Challenging Currently Accepted Surgical Scrub Regimens to a Control: Are These Protocols Truly Advantageous and Cost Effective?

摘要

Background: Scrubbing prior to invasive surgical procedures has been an area that has been devoted to great amounts of research. Unfortunately, after numerous studies, there still is no agreed upon regimen for scrubbing prior to entering the operating room. Numerous methods have been used such as the chlorhexidine and povidone iodine scrub brushes, chlorhexidine/ethyl alcohol liquid scrub, and ethyl alcohol alone. Although all have shown some benefits, data shows that there still exists room for improvement. The goal of this study was to determine the need, if any, for antiseptics and antiseptic scrub brushes in a scrubbing regimen with hands having a larger than normal bacterial load. It compares the decrease in positive aerobic swab culture growth caused by two minute hand scrubbing regimens using a 2% chlorhexidine/ 61% ethyl alcohol liquid scrub, a 4% chlorhexadine scrub brush, non -antibacterial soap, and simply running water. Methods: Four scrub trials were conducted and fifty aerobic swabs were used to take a specimen of the investigator's hand. The trials consisted of scrubbing for two minutes with running water, with non-antibacterial soap, SURGICEPT (2% chlorhexidine/61% ethyl alcohol liquid scrub), and a 4% chlorhexidine scrub brush. The amount of positive aerobic cultures was compared between the four trials. Results: The trial consisting of just running water had statistically significant greater positive aerobic growth; (p=0.0005 with a RR of 2.5) when compared to non-antibacterial soap, (p=0.0011 with a RR of 2.31) when compared with SURGICEPT, and (p=0.0002 with a RR of 2.73) when compared with the chlorhexidine scrub brush. There was no statistically significant difference in the number of positive aerobic swabs in the scrub trials with the non-antibacterial soap, SURGICEPT, and a chlorhexidine scrub brush, (p=0.8961). Conclusions: Plain running water was statistically less effective at decreasing the number of positive aerobic cultures when compared to scrubbing with non-antibacterial soap, SURGICEPT, and a chlorhexidine scrub brush. There was no statistical significance in the effectiveness at decreasing the number of positive aerobic cultures between non-antibacterial soap, SURGICEPT, and a chlorhexidine scrub brush. Level of Evidence: Therapeutic Level 2. See instructions to Authors for a complete description of levels of evidence. Introduction Operating room staff members are required to perform various regimens of hand and forearm scrubbing prior to surgical procedures in hopes of reducing the transfer of microorganisms to patients during surgery that may result in postsurgical infections. Despite the fact that surgical hand scrubbing has been a part of pre-surgical procedure for decades, the optimum scrubbing regimen, such as scrubbing duration, which antiseptics or detergents to use, and whether to use a brush, is still subject to debate [1,2].Normal human skin contains bacteria, usually about 102 to 106 colony forming units (CFU) per cm2 [3]. prior to operating, scrub team members try to remove extraneous organisms, or transient flora, and minimize the amount of their own skin organisms, or resident flora, with a scrubbing regimen [3,4].Recommended practices for surgical hand scrubbing vary widely across organizations and countries. Existing North American guidelines on surgical hand scrubbing do not indicate a specific scrubbing duration or which antiseptic agents to use. In the United States, the Association of Operating Room Nurses (AORN) does not recommend a specific scrubbing duration [5]. however, based on study findings [6,7,8], aorn does recognize the advantages of shorter scrubbing duration. the association for professionals in infection control and epidemiology recommends a handwash followed by scrubbing for at least 120 seconds [1]. apic also recognizes the use of a european technique that is essentially a handwash followed by an alcohol rub for at least 20 seconds [1]. the centers for dise