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Alcohol Based Handrub versus Traditional Hand Scrub as Surgical Hand
Disinfection in a Tertiary Eye Teaching Hospital in Iraq
Suzan AMA Kareem, Ali A Mahmood* and Zaid R Hussein
Ibn Al-Haithem Teaching Eye Hospital, Baghdad, Iraq
*Corresponding author: Ali Abdul Razzaq Mahmood Al-Mafrachi, M.D, F.I.B.M.S (Ophth.), Pediatric Ophthalmology, Ibn Al-Haithem Teaching Eye Hospital, Al-
AndalusSqaure, Al-Wahda Sector, Baghdad, Baghdad 00964, Iraq, Tel: 009647901188764; E-mail: drali20042001@yahoo.com
Received date: April 03, 2014, Accepted date: June 04, 2014, Published date: June 11, 2014
Copyright: © 2014 Kareem SAMA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Aim of the study: To compare alcohol-based handrub solutions and standard surgical scrub in preoperative
hand disinfection.
Methods: Single center, blinded, controlled study performed over a period of 4 weeks in the Ibn Al Haithem
hospital. Surgeons, seniors and residents (with more than 2 years of experience) volunteered for inclusion in this
study by taking their fingerprints on blood agar before and after hand disinfection.
The two methods of disinfection were the following:
A: Alcohol-based handrub with sterillium. The solution is applied to the hands for 1.5 min and then left to dry. The
fingertips and thumb prints are then taken on blood agar plates.
B: The hands are washed with soap and water using a gentle brush for 5 min and then left to dry.The fingertips
and thumbprints are then taken on blood agar plates.
Results: One hundred samples were collected twice. Fifty volunteers were in each group, and samples were
collected before and after washing the hands.
The mean reduction in colony counts was 104.6 (P<0.001) in the alcohol group.
The meanreduction in colony counts was 18.6 (P>0.001) in the standard scrub group.
Conclusion: In preoperative hand disinfection, alcohol-based handrub significantly reduces the bacterial colony
counts compared with standard surgical scrub.
Keywords: Alcohol rub; Scrub; Preoperative hand disinfection
Introduction
Endophthalmitis is a serious medical condition with a high
morbidity rate. The source of infection usually cannot be identified
with certainty. The flora of the eyelids and conjunctiva are the most
frequent infection source, including contamination via incisions in the
early postoperative stages. Other potential infection sources include
contaminated solutions and instruments, environmental air and the
surgeon and the other operating room personnel. Because the skin
cannot be sterilized, it must be properly prepared [1].
Despite significant advances in glove manufacturing techniques and
developments in surgical instrument design, glove perforation rates
have been reported to be as high as 17%, which emphasizes the
importance of good hand antisepsis [2].
In the main tertiary teaching eye hospital (Ibn Al Haithem) in Iraq,
the traditional hand scrubbing technique using water and soap with a
brush had been standard practice for many years; however, in recent
years, alcohol sanitizing preparations became available in the hospital.
Some surgeons have continued to use the traditional scrub technique,
whereas others have changed to alcohol-based handrub. This
comparative study between the two methods was designed and
performed.
Methods
This was a single center, blinded, controlled study performed over a
period of 4 weeks in the Ibn Al Haithem hospital. Surgeons, seniors
and residents (with more than 2 years of experience) volunteered for
inclusion this study.
Each day before performing any surgeries, the study participants
had their fingertips and thumbprints taken on blood agar plates
(insuring that the nails make prints on the agar); the volunteer then
blindly selected a sealed blank envelope enclosing a paper with either
letter A or B indicating the structured protocol for preoperative hand
disinfection. Neither the participants nor the sample collector nor the
lab staff knew which method was used.
Kareem et al., J Clin Exp Ophthalmol 2014, 5:3
DOI: 10.4172/2155-9570.1000340
Short Communication Open Access
J Clin Exp Ophthalmol
ISSN:2155-9570 JCEO, an open access journal Volume 5 • Issue 3 • 1000340
Journal of Clinical & Experimental
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ISSN: 2155-9570
The standard preoperative hand disinfection methods used were:
A: Alcohol-based handrub with sterillium. The solution was applied
to the hands for 1.5 min and then left to dry. The fingertips and
thumbprints were then taken on blood agar plates.
Sterillium (propan-2-ol 45 gm + propan-1-ol 30 gm + mecetronium
ethylsulfate with glycerol 85%, tetradecan-1-ol, fragrance, patent blue
v, 85% and purified water) was used. As a standard protocol, it was
recommended that the participant cleaned the hands with water and
soap only if visibly soiled hands, such as hands with mud on them,
were present. If soap and water was used, the hands were then allowed
to dry. The alcohol-based handrub was then applied for 1.5 min
ensuring that hand is wet during the 1.5 min time, as recommended by
Hartman industry [3]. However, during the process of sample
collection in this study, none of the volunteers had dirt or mud on
their hands; thus, washing the hands before using the alcohol rub was
not needed.
The technique for hand rub performed according to the WHO is
illustrated in Figure 1.
Figure 1: Alcohol-Based Handrub technique according to WHO
guidelines.
B: Standard surgical scrub was performed according to the WHO
and the APIC (Association for professionals in infection control) [4,5].
B: The hands are washed with soap and water using a gentle brush
for 5 min and repeated at least three times, including brushing the
fingernails, and then left to dry.The fingertips and thumbprints are
then taken on blood agar plates.
Blood agar plates were prepared in the Ibn Al-Haithem Hospital
laboratory. To ensure that there was no contamination, the plates were
incubated for 24 h and then taken to the theatre under supervision.
The plates were labeled as before or after washing the hands in a coded
manner so that the laboratory personnel responsible for counting the
colonies would not know which method the sample represents. After
24 h of incubation at 37°C, the plates were examined under
magnification for counting the number of colonies for each sample.
The results were tabulated and analyzed. The paired sample t-test
statistical analysis was conducted using Microsoft excel 2010 and SPSS
version 18. P values of less than 0.05 were considered significant.
Results
One hundred samples were collected twice. Fifty volunteers were in
each group, and samples were collected before and after washing the
hands. The alcohol rub group had 41 samples that showed zero growth
post-rub; the remaining 9 samples showed a statistically significant
decrease in growth. The mean reduction of colony counts was 104.6
(P<0.001) (Figure 2).
Standard surgical scrub group
Only 4 samples showed zero growth post-scrub. The other 22
samples showed a statistically insignificant decrease in growth. Two
samples showed no change in growth on the agar plates. Twenty-two
samples showed an increase in growth after scrubbing. The mean
reduction in colony counts was 18.6 (P>0.001) (Figure 2).
Figure 2: Mean reduction in colonies.
Discussion
Standard surgical scrub has been the main preoperative disinfection
technique for many years. The introduction of alcohol-based solutions
for disinfection has opened possibilities for more sophisticated and
cost effective disinfecting techniques.
In our study, alcohol-based hand rub was found to be significantly
more effective in preoperative hand disinfection than standard surgical
scrub.
Citation: Kareem SAMA, Mahmood AA, Hussein ZR (2014) Alcohol Based Handrub versus Traditional Hand Scrub as Surgical Hand
Disinfection in a Tertiary Eye Teaching Hospital in Iraq. J Clin Exp Ophthalmol 5: 340. doi:10.4172/2155-9570.1000340
Page 2 of 3
J Clin Exp Ophthalmol
ISSN:2155-9570 JCEO, an open access journal Volume 5 • Issue 3 • 1000340
Sigler et al. showed that alcohol-based solutions had a greater
antimicrobial effectiveness than traditional surgical scrub and
povodine iodine surgical scrub. A similar result was found in a study
performed in Singapore by Kah Weng Lai et al. [6,7].
Alcohol-based handrub was found to be superior to traditional
surgical scrub in reducing the risk of surgical site infections in France
by Parienti et al. [8].
A Rouen University Hospital study [9] showed that surgical
handrub had immediate efficacy similar to surgical hand scruband had
more lasting effect and was more cost-effective (by 67%).
Al-Naami et al. found that alcohol-based solutions are preferred in
regards to surgeon skin tolerance [10].
Dabare et al. concluded that among five different surgical scrubbing
agents, alcohol-based handrub was superior to the other techniques
[11].
At a study performed at the University of Sao Paulo, Brazil by
Karen de Jesus Gonçalves et al., it was concluded that surgical hand
antisepsis using alcohol preparations are effective and have benefits
related to cost reduction, water saving, lower application time, lower
skin damaging effects, and ecological gains [12].
Based on our results and the results pooled from other studies, it is
recommend that alcohol-based hand rubs be included in the operating
theatre as an alternative to traditional surgical scrub for surgical hand
disinfection.
Conclusion
In preoperative hand disinfection, alcohol-based handrub
significantly reduces the bacterial colony counts compared with
standard surgical scrub.
References
1. Kanski JJ (2011) Lens. In: Kanski JJ, Bowling B (Eds) Clinical
Ophthalmology: A systemic approach. (7thedn), Elsevier, London, UK,
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2. Kralj N, Beie M, Hofmann F (1999) [Surgical gloves--how well do the
protect against infections?]. Gesundheitswesen 61: 398-403.
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propanol-based hand rub: equivalence of shorter application times. J
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4. Manz EA, Gardner D, Millard M (2006) Clipping, Prepping and Draping
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Citation: Kareem SAMA, Mahmood AA, Hussein ZR (2014) Alcohol Based Handrub versus Traditional Hand Scrub as Surgical Hand
Disinfection in a Tertiary Eye Teaching Hospital in Iraq. J Clin Exp Ophthalmol 5: 340. doi:10.4172/2155-9570.1000340
Page 3 of 3
J Clin Exp Ophthalmol
ISSN:2155-9570 JCEO, an open access journal Volume 5 • Issue 3 • 1000340
