Forer Yaara, Block Colin, Frenkel Shahar
a Department of Ophthalmology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel.
b Clinical Microbiology & Infectious Diseases , Hadassah-Hebrew University Medical Center , Jerusalem , Israel.
Curr Eye Res. 2017 Sep;42(9):1333-1337. doi: 10.1080/02713683.2017.1304559. Epub 2017 May 30.
The goal of this experiment was to evaluate and compare the antimicrobial efficacy of routine preoperative hand washing using commercial medicated sponge brushes versus an alcoholic hand rub, by comparing bacterial growth on ophthalmic surgeons' hands after application of each of these methods.
Twenty ophthalmic surgeons were recruited at the Hadassah-Hebrew University Medical Center in Jerusalem, Israel. Samples were collected twice from the hands of each surgeon after hand decontamination using two different protocols during routine surgical practice. The routine preparation consisted of a 3-minute surgical scrub using commercial brush-sponges incorporating either 4% chlorhexidine gluconate (CHG) or 1% povidone-iodine (PVP-I) formulations with detergent, followed by drying the hands with a sterile towel, while the 70% ethanol solution was applied for 60-seconds and allowed to air dry. Half of the group was randomly assigned to provide samples first after the routine method and the alcoholic solution a week later, and the other half of the group was sampled in the reverse order. Viable counts of bacteria were evaluated using a modified glove juice method. Bacterial colonies were enumerated after incubation for 24 hours and expressed as colony forming units (CFU)/mL for each pair of hands.
Geometric mean counts were 1310 and 39 CFU/mL, in the routine and alcohol rub groups, respectively, representing a mean log reduction in 1.53. The difference between the paired bacterial counts for the routine versus the alcohol rub was statistically significant (p < 0.0001). There was no statistically significant difference between log reductions for CHG and PVP-I (p = 0.97).
This study provides evidence that an alcohol rub protocol is more effective in reducing bacterial counts on hands than routine surgical hand preparation with PVP-I and CHG in a population of practicing ophthalmic surgeons in the operative clinical setting. Thus, it provides a safe alternative as a preoperative hand disinfection method.
本实验的目的是通过比较眼科医生使用每种方法后手上的细菌生长情况，评估并比较使用商用含药海绵刷进行术前常规洗手与使用酒精擦手液的抗菌效果。
在以色列耶路撒冷的哈达萨-希伯来大学医学中心招募了20名眼科医生。在常规手术操作期间，使用两种不同方案对手部进行去污后，从每位医生的手上采集两次样本。常规准备包括使用含有4%葡萄糖酸氯己定（CHG）或1%聚维酮碘（PVP-I）配方与洗涤剂的商用刷式海绵进行3分钟的外科洗手，然后用无菌毛巾擦干双手，而70%乙醇溶液涂抹60秒并让其自然风干。该组一半的医生被随机分配先在常规方法后一周再使用酒精溶液后提供样本，该组另一半医生则按相反顺序取样。使用改良的手套汁液法评估细菌活菌数。孵育24小时后计数细菌菌落，并以每双手的菌落形成单位（CFU）/mL表示。
常规组和酒精擦手组的几何平均计数分别为1310 CFU/mL和39 CFU/mL，平均对数减少1.53。常规组与酒精擦手组配对细菌计数之间的差异具有统计学意义（p < 0.0001）。CHG和PVP-I的对数减少之间无统计学显著差异（p = 0.97）。
本研究提供的证据表明，在手术临床环境中的眼科医生群体中，酒精擦手方案在减少手上细菌数量方面比使用PVP-I和CHG进行常规外科洗手更有效。因此，它作为术前手部消毒方法提供了一种安全的替代方案。
