In Small Animal Surgery Are Alcoholic Hand Rubs Superior to Scrubbing Brushes and Antimicrobial Soap at Reducing Bacterial Counts?

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Appraisal, application and reflection

Two relevant studies were found for this particular PICO question, which both conclude that alcohol is as effective, if not more, than antimicrobial soap for pre surgical hand preparation when used according to the manufacturer guidelines. The AHRs used in the 2 studies, however, was of different formulations. In the first study (Chou et al, 2016) there were 2 formulations of alcohol used: propanol (of different strengths) and alcohol with CHG, of which the alcohol with CHG was found to be the most effective. In the second study (Verwilghen et al 2011) the only alcohol formulation used was propanol (Sterilium). The PICO question only specifies AHRs rather than particular formulations so both studies are relevant. 

Another difference between the studies was that Chou et al (2016) did not use an abrasive method of hand scrubbing as one of the comparisons; their non-abrasive scrub method was with the use of a sponge rather than bristles. As the PICO question in this instance was asking for a comparison between scrubbing brushes and AHRs there are some discrepancies between this and the PICO question, but the decision was made to include it. Verwilghen et al (2011) did use the more traditional surgical scrub with a brush as one of their variables, making it very suited to the PICO question.

On reflection, whether in human or veterinary surgery, the end point of pre-surgical hand antisepsis is the same; to have reduced bacterial colony forming units on the hands. The author therefore feels that a future Knowledge Summary with a slight change to the PICO to include human surgery would still be relevant to veterinary professionals to draw evidence from.

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