The Effect of Surgical Scrub in Orthopaedic Surgery

Ho-Jin Chang; Jun-Ho Nam; Dong-Young Kim; Hee-Soo Kim; Sung-Hyun Park; Sang-Wook Lee; Tae-Hoon Kim; Myung-Rae Cho

doi:10.4055/jkoa.2014.49.1.36

Journal List > J Korean Orthop Assoc > v.49(1) > 1013322

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Chang, Nam, Kim, Kim, Park, Lee, Kim, and Cho: The Effect of Surgical Scrub in Orthopaedic Surgery

Original Article

Journal of the Korean Orthopaedic Association 2014; 49(1): 36-42.

Published online: 27 February 2014

DOI: https://doi.org/10.4055/jkoa.2014.49.1.36

The Effect of Surgical Scrub in Orthopaedic Surgery

Ho-Jin Chang, M.D., Jun-Ho Nam, M.D., Dong-Young Kim, M.D., Hee-Soo Kim, M.D., Sung-Hyun Park, Sang-Wook Lee, M.D., Tae-Hoon Kim, M.D., Myung-Rae Cho, M.D.

Department of Orthopaedic Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea.

Correspondence to: Myung-Rae Cho, M.D. Department of Orthopedic Surgery, Daegu Catholic University Medical Center, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 705-718, Korea. TEL: +82-53-650-4277, FAX: +82-53-626-4272, cmr0426@cu.ac.kr

Received 18 March 2013 Revised 14 May 2013 Accepted 2 November 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Two antiseptic solutions were investigated for their effect on bacterial growth inhibition.

Materials and Methods

A total of 38 patients were included in this study, who visited Daegu Catholic Medical Center from August 2, 2011 to September 2, 2011. Bacterial culture was performed at the pre-scrub, post-scrub, and postoperation; patients were divided into two groups according to use of povidone iodine (3.75%) and povidone iodine with Softa-Man® as antiseptic agents at the surgical.

Results

Comparison between the antiseptic solutions showed a significant difference for the presence of gram positive cocci (p=0.034), however, no difference was observed for the presence of gram positive bacilli (p=0.838). As the scrub time increased, the positive detection ratio of bacteria decreased (p=0.000), and decreased significantly at more than 120 seconds. However, positive detection ratio of bacteria increased significantly at more than 300 seconds in cases with povidone iodine only (p=0.014). Glove wearing time did not have a significant influence on the positive detection ratio of bacteria, and no significant difference was observed between the antiseptic solutions (p=0.143).

Conclusion

Considering the positive detection ratio of bacteria when using povidone iodine only, the appropriate scrub time should be between 4 and 5 minutes. When using both antiseptics, at least 2 minutes of scrub time is needed.

Keywords: surgical scrub, povidone-iodine, povidone iodine+Softa-Man®, bacterial growth inhibition

Figures and Tables

Table 1

Relationship between Scrub Time and Bacterial Growth after Culture

^*Ten positive culture among the culture media. G1C, pre-scrub gram (+) coccus; G1B, pre-scrub gram (+) bacillus; G2C, post-scrub gram (+) coccus; G2B, post-scrub gram (+) bacillus; G3C, postoperative gram (+) coccus; G3B, postoperative gram (+) bacillus.

Table 2

Relationship between Surgical Hand-Washing Agents and Bacterial Growth after Culture

^*3.75% povidone iodine. ^†Softa-man®+3.75% povidone iodine. G1C, pre-scrub gram (+) coccus; G1B, pre-scrub gram (+) bacillus; G2C, post-scrub gram (+) coccus; G2B, post-scrub gram (+) bacillus; G3C, postoperative gram (+) coccus; G3B, postoperative gram (+) bacillus.

Table 3

Relationship between Scrub Time and Bacterial Growth after Culture with Povidone Iodine as a Hand-Washing Agent

^*No data. G1C, pre-scrub gram (+) coccus; G1B, pre-scrub gram (+) bacillus; G2C, post-scrub gram (+) coccus; G2B, post-scrub gram (+) bacillus; G3C, postoperative gram (+) coccus; G3B, postoperative gram (+) bacillus.

Table 4

Relationship between Scrub Time and Bacterial Growth after Culture with Softa-Man®+3.75% Povidone Iodine as a Hand-Washing Agent

G1C, pre-scrub gram (+) coccus; G1B, pre-scrub gram (+) bacillus; G2C, post-scrub gram (+) coccus; G2B, post-scrub gram (+) bacillus; G3C, postoperative gram (+) coccus; G3B, postoperative gram (+) bacillus.

Table 5

Relationship between Operation Time and Bacterial Growth after Culture

References

1. Yinusa W, Li YH, Chow W, Ho WY, Leong JC. Glove punctures in orthopaedic surgery. Int Orthop. 2004; 28:36–39.

2. Eitzen HE, Ritter MA, French ML, Gioe TJ. A microbiological in-use comparison of surgical hand-washing agents. J Bone Joint Surg Am. 1979; 61:403–406.

3. Gruendemann BJ, Bjerke NB. Is it time for brushless scrubbing with an alcohol-based agent? AORN J. 2001; 74:859–873.

4. Berguer R, Heller PJ. Strategies for preventing sharps injuries in the operating room. Surg Clin North Am. 2005; 85:1299–1305.

5. Hollaus PH, Lax F, Janakiev D, Wurnig PN, Pridun NS. Glove perforation rate in open lung surgery. Eur J Cardiothorac Surg. 1999; 15:461–464.

6. Thanni LO, Yinusa W. Incidence of glove failure during orthopedic operations and the protective effect of double gloves. J Natl Med Assoc. 2003; 95:1184–1188.

7. Thomas-Copeland J. Do surgical personnel really need to double-glove? AORN J. 2009; 89:322–328.

8. Twomey CL. Double gloving: a risk reduction strategy. Jt Comm J Qual Saf. 2003; 29:369–378.

9. Chapman S, Duff P. Frequency of glove perforations and subsequent blood contact in association with selected obstetric surgical procedures. Am J Obstet Gynecol. 1993; 168:1354–1357.

10. St Germaine RL, Hanson J, de Gara CJ. Double gloving and practice attitudes among surgeons. Am J Surg. 2003; 185:141–145.

11. Quebbeman EJ, Telford GL, Wadsworth K, Hubbard S, Goodman H, Gottlieb MS. Double gloving. Protecting surgeons from blood contamination in the operating room. Arch Surg. 1992; 127:213–216.

12. Webb JM, Pentlow BD. Double gloving and surgical technique. Ann R Coll Surg Engl. 1993; 75:291–292.

13. Avery CM, Taylor J, Johnson PA. Double gloving and a system for identifying glove perforations in maxillofacial trauma surgery. Br J Oral Maxillofac Surg. 1999; 37:316–319.

14. Greco RJ, Garza JR. Use of double gloves to protect the surgeon from blood contact during aesthetic procedures. Aesthetic Plast Surg. 1995; 19:265–267.

15. de Castro-Peraza ME, Garzón-Rodríguez E, Rodríguez-Pérez V, Sosa-Alvarez I, Gutierrez-Hernández J, Asiain-Ugarte C. Glove perforation in surgery and protective effect of double gloves. Enferm Clin. 2010; 20:73–79.

16. Korniewicz DM. Barrier protection of latex. Immunol Allergy Clin North Am. 1995; 15:123–136.

17. Furukawa K, Ogawa R, Norose Y, Tajiri T. A new surgical handwashing and hand antisepsis from scrubbing to rubbing. J Nippon Med Sch. 2004; 71:190–197.

18. Girard R, Aho LS, Aupée M, et al. Alcohol-based rubs for hand antisepsis. Lancet Infect Dis. 2008; 8:584–585.

19. Al-Naami M, Anjum M, Afzal M, et al. Alcohol-based handrub versus traditional surgical scrub and the risk of surgical site infection: a randomized controlled equivalent trial - annotated bibliography. EWMA J. 2009; 9:5–6. 8–10.

20. Larson E. Guideline for use of topical antimicrobial agents. Am J Infect Control. 1988; 16:253–266.

21. Hobson DW, Woller W, Anderson L, Guthery E. Development and evaluation of a new alcohol-based surgical hand scrub formulation with persistent antimicrobial characteristics and brushless application. Am J Infect Control. 1998; 26:507–512.

22. Herruzo-Cabrera R, Vizcaino-Alcaide MJ, Fdez-Aciñero MJ. Usefulness of an alcohol solution of N-duopropenide for the surgical antisepsis of the hands compared with handwashing with iodine-povidone and chlorhexidine: clinical essay. J Surg Res. 2000; 94:6–12.

23. Tucci VJ, Stone AM, Thompson C, Isenberg HD, Wise L. Studies of the surgical scrub. Surg Gynecol Obstet. 1977; 145:415–416.

TOOLS

Similar articles