Hand-rubbing with an aqueous alcoholic solution vs traditional surgical hand-scrubbing and 30-day surgical site infection rates: a randomized equivalence study.
BACKGROUND
Surgical site infections prolong hospital stays, are among the leading nosocomial causes of morbidity, and a source of excess medical costs. Clinical studies comparing the risk of nosocomial infection after different hand antisepsis protocols are scarce.


OBJECTIVE
To compare the effectiveness of hand-cleansing protocols in preventing surgical site infections during routine surgical practice.


METHODS
Randomized equivalence trial.


METHODS
Six surgical services from teaching and nonteaching hospitals in France.


METHODS
A total of 4387 consecutive patients who underwent clean and clean-contaminated surgery between January 1, 2000, and May 1, 2001.


METHODS
Surgical services used 2 hand-cleansing methods alternately every other month: a hand-rubbing protocol with 75% aqueous alcoholic solution containing propanol-1, propanol-2, and mecetronium etilsulfate; and a hand-scrubbing protocol with antiseptic preparation containing 4% povidone iodine or 4% chlorhexidine gluconate.


METHODS
Thirty-day surgical site infection rates were the primary end point; operating department teams' tolerance of and compliance with hand antisepsis were secondary end points.


RESULTS
The 2 protocols were comparable in regard to surgical site infection risk factors. Surgical site infection rates were 55 of 2252 (2.44%) in the hand-rubbing protocol and 53 of 2135 (2.48%) in the hand-scrubbing protocol, for a difference of 0.04% (95% confidence interval, -0.88% to 0.96%). Based on subsets of personnel, compliance with the recommended duration of hand antisepsis was better in the hand-rubbing protocol of the study compared with the hand-scrubbing protocol (44% vs 28%, respectively; P =.008), as was tolerance, with less skin dryness and less skin irritation after aqueous solution use.


CONCLUSIONS
Hand-rubbing with aqueous alcoholic solution, preceded by a 1-minute nonantiseptic hand wash before each surgeon's first procedure of the day and before any other procedure if the hands were soiled, was as effective as traditional hand-scrubbing with antiseptic soap in preventing surgical site infections. The hand-rubbing protocol was better tolerated by the surgical teams and improved compliance with hygiene guidelines. Hand-rubbing with liquid aqueous alcoholic solution can thus be safely used as an alternative to traditional surgical hand-scrubbing.
Parienti
Jean Jacques
JJ
Departments of Infectious Diseases and Intensive Care Unit, Côte de Nacre University Hospital Centre, 14 033 Caen Cedex, France. parienti@u444.jussieu.fr
Thibon
Pascal
P
Heller
Remy
R
Le Roux
Yannick
Y
von Theobald
Peter
P
Bensadoun
Henri
H
Bouvet
Alain
A
Lemarchand
François
F
Le Coutour
Xavier
X
Bensadoun
Hervé
H
D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D000985:Antisepsis / Q000379:methods*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D018592:Cross-Over Studies; D006235:Hand Disinfection / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D020005:Propanols / Q000008:administration & dosage*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*
D000891:Anti-Infective Agents, Local; D020005:Propanols