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H A N D
H Y G I E N E
Two studies have looked at infection rate as the outcome of interest in comparing alcohol-based rubs to traditional scrubs. The first study was a pre- and post-test design in which a pediatric urologist monitored 550 consecutive surgical cases after he had switched to an alcoholbased product. He then compared the resulting infection rate with that of the last 550 cases he
had performed while preparing with a traditional scrub. Although the hand preparation procedures of other members of the surgical team were not documented or controlled, this surgeon's rates of surgical site infections were very low in both phases of the study and were not significantly different when he switched to the alcohol hand rub regimen.5 The second study in which surgical site infection rate was the outcome included 4,387 surgical procedures. Parienti and colleagues found that scrubs and rubs were equivalent in terms of infection rates, with the rubs performing slightly better.6
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MORE TO THE METHOD Compared to rubs, scrubs require more in the way of staff time, ancillary equipment, water use and waste disposal.
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2. Tolerability
Even a small amount of damage to users' hands should be avoided, since a breakdown in skin means a potential breakdown in the most basic barrier protection. Kikuchi-Numagami and colleagues tested the irritancy of scrubbing versus rubbing with the same povidone-iodine product, discovering that there was significantly more skin moisture loss associated with scrubbing compared to
rubbing.7
The issue of tolerability brings alcohol-based products head-to-head with rubs containing other antimicrobial agents, another choice you might face when selecting hand hygiene products. Larson and colleagues reported significantly less skin damage among OR staff who used an alcohol-based rub as compared with those who used a traditional 4% chlorhexidine gluconate
