B. S. Oriel1,2, K. M. Itani1,3,4 1VA Boston Healthcare System,Surgical Service,West Roxbury, MA, USA 2Tufts Medical Center,Department Of Surgery,Boston, MA, USA 3Boston University School Of Medicine,Department Of Surgery,Boston, MA, USA 4Harvard Medical School,Department Of Surgery,Boston, MA, USA
Introduction:
Products available for surgical hand antisepsis include traditional aqueous scrubs (TAS) and alcohol-based rubs (ABR). As part of a quality improvement initiative, we sought to better understand best practice techniques and preferences among operating room (OR) staff.
Methods:
One-hundred thirty-one anonymous paper surveys were distributed to all surgical and OR personnel who perform surgical hand antisepsis at either one or both of two hospital campuses. Participants represented all surgical specialties. The survey assessed product preference, product-specific patterns of use, hand antisepsis education and product knowledge.
Results:
A total of 97 surveys (74%) were returned; two were incomplete and excluded. The remaining 95 surveys included 44 women (47%), 37 staff surgeons (39%), 29 residents and fellows (31%), and 29 nursing staff (30%). Ninety-five percent confirmed prior use and proper application of both product types, however application times of less than 1 minute for ABR and less than 3-6 minutes for TAS were reported by 10% and 18% of participants, respectively. The application time of each product was most influenced by case-specific wound classification and hand soiling. Among all users, 64% supported having an ABR option available. ABR was favored (52%) and did not differ between physicians and nursing staff (p = 0.67). Respondents preferred ABR for its ease of use (79%) and TAS for its minimal to no side effects (54%). Forty-eight percent had not read the manufacturer's instructions for either product, and over 80% had never received formal in-person training. While 73% of physicians reported familiarity with each product's active ingredients, less than one-third correctly identified alcohol’s concentration of greatest anti-microbial activity or its mechanism of action, and only two-thirds correctly identified chlorhexidine's mechanism of action. Only 3 of 64 physician-respondents reported any familiarity with the Food and Drug Administration's Tentative Final Monograph.
Conclusion:
There were no strong preferences among staff regarding ABR or TAS but ABR was a supported option for surgical hand antisepsis. Preferred product features included ease of use and an acceptable side-effect profile. A definite lack of understanding and education exists regarding product mechanism of action and application. Perceptions of proper use and reported practice were discordant among some staff. The effect of reported practice on surgical site infections should be investigated.