Loeb M B, Wilcox L, Smaill F, Walter S, Duff Z
Department of Laboratory Medicine, Chedoke- McMaster Hospital, McMaster University, Hamilton, Ontario.
Am J Infect Control. 1997 Feb;25(1):11-5. doi: 10.1016/s0196-6553(97)90047-x.
The difference between use of a scrub brush versus soap alone in reducing hand bacterial counts has never been established by a prospective, comparative study.
Fifteen volunteers were taught the 5-minute surgical scrub. Baseline specimens were obtained by the glove fluid sampling procedure. Subjects were randomized to (1) scrub with an inert scrub brush and 4% chlorhexidine soap with isopropyl alcohol or (2) wash with 4% chlorhexidine soap with isopropyl alcohol alone. Specimens were obtained immediately after the scrub was completed and 45 minutes later. The experiment was repeated by use of a cross-over design after a 1-week washout period. The data were analyzed by three methods that took into account the broad range of baseline hand counts (5 x 10(1) to 11.2 x 10(4): method 1, the discordance between presence/absence of hand bacterial counts within individuals at 45 minutes for soap versus soap and brush; method 2, the absolute reduction of bacteria (baseline vs 45 min.) for soap versus soap and brush; and method 3, the proportional change in bacterial counts at 45 minutes from baseline for soap versus soap and brush.
Although there was no statistically significant difference for any method, the point estimates for the odds ratio (OR) showed that up to twice the number of subjects had a greater reduction in bacterial counts when they washed with soap than when they scrubbed with a brush, as evidenced by the following data: method 1, OR 2.3 (95% confidence interval [CI] 0.53, 13.99) for soap alone; method 2, OR 1.0 (CI 0.23, 4.35); and method 3, OR 2.0 (CI 0.54, 9.10) for soap alone.
The effect of use of soap alone in reducing hand bacterial counts at 45 minutes was similar to use of soap and brush. Soap can be used alone and the surgical infection rate prospectively monitored.
前瞻性对比研究从未证实使用擦洗刷与仅使用肥皂在减少手部细菌数量方面的差异。
15名志愿者学习了5分钟的外科洗手方法。通过手套液采样程序获取基线样本。受试者被随机分为两组：（1）使用惰性擦洗刷和含异丙醇的4%氯己定肥皂进行擦洗；（2）仅使用含异丙醇的4%氯己定肥皂洗手。擦洗完成后及45分钟后立即采集样本。在1周的洗脱期后，采用交叉设计重复该实验。数据通过三种方法进行分析，这三种方法考虑了手部基线细菌数量的广泛范围（5×10¹至11.2×10⁴）：方法1，肥皂组与肥皂加刷子组个体在45分钟时手部细菌数量存在与否的不一致性；方法2，肥皂组与肥皂加刷子组细菌的绝对减少量（基线与45分钟时）；方法3，肥皂组与肥皂加刷子组45分钟时细菌数量相对于基线数量的比例变化。
尽管任何方法均无统计学显著差异，但优势比（OR）的点估计显示，多达两倍的受试者使用肥皂洗手时细菌数量的减少幅度大于使用刷子擦洗时，如下数据所示：方法1，仅使用肥皂时OR为2.3（95%置信区间[CI] 0.53，13.99）；方法2，OR为1.0（CI 0.23，4.35）；方法3，仅使用肥皂时OR为2.0（CI 0.54，9.10）。
仅使用肥皂在45分钟时减少手部细菌数量的效果与使用肥皂和刷子相似。可单独使用肥皂，并对手术感染率进行前瞻性监测。
