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Title:
Efficacy of Different Surgical Hand Washing Methods

Author(s):
Mohammad Reza Abbasian MD, Ali Akbar Esmailiejah MD, Hamid Reza Seyyed Hosseinzadeh MD*

Affiliattion(s):
Shahid Beheshti University of Medical Sciences, Tehran, Iran

* Corresponding Author

Vol 2, Num 1, January 2015

 

   

Abstract

Introduction:Hand washing and hand antisepsis in operating theatre (OT) are necessary to decrease post operation infection. Betadine (10% povidone-iodine solution) is used as an antiseptic solution followed by rinsing either with running tap water, sterile water, normal saline or other solutions. Alcohol based solutions are also used as antiseptics. In the current study, we sought to examine hand sterility following rinsing with tap water as final process of surgical hand hygiene and compare it with other new alcohol based antiseptic solutions and other old methods of rinsing the hands as the final process of hand washing.

Materials and Methods:The study was conducted on 24 surgeons and operating personnel washing their hands with Betadine as a disinfectant followed by rinsing with either of the following solutions on four different days: sterile water, normal saline, tap water and alcohol 70%. On another day, the participants washed their hands with an alcohol based solution, Decocept, with no rinsing. On the sixth day, no washing was performed before taking the samples. Samples were taken from the hands of the participants for microbial analysis after performing the washing in all the stages. Tap water was also analyzed for microbial contamination.

Results:At 48h, no microbial growth was detected in the samples taken from those washing their hands with sterile water, normal saline, alcohol 70% and decocept solution. However, in 33.3% (8 cultures) of the samples taken from those washing their hands with tap water, certain microorganisms such as bacillus subtilis and negative staphylococcus coagulase were detected. The results were significantly different from other methods of hand washing (p=0.002). At 72h, microbial growth was detected in 50% (12 cultures) of the samples taken from those washing their hands with normal saline and in 33.3% (8 cultures) of the samples taken from those washing their hands with tap water. However, the difference between the two groups was not significant (p=0.242). No microbial growth was detected in the samples related to washing with alcohol, sterile water and Decocept.

Conclusion:The strict methods of hand washing with solutions free from microorganisms prior to operation are essential to control postoperative infections.

Keyword:Hand washing, Decocept, Alcohol, Tap water

 

   

Introduction

Hand washing following hand antisepsis with Betadine prior to surgery is crucially important in any operating theatre and is usually performed in different methods. In most hospitals in European countries as well as in US, tap running water is used as the final process of hand sterility prior to surgery.(1,2) However, in Japan, it is forbidden to use tap water for surgical hand washing and instead, sterile water is used.(3,4) In certain studies, such as the one conducted by Fujii et al in Japan, it is demonstrated that there is no need to use sterile water as surgical hand washing (5), However, Furukawa demonstrated that surgical hand washing with tap water with chloride concentration more than 0.1 PPM as well as using hand brush scrubs and alcohol based solutions is considered to be adequate for hand sterility (6). Since it is crucially important to ensure sterility of all surgical environments, equipment and surgeon hand in deep and orthopedic surgeries, further studies are essential in providing conclusive evidence over the appropriate method of surgical hand washing. Thus, the present study aims at examining and comparing different methods of hand washing such as using tap water, normal saline, alcohol 70%, sterile water, and Decocept after washing with antiseptics.

Materials and Methods

The present study was conducted on 24 surgeons and operating personnel working in Akhtar Hospial in Tehran in 2013. All the participants were blinded to the study. The study took place in 6 stages with an interval of at least one day (or one surgery interval). In the first four stages, the participants were required to perform an antisepsis routine hand wash and scrub with Betadine followed by washing and rinsing off the Betadine with either of the following methods: normal sterile saline, 70% alcohol, sterile water, and tap running water. In the fifth stage, the participants washed their hands only with Decocept solution for 40 seconds, in the sixth stage, samples were taken from the hands of all the participants before they start their routing Betadine wash and scrub prior to the operation. The sixth stage is considered as the control group increasing the validity of the study.

All the participants were blinded to the method of hand washing and the day each stage of the study was going to be conducted. Samples for microbial culture were taken from the tap water on the day the participants washed their hands with it. All the samples were taken in the morning before the first surgery and none of the participants knew about the type of surgery, duration of surgery and the operating room to avoid the possible interference in the process of hand washing. All the samples were taken from the palm of the hand after hand washing at the standard microbial conditions. All the samples were kept in incubators for 72h in similar conditions for microbiological analysis.

In four stages of the study, the participants performed hand washing with Betadine 7.5% according to AFPP criteria (8) prior to the operation. Since the purpose of the study was to compare different methods of hand washing with tap water, the results of the microbial analysis of the samples taken after hand washing with tap water was compared with those taken after washing with other methods at 24h, 48h and 72h of being in the microbial culture media. Chi square test was used for data analysis and P< 0.05 was considered to be significant.

Results

The results of the analysis indicated that no microbial growth was observed in any of the cultures at 24h. However, at 48h, microbial growth was observed in certain cultures which are presented in table 1.

The microbial culture for tap water was negative at 48h. The comparison of the results of the microbial analysis after washing with tap water with other methods at 48h indicated significant differences (P=0.002). At 72h, certain microorganisms were detected in the cultures for normal saline which was not significantly different from tap water method (P=0.242). However, there were significant differences between the results of washing with tap water and normal saline with other methods of washing.

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    Table 1: The results of the microbial analysis at each stage of the study at 48 h
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    Discussion

    Surgeons, all over the world, according to certain published guidelines, wash their hands with disinfectants followed by rinsing with different types of solutions to control hospital acquired infections. According to the guidelines published in North America, the hands are rinsed with tap water and this has not resulted in higher incidence of postoperative infection as compared with other areas.(2)

    While, in some countries there are strict guidelines to control postoperative infection, tap water is used as a routine procedure for washing off disinfectants in Iran. However, the results of the present study indicate that while no microbial growth was detected in the cultures at 24h, certain microorganisms grew in 8 microbial cultures (33.3% of all cultures) for those who rinsed their hands with tap water. No microbial growth was detected in other culture media for the samples taken from those who washed their hands other solutions. Although less microbial growth was detected in the cultures for tap water group as compared with no wash group (control group), tap water was less effective than other methods of hand washing.

    Further investigation showed that bacterial infection was detected in the cultures for normal saline hand wash group at 72h, which was not significantly different from the tap water hand wash group. However, both tap water and normal saline wash were less appropriate than washing hands with alcohol, sterile water and Decocept, in that, no microorganisms were detected in the relevant culture media.

    Considering the types of microorganisms grown in the culture media, it is not possible to attribute them to lab contamination. Thus, we can conclude that it is necessary to have strict guidelines to control postoperative infections and we recommend further studies with more samples to reach more conclusive evidence.



    Mohammad Reza Abbasian MD
    Assistant Professor, Orthopaedic Surgeon, Shahid Beheshti University of Medical Sciences, Tehran, Iran
    mohammadreza.abbasian@gmail.com

       

    Mohammad Reza Abbasian MD
    Assistant Professor, Orthopaedic Surgeon, Shahid Beheshti University of Medical Sciences, Tehran, Iran
    mohammadreza.abbasian@gmail.com

       

    Hamid Reza Seyyed Hosseinzadeh MD
    Orthopaedic surgeon, Associate professor, Shahid Beheshti Medical Univerity, Tehran, Iran
    hosseinzadehmd@yahoo.com

     
     

    Acknowledgements:
    We must acknowledge all those personels of operating room Akhtar Orthopaedic Hospital who kindly made this research possible.

     
     

    Financial disclosure:
    None declared.

     
     

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