Journal Review: Infection rates same, but workers favor gel

There’s the rub: Alcohol gel as good as hand washing

Infection rates same, but workers favor gel

Parienti JJ, Thibon P, Heeler R, et al. Hand rubbing with an aqueous alcoholic solution vs. traditional surgical hand-scrubbing and 30-day surgical site infection rates: A randomized equivalence study. JAMA 2202; 288:722-727.

Research from Europe continues to support a switch from traditional hand washing to the use of alcohol-based rubs. In this French study, hand rubbing with aqueous alcoholic solution — preceded by a one-minute nonantiseptic hand wash before each surgeon’s first procedure of the day and before any other procedure if the hands were soiled — was as effective as traditional hand scrubbing with antiseptic soap in preventing surgical site infections.

"The hand-rubbing protocol was better tolerated by the surgical teams and improved compliance with hygiene guidelines," the researchers said. "Hand rubbing with liquid aqueous alcoholic solution can thus be safely used as an alternative to traditional surgical hand scrubbing."

To compare the effectiveness of hand-cleansing protocols in preventing surgical site infections during routine surgical practice, the authors conducted a randomized equivalence trial in six surgical services. They followed a total of 4,387 consecutive patients who underwent clean and clean- contaminated surgery between Jan. 1, 2000, and May 1, 2001.

The surgical services used two hand-cleansing methods alternately every other month: a hand-rubbing protocol with 75% aqueous alcoholic solution containing propanol-1, propanol-2, and mecetronium etilsulfate; and a hand-scrubbing protocol with antiseptic preparation containing 4% povidone iodine or 4% chlorhexidine gluconate.

Thirty-day surgical site infection rates were the primary end point, but the operating department teams’ tolerance of and compliance with hand antisepsis also were assessed.

The two protocols were comparable in regard to surgical site infection risk factors. Surgical site infection rates were virtually identical: 55 of 2,252 (2.44%) in the hand-rubbing protocol and 53 of 2,135 (2.48%) in the hand-scrubbing protocol. Based on subsets of personnel, compliance with the recommended duration of hand antisepsis was better in the hand-rubbing protocol of the study compared with the hand-scrubbing protocol (44% vs. 28%), the authors reported. They also cited less skin dryness and less skin irritation after aqueous solution use.