interval [CI]: -14% to 11%) compared with the traditional 5-minute scrub (method 1) (P = 0.99; 16% plate growth). When a traditional surgical scrub was used first followed by a 15-minute period of recontamination, there was a 6% observed difference in method 2 from reference (method 1) (95% CI: -10% to 22%), and 0% observed difference in method 4 from reference (95% CI: -15% to 15%). As the initial cleansing method, the alcohol-only cleanser (method 3) was significantly less effective than the traditional surgical scrub (method 1) (P < 0.001).

Paint-Only Is Equivalent to Scrub-and-Paint in Preoperative Preparation of Abdominal Surgery Sites

Antiseptic preoperative skin site preparation is used to prepare the operative site before making a surgical incision. The goal of this preparation is a reduction in postoperative wound infection. The most straightforward technique necessary to achieve this goal remains controversial. A prospective randomized trial was designed to prove equivalency for two commonly used techniques of surgical skin site preparation. Two hundred thirty-four patients undergoing nonlaparoscopic abdominal operations were consented for the trial. Exclusion criteria included presence of active infection at the time of operation, neutropenia, history of skin reaction to iodine, or anticipated insertion of prosthetic material at the time of operation. Patients were randomized to receive either a vigorous 5-minute scrub with povidone-iodine soap, followed by absorption with a sterile towel, and a paint with aqueous povidone-iodine or surgical site preparation with a povidone-iodine paint only. The primary end point of the study was wound infection rate at 30 days, defined as presence of clinical signs of infection requiring therapeutic intervention. Patients randomized to the scrub-and-paint arm (n = 115) and the paint-only arm (n = 119) matched at baseline with respect to age, comorbidity, wound classification, mean operative time, placement of drains, prophylactic antibiotic use, and surgical procedure (all p > 0.09). Wound infection occurred in 12 (10%) scrub-and-paint patients, and 12 (10%) paint-only patients. Based on our predefined equivalency parameters, we conclude equivalence of infection rates between the two preparations. Preoperative preparation of the abdomen with a scrub with povidone-iodine soap followed by a paint with aqueous povidone-iodine can be abandoned in favor of a paint with aqueous povidone-iodine alone. This change will result in reductions in operative times and costs.

Surgical hand scrub practices in orthopaedic surgery.

The purpose of this study was to determine whether the practice of surgical hand scrubbing among orthopaedic surgeons, faculty, residents, and nurses met the institution's recommended 5-minute scrub policy and how often a 2-minute surgical hand scrub was used. Forty-eight subjects' hand scrub times were recorded discreetly for a total of 125 observations. All individuals scrubbed for a mean of 2.54 minutes and all scrubbed less than the 5-minute institutionally recommended policy. We found that 35.2% scrubbed less than 2 minutes and 64.8% scrubbed greater than 2 minutes. The subjects studied were polled to determine whether they knew the scrub policy, the minimum effective scrub time, and their perception of how long they scrub. Three of the 16 respondents correctly answered the question regarding the hospital's recommended policy regarding scrub time of 5 minutes. All stated they thought they scrubbed at least 2 minutes and all agreed that at least a 2-minute scrub should be done.

Povidone-iodine spray technique versus traditional scrub-paint technique for preoperative abdominal wall preparation

Objective: The study was conducted to compare povidone-iodine spray and traditional scrub-paint techniques in reducing abdominal wall bacteria during preoperative preparation. Study design: Sixty patients scheduled to undergo vaginal surgery were recruited for study. Cultures of the abdominal skin were performed before and after preparation with two techniques: A traditional 5-minute iodophor soap scrub-paint on one half and povidone-iodine aqueous spray on the other. Multiple pairwise comparisons were performed with the Wilcoxon signed rank test. A P value of.05 was considered statistically significant in all analyses. Results: The mean number of colonies for spray after 1 minute was 1.83 ± 3.16, for spray after 3 minutes was 0.40 ± 1.15, and after 5-minute scrub was 0.87 ± 2.97. Both techniques, the spray after 3 minutes and the 5-minute scrub, were statistically more effective at reducing bacterial counts than the spray after 1 minute. There was no statistically significant difference between the spray after 3 minutes and the scrub techniques. Conclusion: Povidone-iodine applied as a spray and left to dry for 3 minutes appears as effective as the traditional scrub-paint technique in reducing abdominal wall bacteria before abdominal surgery. (Am J Obstet Gynecol 2002;187:1434-7.)

A comparison of chlorhexidine and povidone-iodine skin preparation for surgical operations

The purpose of this study was to determine if 2 paints of chlorhexidine as a skin preparation was as effective as a 5-minute povidone-iodine scrub followed by 2 paints of Betadine solution (Betadine solution, povidone-iodine 10% equal to 1% available iodine; Purdue Frederick, Norwalk, Connecticut). In the first trial involving 10 volunteers, one side of the back was painted with 2 coats of chlorhexidine and the other side of the back was scrubbed with povidone-iodine for 5 minutes, left to dry, and then painted with Betadine. Cultures were obtained using the membrane filter adsorption method before the skin preparation and at 30, 60, and 120 minutes after the preparation. In the second trial, both the Betadine and chlorhexidine paints were dried. Bacterial counts were then obtained at 48 hours. There was no difference between the number of colonies cultured from the povidone-iodine/Betadine compared with the chlorhexidine skin preparation. This finding suggests that chlorhexidine is as effective as 5 minutes of povidone-iodine scrub with 2 paints of povidone-iodine solution.

A Comparison of 5-Minute Povidone-Iodine Scrub and 1-Minute Povidone-iodine Scrub followed by Alcohol Foam

The purpose of this study was to determine if a 1-minute scrub with povidone-iodine followed by alcohol foam is as effective as a 5-minute scrub with povidone-iodine in reducing skin bacterial counts. A 1-minute scrub with povidone-iodine followed by alcohol foam and a 5-minute scrub with povidone-iodine was done. In the first study, cultures were obtained after 1 hour, and in the second study, cultures were obtained after 2 hours. Cultures were obtained by imprinting the first, second, and third fingers on nutrient agar plates. Bacterial counts were then obtained at 24 and 48 hours. The study involved two groups of 12 participants and a total of 37 patients over a period of 5 months. The results show that there was no significant difference between the number of colonies cultured for the 1-minute scrub compared with the 5-minute scrub for either the 1-hour or the 2-hour study. In fact, the total number of bacterial colonies was less after the 1-minute scrub with alcohol foam than after the standard 5-minute scrub in both the 1-hour group (10 vs. 18) and the 2-hour group (18 vs. 44).

Impact of a 5-minute scrub on the microbial flora found on artificial, polished, or natural fingernails of operating room personnel.

Impact of a 5-minute scrub on the microbial flora found on artificial, polished, or natural fingernails of operating room personnel.

The effect of surgical handwash routines on the microbial counts operating room nurses

Many factors may affect the efficiency of handwashing techniques. This study examined two interdependent factors: the time taken to wash the hands and the type of antiseptic solution used. A 3-minute initial scrub and 30-second consecutive scrub regimen was compared with a current standard regimen of a 5-minute initial scrub and a 3-minute consecutive scrub. Chlorhexidine gluconate 4% and povidone-iodine 7.5% were the antiseptics used in the two regimens. The sample (n=34) was drawn from nurses employed in the operating room suite of a 950-bed hospital. Chlorhexidine gluconate was found to be responsible for lower numbers of colony-forming units of bacteria than povidone-iodine. The duration of the scrub had no significant effect on the numbers of bacteria when povidone-iodine was used. The optimal regimen was found to be the 5-minute initial and 3-minute consecutive scrubs with chlorhexidine gluconate. (Ann J INFECT CONTROL 1990; 18:354-64)

Effect of chlorhexidine scrub on postoperative bacterial counts

Chlorhexidine surgical scrub was left on the surgeon's hands in 50 orthopedic and vascular surgical procedures to determine whether the number of bacteria on the hands could be decreased postoperatively. After a standard 5-minute scrub, one hand was randomly rinsed prior to gloving; the other was lightly patted with a sterile towel, leaving some foam on the hand. The surgeon then gloved and performed the procedure in the usual manner. After the operation, both hands were immersed in a tryptic soy broth for 30 seconds. The broth was then cultured for bacterial species and number. Cases in which glove puncture occurred were not cultured. The results were analyzed using the Wilcoxon signed-rank test. There were fewer bacterial colonies isolated from the hand coated with chlorhexidine scrub versus the other; this difference was statistically significant (p less than 0.005). There also seemed to be a trend towards higher bacterial counts after longer operations; however, the difference was not significant. Neither surgeon noted any evidence of dermatitis during the study. These results suggest that leaving chlorhexidine scrub on the hands during surgery can lead to lower bacterial counts on the surgeon's hands and less chance of wound contamination should glove puncture occur.