Effects of Hand Hygiene Using 4% Chlorhexidine Gluconate or Natural Soap During Hand Rubbing Followed by Alcohol-Based 1% Chlorhexidine Gluconate Sanitizer Lotion in the Operating Room

Abstract

Objective: Hand hygiene using either 4% chlorhexidine gluconate (CHG) or natural soap during hand rubbing, followed by alcohol-based 1% CHG sanitizer lotion in the operating room was compared to assess bacterial reduction, skin moisture, skin texture, and hand hygiene using qualitative questionnaires. Approach: A crossover study with 36 professional scrub nurses at two medical centers was performed to compare 4% CHG followed by alcohol-based 1% CHG sanitizer lotion, the Two-stage method with handwashing using natural soap followed by alcohol-based 1% CHG sanitizer lotion, and the Waterless method, after a period of 10 days of use. The study completely followed CONSORT, www.consort-statement.org. Results: There was no significant difference in bacterial reduction based on the bacterial colony-forming units between the two methods. The skin moisture and skin roughness scores were not significantly different between the two methods. The Waterless method was significantly better than the Two-stage method regarding "foaming," "quality," "longevity" (p < 0.0001, p < 0.0001, and p < 0.0001, respectively), but "disappearance" was significantly better by the Two-stage method (p = 0.0095) during washing and rubbing. Immediately after washing and rubbing, the Waterless method was significantly better regarding "tightness" and "moisture," whereas the Two-stage method was significantly better regarding "stickiness" (p = 0.0114, p = <0.0001, and 0.0059, respectively) Innovation: The Waterless method using natural soap during handwashing followed by alcohol-based 1% CHG sanitizer lotion was as effective as the Two-stage method of 4% CHG followed by alcohol-based 1% CHG sanitizer lotion. Conclusion: Handwashing using natural soap is simple and superior to hand scrubbing in several aspects.

Keywords: Two-stage methods; Waterless method; chlorhexidine gluconate; hand rubbing lotion; hand scrubbing; natural soap; surgical-site infection.

Sadanori Akita, MD, PhD

Figure 1.

Flow of the study. Total 36 registered nurses from two hospitals were randomly allocated to two groups. Written informed consent was received from all participants. A crossover test was designed. In the first phase, Group A first used the Waterless method, handwashing with a natural soap, followed by an alcohol-based 1% chlorhexidine sanitizer gluconate lotion, then the Two-stage method, scrubbing with antiseptic detergent composed of 4% chlorhexidine gluconate followed by alcohol-based 1% chlorhexidine gluconate sanitizer lotion for a period of 10 days. Group B performed the Two-stage method first and the Waterless method second for 10 days. Each group was switched to the other after 10 days.