Prospective, randomised clinical trial of four different presurgical hand antiseptic techniques in equine surgery

BACKGROUND: Currently, the World Health Organization recommends the use of alcohol‐based hand rubs (ABR) for surgical hand preparation in human surgery. When disinfecting soaps are used, a rubbing technique causes less skin irritation than brush scrubbing. Based on a recent survey, most equine surgeons still use disinfecting soap. The efficacy of scrubbing vs. rubbing and the use of sole ABR compared with chlorhexidine (CHx)‐ based products has not been evaluated in the equine surgical setting. OBJECTIVES: To compare four surgical hand antisepsis techniques in equine surgery for reduction of aerobic bacterial counts from pre‐ to post‐preparation (immediate efficacy) and at the end of surgery (sustained efficacy). STUDY DESIGN: Randomised, prospective clinical trial. METHODS: A 4% CHx‐based product applied with either a scrub or rub technique, one sole ABR (ET; 80% ethanol) and one CHx/alcohol‐combination (CHx/ET; 1% CHx and 61% ethanol) product both applied with a rub technique were evaluated. Samples were collected by glove juice technique and cultured on 3M™ Petrifilm plates and counted using a 3M™ Petrifilm plate reader. RESULTS: Immediate mean bacterial log₁₀ colony forming unit (CFU) reduction was 2.4 for CHx‐scrub, 2.8 for CHx‐rub, 3.1 for CHx/ET and 2.1 for ET. CHx/ET resulted in significantly lower bacterial counts than CHx‐scrub (P<0.005) and ET (P<0.001) while CHx‐rub resulted in significantly lower counts than ET (P<0.001). At the end of surgery bacterial counts were the lowest for CHx‐rub, significantly lower than CHx/ET (P<0.001) and ET (P<0.001). There was no difference between CHx‐rub and ‐scrub techniques (P = 0.7). MAIN LIMITATIONS: Bacterial counts were used as the outcome measure rather than prevalence of surgical site infection, and the effect of hand preparation on skin health was not assessed. CONCLUSIONS: ABR did not decrease bacterial log₁₀CFU counts more effectively than CHx products. When using CHx soaps in the equine setting, hand‐rub is as effective as a hand‐scrub‐technique.