Surgical hand scrubs in relation to microbial counts: systematic literature review.
OBJECTIVE
This paper reports a systematic review whose objective was to determine the effectiveness of surgical hand scrubs in relation to bacterial growth on the hands of operating room staff members.


BACKGROUND
Despite the need for surgical hand scrubs, evidence shows that frequent and prolonged use of antiseptics and brushes may damage the skin. Consequently, lesions may appear, become more heavily colonized by microorganisms and increase the risk of transmitting infection to patients. Recommendations about surgical hand scrubs vary widely and their effectiveness in relation to microbial counts is unknown.


METHODS
A variety of healthcare databases were searched covering the period between January 1990 and December 2004. Based on selection criteria, the abstracts of studies identified were checked to determine whether they fulfilled the inclusion criteria. All studies were assessed as having adequate methodological quality. Using Cochrane Review Manager 4.2 software, weighted mean difference and 95% confidence intervals were calculated.


RESULTS
Three studies were included in this review. Two studies compared the effectiveness of surgical hand scrubs using an alcohol-based product and a 6-minute scrub using 4% chlorhexidine gluconate; meta-analysis showed a statistically significant difference (weighted mean difference = -0.63, 95% confidence intervals = -0.99 to -0.27, P = 0.0006). One study compared the effectiveness of 2- and 3-minute surgical hand scrubs using 4% chlorhexidine gluconate; meta-analysis showed no difference (weighted mean difference = 0.29, 95% confidence intervals = -0.13 to 0.71, P = 0.18).


CONCLUSIONS
Surgical hand scrubs using an alcohol-based product were more effective than a 6-minute scrub using 4% chlorhexidine gluconate. There is no evidence to support a 2-minute surgical hand scrub as being more effective than a 3-minute one using 4% chlorhexidine gluconate.
Hsieh
Hsiu-Fang
HF
Nursing Department, Fooyin University, Kaohsiung Hsien, Taiwan.
Chiu
Hua-Hsien
HH
Lee
Feng-Ping
FP
D000438:Alcohols; D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine / Q000031:analogs & derivatives; D015169:Colony Count, Microbial; D006225:Hand / Q000382:microbiology*; D006235:Hand Disinfection / Q000379:methods*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
D000438:Alcohols; D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine