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