Handrubbing with an aqueous alcohol solution was as effective as handscrubbing with antiseptic soap for preventing surgical site infections
QUESTION: Is a protocol of handrubbing with an aqueous alcohol solution (AAS) as effective as a protocol of handscrubbing with an antiseptic soap for decreasing surgical site infections (SSIs) in routine surgical practice?
Cluster randomised (unclear allocation concealment), unblinded, crossover controlled equivalence trial with follow up at 30 days.
6 surgical services in France.
4823 consecutive patients having surgery. Patients who had contaminated or dirty procedures and those having a second surgery <15 days after a first surgery were excluded. 4387 patients (91%) were included in the as-treated analysis (mean age 50 y).
3 surgical services were allocated to begin with the handrubbing protocol (75% AAS containing propanol-1, propanol-2, and mecetronium etilsulfate [Stérillium, Rivadis Laboratories, Thouard, France]), and 3 were allocated to begin with the handscrubbing protocol (4% povidone iodine [Betadine, Asta Medica, Merignac, France] or 4% chlorhexidine gluconate [Hibiscrub, AstraZeneca, Rueil-Malmaison, France]). At the end of 1 month, each service switched to the alternative antiseptic product. Services alternated protocols monthly for 16 months. Standard surgical scrubbing was done according to Centers for Disease Control Guidelines (≥5 min systematic handscrubbing with a sterile sponge and brush). Surgical personnel in the handrubbing group were instructed to do a 1 minute hand wash (including subungual space cleaning with a brush) with non-antiseptic soap before the first procedure of the …