Intervention Review

Surgical hand antisepsis to reduce surgical site infection

  1. Judith Tanner1,*,
  2. Sandra Swarbrook2,
  3. Jean Stuart3

Editorial Group: Cochrane Wounds Group

Published Online: 23 JAN 2008

Assessed as up-to-date: 3 OCT 2007

DOI: 10.1002/14651858.CD004288.pub2


How to Cite

Tanner J, Swarbrook S, Stuart J. Surgical hand antisepsis to reduce surgical site infection. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004288. DOI: 10.1002/14651858.CD004288.pub2.

Author Information

  1. 1

    De Montfort University and University Hospitals Leicester, Leicester, UK

  2. 2

    Derby Hospitals NHS Foundation Trust, Derby, Derbyshire, UK

  3. 3

    Derby Hospitals NHS Foundation Trust, Derby Royal Infirmary, Derby, Derbyshire, UK

*Judith Tanner, De Montfort University and University Hospitals Leicester, Charles Frears Campus, 266 London Road, Leicester, LE2 1RQ, UK. jtanner@dmu.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 JAN 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Surgical hand antisepsis, to destroy transient micro-organisms and inhibit the growth of resident micro-organisms, is routinely carried out before undertaking invasive procedures. Antisepsis may reduce the risk of surgical site infections in patients.

Objectives

To determine the effects of surgical hand antisepsis on the number of surgical site infections (SSIs) in patients. The secondary objective is to determine the effects of surgical hand antisepsis on the numbers of colony forming units (CFUs) of bacteria on the hands of the surgical team.

Search methods

We searched the Cochrane Wounds Group Specialised Register (June 2007), the Cochrane Central Register of Controlled Trials (Issue 2, 2007), MEDLINE (Week 5, 2007), CINAHL (June 2007), EMBASE (Week 23, 2007) and ZETOC (2005).

Selection criteria

Randomised controlled trials comparing surgical hand antisepsis of varying duration, methods and antiseptic solutions.

Data collection and analysis

Three authors independently assessed studies for selection, trial quality and extracted data.

Main results

Ten trials were included in this review. Only one trial reported the primary outcome, rates of SSIs, and nine trials measured numbers of CFUs.

One trial involving 4387 patients found alcohol rubs with additional active ingredients were as effective as aqueous scrubs in reducing SSIs.

Four trials compared different alcohol rubs containing additional active ingredients with aqueous scrubs for numbers of CFUs on hands. One trial found N-duopropenide more effective than chlorhexidine and povidone iodine aqueous scrubs. One trial found 45% propanol-2, 30% propanol-1 with 0.2% ethylhexadecyldimethyl ammonium ethylsulfate more effective than chlorhexidine scrubs. One trial found no difference between 1% chlorhexidine gluconate in 61% ethyl alcohol or zinc pyrithione in 70% ethyl alcohol against aqueous povidone iodine. A fourth trial found 4% chlorhexidine gluconate scrubs more effective than chlorhexidine in 70% alcohol rubs.

Four trials compared the relative effects of different aqueous scrubs in reducing CFUs on hands. Three trials found chlorhexidine gluconate scrubs were significantly more effective than povidone iodine scrubs. One trial found no difference between chlorhexidine gluconate scrubs and povidone iodine plus triclosan scrubs.

Two trials found no evidence of a difference between alternative alcohol rubs in terms of the number of CFUs.

Four trials compared the effect of different durations of scrubs and rubs on the numbers of CFUs on hands. One trial found no difference after the initial scrub but found subsequent three minute scrubs using chlorhexidine significantly more effective than subsequent scrubs lasting 30 seconds. One trial found that following a one minute hand wash, a three minute rub appears to be more effective than the five minute rub using alcohol disinfectant. The other comparisons demonstrated no difference.

Authors' conclusions

Alcohol rubs used in preparation for surgery by the scrub team are as effective as aqueous scrubbing in preventing SSIs however this evidence comes from only one, equivalence, cluster trial which did not appear to adjust for clustering.

Four comparisons suggest that alcohol rubs are at least as, if not more, effective than aqueous scrubs though the quality of these is mixed and each study presents a different comparison, precluding meta analysis. There is no evidence to suggest that any particular alcohol rub is better than another. Evidence from 4 studies suggests that chlorhexidine gluconate based aqueous scrubs are more effective than povidone iodine based aqueous scrubs in terms of the numbers of CFUs on the hands.

There is limited evidence regarding the effects on CFUs numbers of different scrub durations. There is no evidence regarding the effect of equipment such as brushes and sponges.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Surgical hand antisepsis to reduce surgical site infection.

Members of the surgical team routinely use antiseptic solutions as either scrubs or hand rubs with the aim of reducing the chance of the patient developing an infection following surgery. There was no difference between alcohol rubs which contain additional active ingredients and aqueous scrubs in reducing surgical site infections. However several studies measure the amount of bacteria on the hands before and after the surgical procedure and found that when using aqueous scrubs chlorhexidine was more effective in reducing the amount of bacteria than povidone iodine. The evidence from comparisons of aqueous scrubs with alcohol rubs which contain additional active ingredients is mixed, there is evidence from studies in favour of both forms of antisepsis.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

外科醫師的手消毒可以降低病患手術部位之感染率

手術或是從事具侵襲性治療步驟前,醫謢人員需要良好的手部消毒步驟。這是因為它可以消滅或是抑制可能會藉由工作人員雙手進入病患身體的微生物。也就是說,這個步驟應是可以降低病患手術部位之感染率的。

目標

為了證實醫護人員良好的手部消毒步驟可以降低病患手術部位 (簡稱SSI,Surgical Site Infection) 之感染率,與經消毒後這群醫護人員手部殘存的細菌菌落 (CFUs,colony forming units) 數目 (第二目標) 。

搜尋策略

作者們於以下不同的資料庫中尋找與相關的資料,包括了: 考科藍傷口小組的專業記錄資料庫 (Cochrane Wounds Group Specialised Register,2007年6月) ,考科藍受控試驗登記紀錄 (Cochrane Central Register of Controlled Trials,Issue 2, 2007) ,線上醫學分析與檢索系統 (MEDLINE,Week 5, 2007) ,護理與醫療相關文獻資料庫 (CINAHL,June 2007) ,EMBASE醫藥學文獻資料庫 (Week 23, 2007) ,與 ZETOC全英圖書電子化目錄系統 (2005) 。

選擇標準

涵括手部消毒的步驟、時間長短與消毒溶液種類的隨機性受控試驗。

資料收集與分析

三位作者獨立、分別地收集評估這些資料庫中的試驗報告與其品質,並分析其中的資料。

主要結論

經由檢閱後,本文章共收錄了十個不同的試驗。其中僅有一試驗提到了病患手術部位之感染率,其餘九個則是報告了醫護人員手部殘存的細菌菌落數目。其中一個收集4387位病患的試驗結果顯示了醫護人員不管是利用內含活性劑與酒精成分的消毒液或是水溶性刷手液來刷手,對於降低病患手術部位之感染率一樣有效。四個試驗比較不同成分但含酒精與活性劑的刷手液消毒和水溶性刷手液來刷手後,醫護人員手部殘存的細菌菌落數目。以下為這四個不同試驗的結論: 1. 含有Nduopropenide的消毒液比含沙威隆 (chlorhexidine) 和水溶性優碘的有效。 2. 含 45% propanol2、 30% propanol1 與 0.2% ethylhexadecyldimethyl ammonium ethylsulfate 的刷手液比只含沙威隆的有效。3. 以61% 乙醇為主內含沙威隆葡萄糖酸鹽 (chlorhexidine gluconate) 或是以70% 為主內含zinc pyrithione的刷手液和水溶性優碘為主的刷手液比較並無差異。4. 含 4% 沙威隆葡萄糖酸鹽的刷手液比以70% 酒精為主再加上沙威隆的刷手液有更佳的效果。此外,有另四個試驗提出使用不同種類水性消毒液後,醫護人員手部殘存的細菌菌落數目:其中3個試驗顯示添加了沙威隆葡萄糖酸鹽的溶液會比碘酒有較佳的結果。但是某一試驗 (在與碘酒加三氯沙triclosan做比較後) 卻找不出含沙威隆葡萄糖酸鹽的溶液具有明顯的優勢。有兩個試驗認為若以菌落數目為依據,用含酒精成分的刷手液並不會影響結果。而有四個試驗比較了刷手時間的長短與醫護人員手部殘存的細菌菌落數目之間的關係:其中某一試驗發現在第二次刷手與使用沙威隆時,若能持續三分鐘,其成效將遠優於只刷三十秒。另一試驗則顯示了在一分鐘的洗手後加上三分鐘的刷手動作會比只用酒精類消毒液刷手五分鐘有更低的菌落數。另外兩個試驗則認為無差異。

作者結論

在預防手術部位感染的成效上,使用含酒精的刷手液與水溶性的刷手液似乎是相同的。可惜的是,僅有一試驗有如此的結論。在手部菌落數目上,四個試驗則顯示了含有酒精的刷手液效果似乎不會比水溶性刷手液來的差。而不同種類的刷手液 (含酒精) 效力則相差不遠。只是對於分析這四個品質高低不一、比較的溶液也均不相同的試驗結果而言,此結論是具有一定誤差的。至於含沙威隆葡萄糖酸鹽的水性溶液是比只含碘酒的水性溶液可以降低更多的細菌菌落數。而刷手時間長短則是不具太大的影響力的。除此之外,這些試驗無法提出刷具種類 (刷子或海棉) 與刷手成效相關的證據。

翻譯人

本摘要由成功大學附設醫院林劭潔翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

良好的手部消毒步驟是可以降低病患手術部位感染率。醫護人員常規使用消毒液 (刷手或是手部搓揉劑) 來刷 (洗) 手,藉此降低風險。添加活性劑的酒精手部搓揉劑與水溶性刷手液在減少手術部位感染方面沒有差異。不過一些評估手術前後菌落數的研究發現使用水溶性刷手液Chlorhexidine在減少菌落數方面較優碘有效。比較水溶性刷手液與含有添加活性成分的酒精搓揉劑的證據不一,來自研究的證據顯示兩種形式的消毒液都可以採用。