Surgical site infections are the most common source of nosocomial infections. The use of gloves decreases this risk, but glove perforation is common. Surgeons’ hands contain high numbers of pathogens because of increased contact with infected wounds as well as overly aggressive presurgical scrubbing practices that render the skin harder to disinfect. Over the past decade, alcohol-based hand solutions (AHS) have become the standard in human surgery because they are efficacious, rapid, and gentler even with repeated use. The World Health Organization currently recommends AHS for surgical hand preparation. An online survey of veterinary surgeons (n = 480) found most (79.9%) still use disinfecting soaps for presurgical hand asepsis; of these, the majority (81.4%) use chlorhexidine gluconate (CHX). CHX is bactericidal against a variety of gram-negative and gram-positive organisms and has a moderate residual effect but has no sporicidal activity and methicillin-resistant Staphylococcus aureus and enterococci may be resistant to it. Only 7% of respondents in this study used a neutral soap to remove surface dirt followed by AHS, despite the fact that current evidence suggests this practice is superior. In vivo and in vitro studies have shown AHS rubs have equal or better efficacy as compared with medicated soaps. AHS rubs require shorter contact times (1.5–3 min) and are easy to use and gentler on hands, improving compliance by surgical staff. Nearly 20% of respondents used a medicated soap scrub followed by an AHS rub, which is discouraged because this decreases decontamination effects. Veterinary surgeons are recommended to adopt the less aggressive, more efficient AHS rubs for presurgical hand asepsis by current international regulatory standards.

Commentary: Institutionalized habits are hard to break, but this article presents all reasons to make the switch from traditional soapy scrubs with water to an alcohol-based rub. Drying of the skin from alcohol should be tempered with hand lotion, which does not interfere with the hand-rub action. In fact, the argument against scrubbing is that it will actually remove the protective lipid layers of the skin and cause microscopic skin damage to allow further bacterial colonization of the deeper layers of the surgeons’ hands. —Jonathan Miller, DVM, Diplomate ACVS

Presurgical hand antisepsis: Concepts and current habits of veterinary surgeons. Verwilghen D, Grulke S, Kampf G. VET SURG 40:515-521, 2011.