The impact of surgical hand antisepsis technique on surgical site infection.
BACKGROUND
Limited evidence exists regarding the effect on superficial and deep incisional surgical site infections (SDSSIs) of alcohol-based hand rubs (ABR) versus traditional aqueous surgical scrubs (TSS). User preferences and practice are unknown.


METHODS
A retrospective cohort study examining SDSSIs using VA Surgical Quality Improvement Program cases before ABR implementation (2007-2009, TSS group) and after (2013-2014, ABR group). A descriptive survey.


RESULTS
SDSSI rates were 1.8% and 1.5% for TSS (n=4051) and ABR (n=2293), respectively (p=0.31). The adjusted odds of SDSSI using ABR was not significant (OR 0.82; 95% CI, 0.51-1.32). Greatest SDSSI risk was from preoperative radiotherapy (OR, 2.78; 95% CI, 1.14-6.78), general surgery (OR, 2.39; 95% CI, 1.30-4.39) and preoperative smoking (OR, 1.58; 95% CI, 1.02-2.44). Of 95 surveys included, 52% favored ABR. Although 95% self-reported correct product application, improper duration was revealed in both groups (TSS 18% and ABR 10%).


CONCLUSIONS
Implementation of an ABR for use in surgical hand antisepsis did not alter SDSSI rates. Improving product knowledge and compliance may improve SSI rates.
Department of Surgery, VA Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA; Department of Surgery, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02110, USA. Electronic address: brad.oriel@va.gov.
Brad S
BS
Oriel
Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 South Huntington Avenue, Building 9, Boston, MA 02130, USA. Electronic address: qi.chen2@va.gov.
Qi
Q
Chen
Department of Surgery, VA Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA; Department of Surgery, Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, USA; Department of Surgery, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. Electronic address: kamal.itani@va.gov.
Kamal M F
KM
Itani
D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local; D000985:Antisepsis; D000431:Ethanol; D005260:Female; D006235:Hand Disinfection; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D058996:Quality Improvement; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology*
D000891:Anti-Infective Agents, Local; D000431:Ethanol
Hand hygiene; Surgical hand antisepsis; Surgical rub; Surgical scrub; Surgical site infection