Hand washing in operating room: a procedural comparison

Background: Hand washing has been considered a measure of personal hygiene for centuries and it is known\udthat improper hand hygiene among healthcare workers is responsible for about 40% of healthcare-associated\udinfections. Therefore, surgical hand preparation is a critical element for healthcare safety in order to reduce the\udmicrobial contamination of surgical wounds in case of a non-detected perforation of a glove. The aim of our study\udwas to evaluate the efficacy of three antiseptics: Povi-iodine scrub, EPG (Ethanol, Hydrogen Peroxide, Glycerol)\udrecommended by WHO and common Marseille soap in a liquid formulation.\udMethods: We designed a single-centre pre-post study conducted in the University Hospital of Messina, from January\udto June 2013. We asked operating room personal to put the fingertips of their right hand (if not left-handed) for one\udminute on PCA medium, before washing with the three types of antiseptics, and after washing and drying. Drying was\udcompleted using sterile gauzes or disposable wipes. We then measured the number of colony forming units per mL\ud(CFU/mL) and calculated the percentage of microbial load reduction. The criteria for inclusion were to be part of a\udsurgical team ready to perform a surgical intervention within 20 minutes of subsequent sampling. The Mann Whitney\udtest was used to verify if the reduction of microbial load was statistically significant for each antiseptic.\udResults: 210 samples were considered for statistical analysis. Washing with Marseille soap led to a reduction of\udmicrobial load of 64,3% (standard deviation s.d. 25,6), washing with Povi-iodine scrub of 75,9% (s.d. 27,1),\udwashing with EPG of 86,5% (s.d. 20,4). The reduction of the microbial load was statistically significant (p\udvalue<0,01) for each antiseptic.\udConclusions: Although washing with Marseille soap and with Povi-iodine scrub led to a statistically significant reduction\udof the microbial load of the hands, our study showed that washing with EPG had superior efficacy in CFU reduction.\udAntiseptic hand washing, however, should not be considered the only measure to reduce infections: the anomaly of\udsome results (initial microbial load lower than after washing) demonstrated that drying is an essential phase in the\udpre-surgical preparation. Therefore, hand hygiene must be part of a more complex strategy of surveillance and control\udof healthcare-associated infections