Prospective, randomised clinical trial of four different presurgical hand antiseptic techniques in equine surgery
Biermann, N. M., McClure, J. T., Sanchez, J., Saab, M., Doyle, A.J.
Currently, the World Health Organization recommends the use of alcohol‐based hand rubs (ABR) for surgical hand preparation in human surgery. When disinfecting soaps are used, a rubbing technique causes less skin irritation than brush scrubbing. Based on a recent survey, most equine surgeons still use disinfecting soap. This prospective clinical trial compared the efficacy of four surgical hand preparation techniques (three rubs and one scrub) for reduction of aerobic bacterial counts from pre‐ to post‐preparation (immediate efficacy) and at the end of surgery (sustained efficacy).
The four techniques used were a hand scrub with 4% chlorhexidine gluconate soap (CHx scrub), a hand rub with 4% chlorhexidine gluconate soap (CHx rub), a hand rub with 61% ethanol solution with 1% chlorhexidine gluconate (CHx/ET), and a hand rub with a mixture of 30% 1‐propanol and 45% 2‐propanol solution (IPO).
Clinicians participating in equine surgical procedures were enrolled during an 18‐month study period and were not blinded to hand preparation technique. Techniques were randomly assigned and a wash out period of approximately 3 days given between them. Samples were collected by the glove juice technique after one‐minute of a neutral soap hand wash (pre‐preparation), following completion of the randomly assigned hand preparation technique (post-preparation), and finally at the end of surgery (post-surgery). Aerobic bacterial log10 colony forming units (CFU) counts were performed.
A total of 228 hands from seven clinicians were sampled in 109 surgical procedures. Immediate mean bacterial log10 CFU reduction was 2.4 for CHx‐scrub, 2.8 for CHx‐rub, 3.1 for CHx/ET rub and 2.1 for IPO rub. CHx/ET rub resulted in significantly lower bacterial counts than CHx‐scrub and IPO rub, while CHx‐rub resulted in significantly lower counts than IPO rub. At the end of surgery bacterial counts were the lowest for CHx‐rub, significantly lower than CHx/ET rub (P<0.001) and IPO rub (P<0.001). There was no difference between CHx‐rub and ‐scrub techniques.
Bottom line: ABR did not decrease bacterial log10 CFU counts more effectively than CHx products. When using CHx soaps in the equine setting, hand‐rub is as effective as a hand‐scrub technique.