Preoperative Scrubbing Research Articles

A Randomized Control Trial to Compare the Efficacy of Routine Soap Water V/S Alcohol Based Hand Sanitizer in Pre-Operative Scrubbing at Tertiary Health Centre in Western India

Introduction: Hand Hygiene is important for preventing healthcare related infections. Effective hand scrubbing is important for the success of surgical procedure. Pre operative scrubbing using soap and water is routinely used, however, there are many benefits of using alcohol-based hand sanitizer in preoperative scrubbing. Objective: The objective was to compare the efficacy of Routine soap water scrubbing versus Alcohol based hand sanitizer in pre-operative scrubbing by comparing the microbiological profile of swab samples of scrubbed participants. Materials and Methods: Total 200 participants who got scrubbed in the Surgery Department of an Ahmedabad based medical college, were enrolled for the study. Study design chosen was randomized trial where out of 200 participants, 100 each were randomly allocated into two groups of (1) Routine soap water scrubbing and (2) Alcohol-based hand sanitizer scrubbing. After hand scrubbing in either of the group, every participant was sampled from different areas of hand immediately before the operation. The samples were sent for culture and sensitivity (C & S) testing and results obtained were documented. Results: No growth of organism was observed in C & S reports from the swabs of all 200 participants. Conclusions: Alcohol based hand sanitizer is equally efficacious to Routine soap water scrubbing in preoperative scrubbing. Keywords: Soap water scrub, Alcohol-based hand sanitizer, pre-operative scrubbing,

Water – An Evaporating Resource

Humans are affected in numerous ways by climate change. Drought and water scarcity is an important area that must be addressed. Hospitals use a large amount of their community's water supply and therefore play a part in water conservation. The orthopaedist can minimize water waste in the operating room in multiple ways. The most immediate impact can be made by using less water for pre-operative scrubbing, either by turning off the water when not actively rinsing or by converting to waterless scrub. Eliminating rarely used surgical instruments from trays can save water and decrease costs to the hospital. Conserving water benefits both the hospital and the planet.

Surgical site infections following caesarean sections in the largest teaching hospital in Ghana

SummaryBackgroundSurgical site infections complicate up to 15% of all surgical procedures depending on surgery type and underlying patient status. They constitute 14–31% of all hospital-acquired infections, placing huge financial burdens on patients, healthcare institutions and the nation.ObjectiveTo determine the incidence, risk factors, microbiological aetiology and antibiotic susceptibility patterns of surgical-site infections following caesarean sections (CSs) at Korle Bu Teaching Hospital (KBTH), Accra, Ghana.MethodsThis prospective study involved 500 women who underwent CS from April to July 2017 at KBTH. Overall, 474 women completed the study with 26 women lost to follow-up or opting out of the study. Women were recruited on the first postoperative day and followed-up postnatally. Sociodemographic and obstetric data were obtained using a structured questionnaire. Swabs of infected surgical wounds were taken for culture and sensitivity testing using the Kirby–Bauer disk diffusion technique. Data was analysed using SPSS version 22.ResultsSixty-one (61/474) women (12.8%) had SSIs after CS. Of these, 41 (67.2%) were superficial, 18 (29.5%) were deep incisional and 2 (3.3%) were organ space SSIs. Significant risk factors for SSI were: emergency CS after 8 h of active labour, midline incisions, use of stored water for surgeon's pre-operative scrubbing, maternal status being single and alcohol consumption during pregnancy. Staphylococcus aureus was the commonest pathogen isolated with 6 (9.8%) being meticillin resistant (MRSA). Antibiotic susceptibility was mostly to quinolones.ConclusionSSI occurred in 12.8% of CS wounds at the KBTH, commonly caused by S. aureus.

12726 Allergic contact dermatitis in the operating room: A comprehensive analysis of surgical scrubs and disinfectants

Background: Antiseptics and disinfectants used for preoperative scrubbing and patient site preparation are integral to avoidance of postsurgical infections. While allergic contact dermatitis to these products has been reported (1-5), little is known about their ingredients.

Frequency of Infection in Cervical Lymph Node Biopsy Site using Chlorhexidine and Povidine Iodine

Abstract:Background: Lymph node are located throughout the lymphatic system, they are concentrated in certain areas of the body including head and neck. Cervical lymph nodes are lymph nodes found in the neck. Of the 800 lymph nodes in the human body, 300 are in the neck. Cervical lymph nodes are subject to several different pathological conditions including tumours, infection and inflammation.Methodology: The Povidine-iodine and chlorhexidine for preoperative skin preparation in cervical lymph node biopsy procedure were used in this study and patients were asked for follow up after a week. On follow up day their wounds were checked, assessed and withdraw all stiches and complications were recorded accordingly and analysed them. It was discussed and showed that which one of Povidine-iodine and chlorhexidine is best to use for preoperative skin preparation in cervical lymph node biopsy procedures to reduce surgical site infection and economical one.Results: Out of 150 patients, 46% (69) were males and 54% (81) were females that had cervical lymphadenopathy after skin preparation by chlorhexidine antiseptic solution showed frequency of infection in total of 150 patients 16.67% (25) were infected while the other 83.33%(125) were not infected. Out of 150 patients who were underwent cervical lymphadenopathy after using povidine iodine skin preparatory antiseptic solution, 42% (63) were males and 58% (87) were females and among those frequency of infection showed 44.67% (67) were infected while the others 55.33% (83) were not.Conclusion: Preoperative scrubbing of the patient’s skin with chlorhexidine–alcohol is better than scrubbing with povidone–iodine for preventing surgical-site infection after cervical lymph node biopsy.

Preoperative Skin Preparation

Recent work by Ellenhorn and coworkers tested the idea that preoperative scrubbing of skin with povidoneiodine soap adds no incremental protection against wound infection. Two cohorts (n 115 and n 119) were created by randomizing abdominal surgery patients to “paint-only” or “scrub-plus-paint” categories. If the authors were fastidious in their experimental execution, if randomization was “perfect” (ie, risk factors balanced), and if infection surveillance accuracy was the same for each cohort, comparing infection rates for the two experimental cohorts might support a generalization about the value of a povidone-iodine scrubbing step. The authors observed an incisional infection rate of 10% for each of their cohorts and essentially identical intraabdominal infection rates (3% and 2%) as well. I worry that certain nuances in their interpretation of these findings could unintentionally confuse fatigued readers who might skim the article’s abstract after full days of elective operating or long nights on emergency call. Whenever inferential statistics are used to compare frequencies of some defined outcomes in two clinical trial cohorts, a thought experiment is being performed in hopes of sharpening knowledge of reality. Essentially, such cohorts are viewed as samples taken from two populations or universes. In the Ellenhorn study, one imagined universe was “all abdominal surgery patients on Earth receiving paint and scrub” and the other imagined universe was “all abdominal surgery patients on Earth receiving only paint.” A statistical maneuver estimates the range of rate differences between universes that are compatible with some observed cohort rate difference, which might be zero, as measured in the present case. The authors used a method described by Rodary and colleagues and obtained an nonsignificant p value, concluded that the skin preparation routines are equivalent, and called for the elimination of povidone-iodine scrubbing. The meaning of equivalence is critical in digesting this article. The authors declared before commencing the trial that an absolute infection rate difference as great as 6% would be deemed compatible with equivalence of the skin preparation routines, but no clinical rationale was offered for selecting that value. In addition, hasty readers can misconstrue the adjective absolute. Unfortunately, the authors did not emphasize that their results cannot rule out a large advantage of adding povidoneiodine scrubbing. For example, their data are compatible with an actual infection frequency of 14.5% in the paintonly universe and 7% in the paint-plus-scrub universe. In clinical practice, this would represent an infection risk differential of 50% and few infection prevention protocols can discount any tactic having that potential impact. Using the authors’ raw data, computation of an exact 95% confidence interval (with continuity correction) for the difference in infected proportion between universes reveals a considerably wide range ( .085 to .089). We can confidently conclude only this: povidone-iodine scrubbing might add benefit, might have no effect at all, or might actually increase infection likelihood. These are the same three possible knowledge states that existed before the authors’ experiment was performed. Maybe we should discard preoperative povidone-iodine scrubbing. Maybe we should not.

Delayed Massive Hemorrhage after Pancreaticoduodenectomy: A New Therapeutic Approach

riority trial require that an initial difference in outcomes between groups be designated as a clinically relevant difference. Adhering to a strict interpretation of the results of the equivalency trial, one can only make conclusions with respect to the difference in outcomes initially designated. For our study, we chose 6% as that designated difference, to avoid a potentially meaningless difference in infection rate between groups, which might be statistically different but not clinically relevant. This was balanced with the sample size requirements for a smaller equivalence threshold. In Dr Lee’s example for comparing 9% infection rate for paint-only versus 4% in paint-plus-scrub, the sample size requirements would be approximately 650 patients per group (1,300 patients total). We have contributed to the literature a controlled clinical trial that was designed to test the idea that preoperative scrubbing of skin with povidone-iodine soap adds no incremental protection against wound infection. We do not agree with Dr Lee that our results have the same interpretation as a hypothetical trial, where the actual infection frequency was 9% in the paint-only arm and 4% in the paint-plus-scrub arm. Although Dr Lee’s worst-case outcomes would be within the tolerance of our 6% equivalence threshold based on our current results and the results of previous trials, that specific outcome would be unlikely given the data that has been reported as of this writing. Admittedly, Dr Lee is correct that the interpretation of our results has not added to the possible knowledge-space: povidone-iodine scrubbing might add benefit, might have no effect at all, or might actually increase infection likelihood. Statistical reasoning does not deal in perfect knowledge states. It can lead to conclusions that speak to the likelihood of outcomes. We would argue that our data have shown that the advantage of povidone-iodine scrubbing over paint-only is minimal at best because it is the most likely interpretation. Despite the results of even the most rigorously designed single clinical trial, the thoughtful clinician will always weigh the pros and cons of altering his or her clinical practice. Results of our single clinical trial must be interpreted in the context of the four earlier clinical trials available for review, all of which are cited in our publication. Each of these was a negative trial, and each trial compared the “gold standard” scrub-plus-paint to something different and often less than scrub-pluspaint. In view of this body of literature and our clearly negative clinical trial, an objective observer who is not lost in the vagaries of statistical minutiae, can conclude that a reasonable argument can be made for abandoning scrub-and-paint.

Scrubbing brush decontamination—cement burn treatment

Use of a pre-operative scrubbing brush to decontaminate cement burns is described. As cement particles are removed, further damage is prevented and patients derive great relief.

Are Sterile Water and Brushes Necessary for Hand Washing before Surgery in Japan?

To examine whether sterile water and brushes are necessary for hand washing before surgery. Twenty-two operating room nurses were randomly divided into two groups as follows: 11 nurses who used 7.5% povidone iodine (PVI group) and another 11 nurses who used 4% chlorhexidine gluconate (CHG group) to wash their hands using the rubbing method. All the nurses were examined for bacterial contamination of their hands before and after surgical hand rubbing. We used tap water to wash the hands at the sink used for washing surgical instruments in the operating room and non sterilized plastic brushes. No bacteria were detected in the tap water. Before washing the hands, the number of bacteria detected was 5.0 x 10(3) cfu/H in the PVI group and 4.0 x 10(3) cfu/H in the CHG group, which were similar in both groups. After washing the hands, the median value of the bacteria decreased to 8.7 x 10(2) cfu/H in the PVI group and 0 cfu/H in the CHG group. Sterile water and brushes are not necessary for preoperative scrubbing up. When using tap water for surgical hand washing, 1) the hand-rubbing method should be used; 2) a quick-alcohol-based disinfectant scrub should be used; 3) the concentration of free chloride in the water should be maintained at over 0.1 PPM; 4) the bacterial contamination of the water should be checked; and 5) the faucet should be routinely cleaned and sterilized.

Pre-operative scrubbing safe without use of brushes

Pre-operative scrubbing safe without use of brushes

Pre-operative scrubbing: what a waste of water!

Pre-operative scrubbing: what a waste of water!

Studies of the surgical scrub.

To evaluate the effectiveness of various scrub techniques in reducing bacterial skin flora, the present study was developed in three stages. Each stage involved fingertip bacterial colony counts measured before, immediately after and 30 min after a variety of handwashing techniques using 10% povidone iodine solution. The first compared 1, 2 or 3 non-timed washes from fingertips to elbows in 10 volunteers. The second compared two volunteers scrubbing for equal durations with or without friction rubbing, while the third involved 15 volunteers who each scrubbed for different time intervals. The first stage showed that a single wash episode failed to provide lasting bacterial colony count reductions on fingertip cultures. The second showed that enduring colony count reductions occur whether friction rubbing of the hands was used or not, and the third showed that a 30 s wash was as effective as washing for longer periods in reducing fingertip flora. These findings suggest that prolonged vigorous pre-operative scrubbing is unnecessary, although more than a cursory wash is required to produce lasting fingertip antisepsis.

Mechanical Air Drying of Hands following Preoperative Scrubbing

Mechanical Air Drying of Hands following Preoperative Scrubbing

A study of the effectiveness of some skin detergents under conditions of use

From a study of the antibacterial action of three clinical skin detergents under conditions of use the following suggestions are made: 1. 1. Of the three compounds tested, pHisoderm containing 3 per cent hexachlorophene is a more effective degerming agent than a compound containing Phemerol ( 2 1 2 per cent). Both of these compounds are more effective after one- and four-hour periods than a liquid soap containing hexachlorophene in the amount of 2 per cent of the soap content (36 per cent). 2. 2. A comparison of the antibacterial action of liquid soap containing 2 per cent hexachlorophene with tincture of U. S. P. green soap at half-hour intervals indicates that there is an over-all reduction of 60.6 per cent of transient and resident organisms; with liquid germicidal detergent containing 2 1 2 per cent Phenemrol a reduction of 3 per cent is noted; and with pHisoderm containing 3 per cent hexachlorophene, a reduction of 84 per cent. 3. 3. Blood agar plates held in contact with unwashed hands for ten seconds show three and one-half times more organisms than when the hands are washed with pHisoderm containing 3 per cent hexachlorophene: a mean total plate count of 93.7 with an S.D. of 78.6 as compared to the mean total plate count of the washed hands of 26.3 with an S.D. of 30.1. The methods of procedure presented here offer a practical and comparative approach to the testing of surgical detergents and are in keeping with the newer techniques of preoperative scrubbing with hexachlorophene. The over-all scrubbing time has been reduced from approximately fifteen minutes with the old technique of using liquid soap and an alcohol rinse to three minutes with pHisoderm containing hexachlorophene 3 per cent. With the latter material a marked degermation of the skin microorganisms is obtained. The results reported in this study demonstrate that by continued use of this compound containing 3 per cent hexachlorophene the dentist can obtain a greater degree of surgical cleanliness of the hands than that possible through the use of any other detergent. By following this suggested procedure the dentist can obtain a greater degree of protection to himself as well as to his patient.