The New Zealand Veterinary Journal has recently published an excellent review article, written by Kat Crosse and funded by HPNZ, on pre-surgical hand preparation in veterinary practice.
The conclusion was clear: alcohol-based rubs are effective in eliminating transient flora, reducing resident flora, safe for repeated use, have high compliance with appropriate training, can be used in or out of clinic facilities, are cost effective and water saving. Even if an alcohol-based rub is only as effective as traditional scrubbing in terms of bacterial load reduction, the other benefits should be enough to sway our practice in favour of their preferred use.
The article gives a brief review of the history of our understanding of ‘germs’; understanding resident vs transient flora risks on our hands; the many steps required to ensure sterility, maximising wound healing and reducing the risk of surgical site infections; client expectations; finally comparing the different methods of hand preparation using traditional povidine-iodine and chlorhexidine hand scrubs with the newer alcohol-based rubs.
While the immediate effect was comparable between methods, an alcohol-based rub had a better sustained effect and higher compliance. Povidine-iodine in particular demonstrates more rapid regrowth, while the emergence of resistance to chlorhexidine-based scrubs is concerning. There is still a strong recommendation to wash hands with soap prior to any surgical scrub to remove gross contaminants which are common in veterinary practice.
Interestingly, other studies have shown healthcare workers generally show poor compliance with good hand hygiene practices, with dryness & itchiness most commonly cited as the reason for avoidance. This is much more likely when a scrub brush is used, and especially in the winter months. Despite the common parlance of “scrubbing” to infer surgical preparation, the use of a scrub brush is also widely discouraged in the literature. Crowded scrub areas also contributed to increased contamination.
The use of sterile surgical gloves is also an ideal barrier to protect patients from the bacteria on the surgeons’ hands, however gloves are not perfect, with hand hygiene still being the core of excellent in aseptic technique. So alcohol-based rubs should be the preferred method of pre-surgical hand preparation for all vets.