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Hand-Rubbing With an Aqueous Alcoholic Solution vs Traditional Surgical Hand-Scrubbing and 30-Day Surgical Site Infection Rates
A Randomized Equivalence Study
Jean Jacques Parienti, MD, DTM& ;H;
Pascal Thibon, MD;
Remy Heller, PharmD, PhD;
Yannick Le Roux, MD, DCh;
Peter von Theobald, MD, DCh;
Hervé Bensadoun, MD, DCh;
Alain Bouvet, MD;
François Lemarchand, MD, DCh;
Xavier Le Coutour, MD;
for Members of the Antisepsie Chirurgicale des Mains Study Group
JAMA. 2002;288:722-727.
Context Surgical site infections prolong hospital stays, are among the leading nosocomial causes of morbidity, and a source of excess medical costs. Clinical studies comparing the risk of nosocomial infection after different hand antisepsis protocols are scarce.
Objective To compare the effectiveness of hand-cleansing protocols in preventing surgical site infections during routine surgical practice.
Design Randomized equivalence trial.
Setting Six surgical services from teaching and nonteaching hospitals in France.
Patients A total of 4387 consecutive patients who underwent clean and clean-contaminated surgery between January 1, 2000, and May 1, 2001.
Interventions Surgical services used 2 hand-cleansing methods alternately every other month: a hand-rubbing protocol with 75% aqueous alcoholic solution containing propanol-1, propanol-2, and mecetronium etilsulfate; and a hand-scrubbing protocol with antiseptic preparation containing 4% povidone iodine or 4% chlorhexidine gluconate.
Main Outcome Measures Thirty-day surgical site infection rates were the primary end point; operating department teams' tolerance of and compliance with hand antisepsis were secondary end points.
Results The 2 protocols were comparable in regard to surgical site infection risk factors. Surgical site infection rates were 55 of 2252 (2.44%) in the hand-rubbing protocol and 53 of 2135 (2.48%) in the hand-scrubbing protocol, for a difference of 0.04% (95% confidence interval, -0.88% to 0.96%). Based on subsets of personnel, compliance with the recommended duration of hand antisepsis was better in the hand-rubbing protocol of the study compared with the hand-scrubbing protocol (44% vs 28%, respectively; P = .008), as was tolerance, with less skin dryness and less skin irritation after aqueous solution use.
Conclusions Hand-rubbing with aqueous alcoholic solution, preceded by a 1-minute nonantiseptic hand wash before each surgeon's first procedure of the day and before any other procedure if the hands were soiled, was as effective as traditional hand-scrubbing with antiseptic soap in preventing surgical site infections. The hand-rubbing protocol was better tolerated by the surgical teams and improved compliance with hygiene guidelines. Hand-rubbing with liquid aqueous alcoholic solution can thus be safely used as an alternative to traditional surgical hand-scrubbing.
Author Affiliations: Departments of Infectious Diseases and Intensive Care Unit (Dr Parienti), Hygiene and Public Health (Drs Parienti, Le Coutour, and Thibon), Abdominal Surgery (Dr Le Roux), Gynaecology and Obstetrics (Dr von Theobald), and Urology (Dr Bensadoun), Côte de Nacre University Hospital Centre, Caen; Department of Hygiene, General Hospital, Colmar (Dr Heller); Department of Anaesthesiology, François Baclesse Oncology Centre, Caen (Dr Bouvet); and Department of General Surgery, General Hospital, Pont-Audemer (Dr Lemarchand), France.
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JAMA. 2002;288(21):2688-2689.
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