1Infection Control Service, University Hospital of the Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP Brazil.
University Hospital of Ribeirão Preto Medical School, Avenida Bandeirantes, 3900 - Vila Monte Alegre, Ribeirão Preto, SP 14048-900 Brazil.
Antimicrob Resist Infect Control. 2018 Jul 9;7:80. doi: 10.1186/s13756-018-0372-7. eCollection 2018.
Although alcohol-based surgical hand preparation offers potential advantages over the traditional surgical scrubbing technique, implementing it may be challenging due to resistance of surgeons in changing their practice. We aimed to implement alcohol-based surgical hand preparation in the hospital setting evaluating the impact of that on the quality and duration of the procedure, as well as on the prevention of surgical site infections.
A quasi-experimental study conducted at a tertiary-care university hospital from April 01 to November 01, 2017. Participants were cardiac and orthopedic surgical teams ( = 56) and patients operated by them ( = 231). Intervention consisted of making alcohol-based handrub available in the operating room, convincing and training surgical teams for using it, promoting direct observation of surgical hand preparation, and providing aggregated feedback on the quality of the preparation. The primary study outcome was the quality of the surgical hand preparation, inferred by the compliance with each one of the steps predicted in the World Health Organization (WHO) technique, evaluated through direct observation. Secondary study outcome was the patient's individual probability of developing surgical site infection in both study periods. We used the Wilcoxon for paired samples and McNemar's test to assess the primary study outcome and we build a logistic regression model to assess the secondary outcome.
We observed 534 surgical hand preparation events. Among 33 participants with full data available for both study periods, we observed full compliance with all the steps predicted in the WHO technique in 0.03% (1/33) of them in the pre-intervention period and in 36.36% (12/33) of them in the intervention period (OR:12.0, 95% CI: 2. 4-59.2, = 0.002). Compared to the pre-intervention period, the intervention reduced the duration of the preparation (4.8 min vs 2.7 min, respectively; < 0.001). The individual risk of developing a surgical site infection did not significantly change between the pre-intervention and the intervention phase (Adjusted RR = 0.66; 95% CI 0. 16-2.70, = 0.563).
Our results demonstrate that, when compared to the traditional surgical scrub, alcohol-based surgical hand preparation improves the quality and reduces the duration of the preparation, being at least equally effective for the prevention of surgical site infections.
虽然基于酒精的外科手消毒在提供潜在优势方面优于传统的外科刷手技术，但由于外科医生抗拒改变其操作习惯，实施该技术可能具有挑战性。我们旨在评估在医院环境中实施基于酒精的外科手消毒对手术质量和持续时间以及预防手术部位感染的影响。
这是一项在 2017 年 4 月 1 日至 11 月 1 日在一家三级保健大学医院进行的准实验研究。参与者为心脏和骨科手术团队（ = 56）和由他们手术的患者（ = 231）。干预措施包括在手术室提供基于酒精的洗手液，说服并培训手术团队使用它，促进对手术手消毒的直接观察，并提供关于消毒质量的综合反馈。主要研究结果是手术手消毒的质量，通过直接观察推断出符合世界卫生组织（WHO）技术预测的每一步骤的程度。次要研究结果是在两个研究期间患者发生手术部位感染的个体概率。我们使用 Wilcoxon 配对样本检验和 McNemar 检验评估主要研究结果，并构建逻辑回归模型评估次要结果。
我们观察了 534 次手术手消毒事件。在 33 名具有完整数据的参与者中，在干预前期间，我们观察到完全符合 WHO 技术预测的所有步骤的参与者比例为 0.03%（1/33），而在干预期间为 36.36%（12/33）（OR：12.0，95%CI：2.4-59.2， = 0.002）。与干预前相比，干预措施缩短了准备时间（分别为 4.8 分钟和 2.7 分钟； < 0.001）。与干预前相比，干预组与对照组相比，手术部位感染的个体风险没有显著变化（调整 RR = 0.66；95%CI 0.16-2.70， = 0.563）。
与传统的外科刷手相比，基于酒精的外科手消毒可提高手术质量并缩短准备时间，对于预防手术部位感染至少同样有效。
