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Prospective, randomised clinical trial of four different pre-surgical hand antiseptic techniques in equine surgery.

Research paper by N M NM Biermann, J T JT McClure, J J Sanchez, M M Saab, A J AJ Doyle

Indexed on: 20 Dec '18Published on: 20 Dec '18Published in: Equine Veterinary Journal



Abstract

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 utilise disinfecting soap. The efficacy of scrubbing versus rubbing and the use of sole ABR compared to chlorhexidine (CHx)- based products has not been evaluated in the equine surgical setting. To compare four surgical hand antisepsis techniques in equine surgery for reduction of aerobic bacterial counts from pre- to post-preparation (immediate efficacy) and at the end of surgery (sustained efficacy). Randomised, prospective clinical trial. A 4% CHx-based product applied with either a scrub or rub technique, one sole ABR (IPO; 30% 1-propanol and 45% 2-propanol) and one CHx/alcohol-combination (CHx/ET; 1% CHx and 61% ethanol) product both applied with a rub technique were evaluated. Samples were collected by glove juice technique and cultured on 3M Petrifilm plates and counted using a 3M Petrifilm plate reader. Immediate mean bacterial log colony forming unit (CFU) reduction was 2.4 for CHx-scrub, 2.8 for CHx-rub, 3.1 for CHx/ET and 2.1 for IPO. CHx/ET resulted in significantly lower bacterial counts than CHx-scrub(p<0.005) and IPO(p<0.001) while CHx-rub resulted in significantly lower counts than IPO(p<0.001). At the end of surgery bacterial counts were the lowest for CHx-rub, significantly lower than CHx/ET(p<0.001) and IPO(p<0.001). There was no difference between CHx-rub and -scrub techniques (p = 0.7). Bacterial counts were used as the outcome measure rather than prevalence of surgical site infection, and the effect of hand preparation on skin health was not assessed. ABR did not decrease bacterial log CFU counts more effectively than CHx products. When using CHx soaps in the equine setting, hand-rubs are as effective as hand-scrub-techniques. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.