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Presurgical hand antisepsis
A D VA N C E S
PRESURGICAL HAND ANTISEPSIS Background Surgical site infections (SSIs) are a major cause for increasing health care costs in human and veterinary medicine because of delayed wound healing, increased use of antibiotics, and increased hospital stay. In some cases, death results. Still, discussion of hand disinfection seems to generate little interest among veterinary surgeons compared with human surgeons. A brief literature search using the terms “surgical hand disinfection” yielded 815 hits in human medicine over the last 50 years, whereas the inclusion of “veterinary” yielded only 6 conclusive hits. Risk of SSI correlates directly with dose, virulence of microbial contamination, and the patient’s resistance. Generally, there is increased risk of SSI when the bacterial count in wounds is as little as 100,000 bacteria/g of tissue. Use of surgical gloves significantly decreases surgical site contamination. However, glove perforation, principally involving the index finger of the non-dominant hand, occurs in 67% of surgical interventions.
PAG E 7
PAG E 8
A D VA N C E S
Various categories of flora can populate the skin of surgeons: transient, resident, or infectious flora. Resident skin flora is mainly found under the superficial cells of the stratum corneum and are not usually regarded as pathogens on intact skin. These flora have a protective function by inducing new microbial antagonism and competing for nutrients in the ecosystem. Transient flora acquired by contact with other people, animals, or contaminated environmental surfaces only colonize the superficial layers of intact skin and are the most common cause for inducing SSI. Surgical staff have higher bacterial counts of more pathogenic organisms on their hands than on hands of other health care workers. Each hand wash detrimentally alters the water lipid layer of the superficial skin, creating a loss of its protective agents. Prolonged or repeated washing leads to damaged barrier function of the stratum corneum, resulting in the skin becoming more permeable for bacteria. Scrubbing also causes small excoriations, which increase the risk of colonization of the skin by pathogens. Antiseptic solutions for surgical hand antisepsis include aqueous scrubs alcoholbased rubs and alcohol rubs each containing additional active ingredients. Aqueous solutions contain either povidone iodine or chlorhexidine gluconate and have been the standard procedure for many decades although alcohol-based hand rubs (AHR) have been described for this purpose for more than a century. The popularity of AHRs is increasing among surgeons in human medicine, because AHRs have rapid and immediate action, are considerably faster to use than disinfecting soap scrubs. AHRs also cause less skin damage after repeated use. The World Health Organization (WHO) currently recommends this method of hand asepsis.
Objectives To assess current habits for surgical hand preparation among veterinary surgical specialists and to compare data with current guidelines for hand asepsis techniques.
Procedure An internet-based survey of hand preparation methods before surgical procedures
was conducted of 1,300 listed diplomates of the American and European Colleges of Veterinary Surgeons.
Results A 42.6% response rate was obtained. Approximately, 80% of respondents use disinfecting soaps as a primary method for hand antisepsis. Of those, 81% use chlorhexidine-based scrubs and 7% use a neutral soap followed by a hydroalcoholic solution.
Author Conclusion Contrary to current recommendations of the WHO and scientific evidence supporting use of hydro-alcoholic rubs of presurgical hand preparation, veterinary surgical specialists still use surgical scrub solutions containing disinfecting soaps.
Inclusions Two tables, 78 references.
Editor Annotation
Journals Monitored • American Journal of Veterinary Research • Australian Veterinary Journal • Australian Veterinary Practitioner • Avian Diseases • British Veterinary Journal • Canadian Journal of Veterinary Research • Canadian Veterinary Journal • Journal of Avian Medicine and Surgery • Journal of the American Animal Hospital Association • Journal of the American Veterinary Medical Association • Journal of Small Animal Practice • Journal of Small Exotic Animal Medicine
Old habits are hard to break! Most veterinarians have been trained to vigorously scrub hands and arms with a brush and antiseptic soap for 5 to 10 minutes before each surgery. Additionally, dictums persist, such as “the number of strokes and the vigor of the scrub is far more important than the time spent scrubbing” and “there should be at least 40 strokes on each finger and 20 strokes each on the nails, palm, and back of the hand.” These techniques, however, may cause skin irritation or abrasions, remove protective barriers, and increase the number of potentially infective organisms on the skin. Running water may recontaminate the skin, bacteria may become resistant to antiseptics, and antiseptics may be ineffective or irritating to the skin. We can save water and time while improving antimicrobial effectiveness if we shed old habits and adopt the WHO guidelines for hand hygiene by using surgical preparations of alcohol-based hand rubs prior to surgery. (CSH)
• Journal of Veterinary Dentistry
Verwilghen D, Grulke S, and Kampf G. Presurgical hand antisepsis: concepts and current habits of veterinary surgeons. Vet Surg 2011;40:515-521.
• Veterinary Surgery
• Journal of Veterinary Emergency and Critical Care • Journal of Veterinary Internal Medicine • Journal of Veterinary Pharmacology and Therapeutics • Journal of Zoo and Wildlife Medicine • New Zealand Veterinary Journal • Research in Veterinary Science • Veterinary and Comparative Orthopaedics and Traumatology • Veterinary Dermatology • Veterinary Immunology and Immunopathology • Veterinary Pathology • Veterinary Radiology & Ultrasound • Veterinary Record • Veterinary Research Communications ... and more than 20 others
PRESURGICAL HAND ANTISEPSIS Background Surgical site infections (SSIs) are a major cause for increasing health care costs in human and veterinary medicine because of delayed wound healing, increased use of antibiotics, and increased hospital stay. In some cases, death results. Still, discussion of hand disinfection seems to generate little interest among veterinary surgeons compared with human surgeons. A brief literature search using the terms “surgical hand disinfection” yielded 815 hits in human medicine over the last 50 years, whereas the inclusion of “veterinary” yielded only 6 conclusive hits. Risk of SSI correlates directly with dose, virulence of microbial contamination, and the patient’s resistance. Generally, there is increased risk of SSI when the bacterial count in wounds is as little as 100,000 bacteria/g of tissue. Use of surgical gloves significantly decreases surgical site contamination. However, glove perforation, principally involving the index finger of the non-dominant hand, occurs in 67% of surgical interventions.
PAG E 7
PAG E 8
A D VA N C E S
Various categories of flora can populate the skin of surgeons: transient, resident, or infectious flora. Resident skin flora is mainly found under the superficial cells of the stratum corneum and are not usually regarded as pathogens on intact skin. These flora have a protective function by inducing new microbial antagonism and competing for nutrients in the ecosystem. Transient flora acquired by contact with other people, animals, or contaminated environmental surfaces only colonize the superficial layers of intact skin and are the most common cause for inducing SSI. Surgical staff have higher bacterial counts of more pathogenic organisms on their hands than on hands of other health care workers. Each hand wash detrimentally alters the water lipid layer of the superficial skin, creating a loss of its protective agents. Prolonged or repeated washing leads to damaged barrier function of the stratum corneum, resulting in the skin becoming more permeable for bacteria. Scrubbing also causes small excoriations, which increase the risk of colonization of the skin by pathogens. Antiseptic solutions for surgical hand antisepsis include aqueous scrubs alcoholbased rubs and alcohol rubs each containing additional active ingredients. Aqueous solutions contain either povidone iodine or chlorhexidine gluconate and have been the standard procedure for many decades although alcohol-based hand rubs (AHR) have been described for this purpose for more than a century. The popularity of AHRs is increasing among surgeons in human medicine, because AHRs have rapid and immediate action, are considerably faster to use than disinfecting soap scrubs. AHRs also cause less skin damage after repeated use. The World Health Organization (WHO) currently recommends this method of hand asepsis.
Objectives To assess current habits for surgical hand preparation among veterinary surgical specialists and to compare data with current guidelines for hand asepsis techniques.
Procedure An internet-based survey of hand preparation methods before surgical procedures
was conducted of 1,300 listed diplomates of the American and European Colleges of Veterinary Surgeons.
Results A 42.6% response rate was obtained. Approximately, 80% of respondents use disinfecting soaps as a primary method for hand antisepsis. Of those, 81% use chlorhexidine-based scrubs and 7% use a neutral soap followed by a hydroalcoholic solution.
Author Conclusion Contrary to current recommendations of the WHO and scientific evidence supporting use of hydro-alcoholic rubs of presurgical hand preparation, veterinary surgical specialists still use surgical scrub solutions containing disinfecting soaps.
Inclusions Two tables, 78 references.
Editor Annotation
Journals Monitored • American Journal of Veterinary Research • Australian Veterinary Journal • Australian Veterinary Practitioner • Avian Diseases • British Veterinary Journal • Canadian Journal of Veterinary Research • Canadian Veterinary Journal • Journal of Avian Medicine and Surgery • Journal of the American Animal Hospital Association • Journal of the American Veterinary Medical Association • Journal of Small Animal Practice • Journal of Small Exotic Animal Medicine
Old habits are hard to break! Most veterinarians have been trained to vigorously scrub hands and arms with a brush and antiseptic soap for 5 to 10 minutes before each surgery. Additionally, dictums persist, such as “the number of strokes and the vigor of the scrub is far more important than the time spent scrubbing” and “there should be at least 40 strokes on each finger and 20 strokes each on the nails, palm, and back of the hand.” These techniques, however, may cause skin irritation or abrasions, remove protective barriers, and increase the number of potentially infective organisms on the skin. Running water may recontaminate the skin, bacteria may become resistant to antiseptics, and antiseptics may be ineffective or irritating to the skin. We can save water and time while improving antimicrobial effectiveness if we shed old habits and adopt the WHO guidelines for hand hygiene by using surgical preparations of alcohol-based hand rubs prior to surgery. (CSH)
• Journal of Veterinary Dentistry
Verwilghen D, Grulke S, and Kampf G. Presurgical hand antisepsis: concepts and current habits of veterinary surgeons. Vet Surg 2011;40:515-521.
• Veterinary Surgery
• Journal of Veterinary Emergency and Critical Care • Journal of Veterinary Internal Medicine • Journal of Veterinary Pharmacology and Therapeutics • Journal of Zoo and Wildlife Medicine • New Zealand Veterinary Journal • Research in Veterinary Science • Veterinary and Comparative Orthopaedics and Traumatology • Veterinary Dermatology • Veterinary Immunology and Immunopathology • Veterinary Pathology • Veterinary Radiology & Ultrasound • Veterinary Record • Veterinary Research Communications ... and more than 20 others