Prospective, randomised clinical trial of four different presurgical hand antiseptic techniques in equine surgery

Abstract

Background: 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 use disinfecting soap. The efficacy of scrubbing vs. rubbing and the use of sole ABR compared with chlorhexidine (CHx)- based products has not been evaluated in the equine surgical setting.

Objectives: 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).

Study design: Randomised, prospective clinical trial.

Methods: A 4% CHx-based product applied with either a scrub or rub technique, one sole ABR (ET; 80% ethanol) 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.

Results: Immediate mean bacterial log₁₀ 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 ET. CHx/ET resulted in significantly lower bacterial counts than CHx-scrub (P<0.005) and ET (P<0.001) while CHx-rub resulted in significantly lower counts than ET (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 ET (P<0.001). There was no difference between CHx-rub and -scrub techniques (P = 0.7).

Main limitations: 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.

Conclusions: ABR did not decrease bacterial log₁₀ CFU counts more effectively than CHx products. When using CHx soaps in the equine setting, hand-rub is as effective as a hand-scrub-technique.

Keywords: equine surgery; hand preparation; horse; neutralisation; surgical antisepsis.