Waterless, Scrubless Alcohol-Based Surgical Scrub Agent Compared to Traditional Surgical Scrub Using Chlorhexidine

BACKGROUND/OBJECTIVES: In veterinary surgery traditionally, the surgical hand scrub involves scrubbing the hand and forearms with a brush or impregnated sponge/brush for 6 minutes using a timed method or an anatomic stroke-count method. The new brushless techniques consist of vigorously rubbing an antimicrobial agent on the hands and arms for approximately 1.5-3 minutes. Alcohol-based scrub agents have been suggested as an alternative to the traditional method since prior studies have shown that prolonged and repeated scrubbing with a scrub brush increases skin damage and microbial skin counts. This study examined the effectiveness of a 1.5-2 minute application of a waterless, scrubless hand preparation containing 61% ethyl alcohol and 1% chlorhexidine, as compared to a traditional 6 minute scrub using 2% chlorhexidine on the initial reduction of bacterial counts on the hands of veterinary students preparing for surgery. The hypothesis was the scrubless alcohol-based technique would reduce bacterial counts at one-minute post scrubbing as effectively as a traditional surgical scrub using 2% chlorhexidine. METHODS: Thirty-two veterinary students were randomly assigned to perform either a traditional scrub or an alcohol-based scrub one week. The alternative technique was done the second week. Prior to the first surgical scrub of the day, hand cultures were performed using the modified glove-juice technique. After performing the randomly assigned scrub technique, the hand was cultured a second time one minute post scrub. An aliquot of culture solution was plated and colony-forming units were determined. The differences between groups in pre- and post-treatment log counts and log reductions were examined with a paired studentʹs t-test using statistical significance of P ≤ 0.05. RESULTS: Both 2% chlorhexidine and the alcohol-based prep technique showed significant (P < 0.0001) reductions from baseline bacterial counts at one minute. No difference occurred between the groups in log reduction from baseline counts or post treatment log counts. CONCLUSIONS: This scrubless, waterless, alcohol-based scrub agent provides an effective alternative to the more traditional chlorehxidine and scrub brush techniques in reducing bacterial counts on hands being prepared for surgery.