Comparative antimicrobial efficacy of 4 surgical-hand-preparation procedures prior to application of alcohol-based hand rub in veterinary students

Abstract

OBJECTIVE: To determine the influence of skin preparations before application of an alcohol-based hand rub (ABHR) on bacterial counts before and after elective surgery. STUDY DESIGN: Clinical prospective study. SAMPLE POPULATION: Veterinary students (n=103) performing ovariohysterectomies on 140 dogs. METHODS: Participants were randomly assigned to 1 initial surgical preparation on the day of surgery: A–hand preparation with medicated solution (4% w/v chlorhexidine bigluconate followed by an ABHR; B–application of a medication solution (benzalkonium chloride 0.1%-1%and polymeric biguanide hydrochloride0.01%-0.1%) followed by an ABHR; C–nonmedicated pH-neutral soap hand wash followed by ABHR, and D–direct application of an ABHR. Samples were taken by pressing the distal finger tips to an agar plate before the hand preparation, after the hand preparation (n=3), after ABHR application, and 120 minutes later. Colony-forming units (CFUs) for samples were determined. Total log CFU and CFU log10 reduction were calculated and used for comparison with P<.05. RESULTS: Two hours after surgery commenced, the participants of groups that performed a hand preparation had lower total CFUs than those that did not perform a hand preparation (P=.001). In particular, the number of CFUs was lower when ABHR was performed after application of pHN compared to direct ABHR (P=.001). CONCLUSION: In this population, performing a hand preparation with pHN prior to applying an ABHR had better antimicrobial effect for the duration of surgery than not performing a hand preparation. CLINICAL SIGNIFICANCE: Surgeons should wash their hands prior to ABHR before starting their first surgery of the day, even when hands appear clean.