When Preparing Veterinary Patients for Surgery Is the Friction (Back and Forth) Method of Scrubbing the Skin More Effective Than Concentric Circles at Reducing Bacterial Levels on the Skin?

[...]

Appraisal, application and reflection

One human study was found to be relevant to the PICO which reports superior action of the up and down friction method compared with the circular technique, however, results may be confounded by the use of different products; it is unclear whether the treatment effect was due to the scrub technique or the disinfectant applied. The main limitation to this study is its application in the veterinary world due to the nature and site of the areas being prepared in the human study.

The veterinary study found is taken from a veterinary nurse undergraduate dissertation published in a veterinary nursing publication. Although the study is very good, the sample size is small and the study likely to be underpowered, meaning that due to it not being a true representation of a population it may miss out on a significant result. It is not known whether a significant difference may be found with a larger sample size, as there are no similar studies carried out in this area. There is still a gap in the evidence for a larger scale veterinary study to be carried out in this area which could provide some usable evidence through controlling aspects such as species, type of disinfection used, contact time and method of application.

Not every clinical decision made comes down to only evidence. Based on experience and opinion it may be argued that the circular method a) doesn’t thoroughly disinfect the proposed incision site and b) risks bringing bacteria from the periphery back over the proposed incision site before the swab is discarded. The back and forth method could produce more friction, and it is this mechanical action which could help to reduce bacterial levels on the skin (Davids et al 2015). However, in the absence of evidence, protocol should be made based on what works best for the practice and has proven to be most efficient and achieves the best results.

[…]