A New Surgical Handwashing and Hand Antisepsis From Scrubbing to Rubbing

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Abstract
In 2002, the Centers for Disease Control and Prevention (CDC) published guidelines for surgical handwashing and hand antisepsis on the Internet. According to these guidelines, we revised our surgical handwashing method from scrubbing with brushes to rubbing with antiseptic. The new method consists of scrubbing around the nails with brushes and rubbing the hands and arms with antiseptic from the elbow to the antebrachium. A total of 182 surgeons and operating-room nurses participated in the current study. Bacterial contamination was investigated using the glove-juice method. The new surgical handwashing method is simple, and requires only a short time to perform (2 minutes 50 seconds). The bacterial examination confirmed that rubbing the hands with antiseptic was significantly more effective than scrubbing with brushes. In terms of sterilization or prolonged effects, 4% chlor-hexidine gluconate (CHG) was superior to 7.5% povidone-iodine (PVI) throughout a 3-hour period after hand antisepsis. Although bacterial counts were increased 3 hours after the beginning of surgery, additional hand rubbing with 0.2% chlorhexidine-83% ethanol (HibisoftTM) was effective in suppressing the number of bacteria. HibisoftTM successfully prolonged sterilization for more than 3 hours. For long surgical procedures, CHG should be used as an antiseptic and gloves should be changed every 3 hours, alcohol-based hand rubbing should also be performed 3 hours after the initial handwashing. This new technique will be included in the OSCE curriculum to ensure its standardization. Moreover, in-depth education regarding central operating-room practices is desired.